Successful Reporting: Successful reporting would include a validated QVAS or similarly validated tool showing for pain and functionality show a two (2) point pain improvement since last clinical encounter with the treating provider or maintenance of a functional improvement greater than or equal to a six (>6). If functionality 5 or less and/or pain 7 or more, medical record documentation of treatment change or diagnostic work up is present. Failure to document these changes with continued treatment despite lessening functionality and/or increasing pain would result in measure failure. Providers would be providing manual medicine in addition to non-traditional, but literature proven alternative medicine modalities (i.e.: acupuncture) with patients who have imaging confirmed spinal stenosis (M99 ICD-10 Code). Measure explanation: Spinal stenosis typically is conservatively managed until surgical fusion or foraminotomy is necessitated based upon pain or neuropathic progression necessitating spinal fusion and/or foraminotomy. These surgeries carry risk to the patient and major expense to the system. Moreover, once a spinal fusion occurs, typically the areas above and/or below this area are fused in another 5-10 years. Avoiding the initial surgery is the only means to avoid subsequent surgeries and the associated risks and costs. Manipulative medicine combined with alternative medical therapies have been shown to improve pain and avoid surgical intervention, thus, this measure is designed to report such treatment.