12/04/2025
Reimagining care for older adults with lumbar spinal stenosis: a public health priority
Lumbar spinal stenosis (LSS) is one of the leading causes of pain, limited mobility, and loss of independence in older adults. As our population ages, the burden of LSS has become not just a clinical issue, but a public health concern tied to falls, social isolation, inactivity, and avoidable healthcare costs.
A new review in Chiropractic & Manual Therapies highlights a key message:
Conservative, non-operative care should be the first-line approach for most older adults with LSS.
Why conservative care matters:
• Preserves mobility and prevents disability.
Movement-based care helps older adults walk farther, stay active, and maintain independence.
• Reduces reliance on high-risk, high-cost interventions.
Many patients are offered surgery or long-term medications despite limited evidence for long-term benefit. Conservative care offers a safer, more sustainable path.
• Addresses contributors beyond anatomy.
A biopsychosocial approach recognizes the roles of fear, confidence, mood, and unmet social needs, factors that shape disability as much as imaging findings.
A call for systems-level change:
To make real progress, we need to:
– Integrate conservative musculoskeletal care into community and aging services
– Strengthen interprofessional pathways across chiropractic, PT, primary care, and public health
– Expand access for older adults facing financial or geographic barriers
– Educate patients and caregivers early about non-operative options
– Use functional outcomes that reflect what matters most: walking, standing, daily life
LSS may begin as a clinical diagnosis, but its ripple effects touch disability, mental health, social connection, and quality of life. This review reinforces the importance of evidence-based, person-centered conservative care as a foundation for healthy aging.
Aging equity depends on mobility and this new evidence gives us direction for moving forward.
