When is the proper moment to operate a lumbar spinal stenosis?

There are many low back pain patients, according to the scientific american in one of its articles, developing countries are on the rise for this disease in particular. It is well known that this pathology is associated with life style. I particularly have found many patients with non displaced bilateral pars articularis fracture (degenerative or inborn ?) of L5 related with LBP so how can you now if this is the problem or how to prevent it (I think by taking kids to sports at a young age) 

Like low back pain is created by many factors then it could be treated by many ways at the same time, many patients come to the clinic asking for a magical solution or a magical pill, but the spinal column specially the lower back requires much attention, there is postural higiene, for example you should use your knees when picking things up the floor, low impact exercise like walking or jogging or swimming are good, cause you are using all the muscles at the same time and I think that most of the time what the spinal columns needs is to use or calibrate all the back muscles to be used equally, why I say that, take for instance when you use hot water or hot bag at the neck you will notice that cracking sounds disappears, that means that many deep muscles are not used from time to time, so people that work only tends to be affected like that.

Then there are steps for taking care of the low back pain, you start prescribing any common painkiller and if it works then never mind, but the patient keep coming to the clinic, now is not working the previous medication, you should change and if you nailed it then ok. Many used blockage with depomedrol and bupi, either paravertebral or at the hiatus sacro, and on many time works, but now after a year the patient comes again, you use the previous tactic but it fails, then what to use at this stage well I use a good drugs that works perfectly so far, but if you want to know ask me by message and I will tell you!. 

After all this fails then we entry to a stage of refractory low back pain, then you can star wonder if operation is needed, but keep in mind, the patient is useful for society or not!, big difference, if yes then operate if not prescribe walker frame, ask to loss weight, physiotherapy, use cold and warm bag locally or lidocaine patches. 

Do not offer operation from the begging the patient would like the easiest solution that doesn't always means the correct one, keep in mind the best approach is not to operate, operation change the sagital alignment by severing the muscles and by that you are creating new problems. Of course there are straightforward patient you will notice, patient with absolute spinal canal stenosis, but keep in mind the conservative way from the beginning .

You can create your own way to deal with the issue, many people don't care about the importance of his lower back, you also need to educate them, inform them, LBP creates significant loss of GDP on many countries, and many patients only come for the sick leaves that issues is for another articles, but very difficult to avoid!

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