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Many adults with CVS have sympathetic nervous system dysregulation.10,25,26 Studies have reported increases in sympathetic tone in patients with CVS, recorded through various tests of autonomic function, such as postural adjustment ratio, heart rate variability, tilt table test, and sudomotor tests.10,2729 The most frequent finding in these reports was an adrenergic anomaly, in addition to coexisting abnormalities of vagal cholinergic function

A 2009 consensus statement from nine endocrine societies reinforced this target: "IGF-1 levels should be maintained within the age-appropriate normal range, aiming for the mid-to-upper normal range to optimize clinical benefit" 2

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Surgery may be necessary for spinal stenosis if it causes moderate to severe symptoms that dont respond to at least six to 12 months of non-surgical treatment.

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