Julie M Fritz1, Sean D Rundell2, Paul Dougherty3, Angela Gentili4, Gary Kochersberger5, Natalia E Morone6, Srinivasa Naga Raja7, Eric Rodriguez8, Michelle I Rossi9, Joseph Shega10, Gwendolyn Sowa11, Debra K Weiner12. 1. *Department of Physical Therapy and College of Health, University of Utah, Salt Lake City, Utah. 2. Department of Rehabilitation Medicine, University of Washington, Seattle, Washington. 3. Canandaigua VA Medical Center, Canandaigua, New York Department of Research, New York Chiropractic College, Seneca Falls, New York Division of Geriatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York. 4. Hunter Holmes McGuire VA Medical Center, Richmond, Virginia **Virginia Commonwealth University Health System, Richmond, Virginia. 5. Canandaigua VA Medical Center, Canandaigua, New York Division of Geriatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York. 6. Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and. 7. Department of Anesthesiology, Critical Care Medicines, and Division of Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. 8. Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and. 9. Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and. 10. VITAS Healthcare, Miami, Florida; Departments of. 11. Physical Medicine and Rehabilitation, Orthopedic Surgery, Bioengineering. 12. Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and Psychiatry, and ****Anesthesiolgoy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Debra.Weiner@va.gov.
Abstract
OBJECTIVE: . To present the sixth in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. This article focuses on the evaluation and management of lumbar spinal stenosis (LSS), the most common condition for which older adults undergo spinal surgery. METHODS: . The evaluation and treatment algorithm, a table articulating the rationale for the individual algorithm components, and stepped-care drug recommendations were developed using a modified Delphi approach. The Principal Investigator, a five-member content expert panel and a nine-member primary care panel were involved in the iterative development of these materials. The illustrative clinical case was taken from the clinical practice of a contributor's colleague (SR). RESULTS: . We present an algorithm and supportive materials to help guide the care of older adults with LSS, a condition that occurs not uncommonly in those with CLBP. The case illustrates the importance of function-focused management and a rational approach to conservative care. CONCLUSIONS: . Lumbar spinal stenosis exists not uncommonly in older adults with CLBP and management often can be accomplished without surgery. Treatment should address all conditions in addition to LSS contributing to pain and disability.
OBJECTIVE: . To present the sixth in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. This article focuses on the evaluation and management of lumbar spinal stenosis (LSS), the most common condition for which older adults undergo spinal surgery. METHODS: . The evaluation and treatment algorithm, a table articulating the rationale for the individual algorithm components, and stepped-care drug recommendations were developed using a modified Delphi approach. The Principal Investigator, a five-member content expert panel and a nine-member primary care panel were involved in the iterative development of these materials. The illustrative clinical case was taken from the clinical practice of a contributor's colleague (SR). RESULTS: . We present an algorithm and supportive materials to help guide the care of older adults with LSS, a condition that occurs not uncommonly in those with CLBP. The case illustrates the importance of function-focused management and a rational approach to conservative care. CONCLUSIONS: . Lumbar spinal stenosis exists not uncommonly in older adults with CLBP and management often can be accomplished without surgery. Treatment should address all conditions in addition to LSS contributing to pain and disability.
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