Nonsurgical treatment options focus on restoring function and relieving pain. Although nonsurgical methods do not improve the narrowing of the spinal canal, many people report that these treatments do help relieve symptoms.
Physical therapy. Stretching exercises, massage, and lumbar and abdominal strengthening often help manage symptoms.
Lumbar traction. Although it may be helpful in some patients, traction has very limited results. There is no scientific evidence of its effectiveness.
Anti-inflammatory medications. Because stenosis pain is caused by pressure on a spinal nerve, reducing inflammation (swelling) around the nerve may relieve pain. Non-steroidal anti-inflammatory drugs (NSAIDs) initially provide pain relief. When used over the course of 5-10 days, they can also have an anti-inflammatory effect.
Most people are familiar with nonprescription NSAIDs, such as aspirin and ibuprofen. Whether over-the-counter or prescription strength, these medicines must be used carefully. They can lead to gastritis or stomach ulcers. If you develop acid reflux or stomach pains while taking an anti-inflammatory, be sure to talk with your doctor.
Steroid injections. Cortisone is a powerful anti-inflammatory drug. Cortisone injections around the nerves or in the "epidural space" can decrease swelling, as well as pain. They also reduce numbness, but not weakness, in the legs. Patients should receive no more than three injections a year.
Acupuncture. Acupuncture can be helpful in treating some of the pain for less severe cases of lumbar stenosis. Although it can be very safe, long-term success with this treatment has not been proven scientifically.
Surgery for lumbar spinal stenosis is generally reserved for patients who have poor quality of life due to pain and weakness. Patients may complain of difficulty walking for extended periods of time. This is often the reason that patients consider surgery.
There are two main surgical options to treat lumbar spinal stenosis: laminectomy and spinal fusion. Both options can result in excellent pain relief. Be sure to discuss the advantages and disadvantages of both with your doctor.
Laminectomy. This procedure involves removing the bone, bone spurs, and ligaments that are compressing the nerves. This procedure may also be called a "decompression." Laminectomy can be performed as open surgery, in which your doctor uses a single, larger incision to access your spine. The procedure can also be done using a minimally invasive method, where several smaller incisions are made. Your doctor will discuss the right option for you.
Spinal fusion. If arthritis has progressed to spinal instability, a combination of decompression and stabilization or spinal fusion may be recommended.
Rehabilitation. After surgery, you may stay in the hospital for a short time, depending on your health and the procedure performed. Healthy patients who undergo just decompression may go home the same or next day, and may return to normal activities after only a few weeks. Fusion generally adds 2 to 3 days to the hospital stay.
Your surgeon may give you a brace or corset to wear for comfort. He or she will likely encourage you to begin walking as soon as possible. Most patients only need physical therapy to strengthen their backs.
Your physical therapist may show you exercises to help you build and maintain strength, endurance, and flexibility for spinal stability. Some of these exercises will help strengthen your abdominal muscles, which help support your back. Your physical therapist will create an individualized program, taking into consideration your health and history.
Most people can go back to a desk job within a few days to a few weeks after surgery. They may return to normal activities after 2 to 3 months. Older patients who need more care and assistance may be transferred from the hospital to a rehabilitation facility prior to going home.
Surgical risks. There are minor risks associated with every surgical procedure. These include bleeding, infection, blood clots, and reaction to anesthesia. These risks are usually very low.
Elderly patients have higher rates of complications from surgery. So do overweight patients, diabetics, smokers, and patients with multiple medical problems.
Specific complications from surgery for spinal stenosis include:
Tear of the sac covering the nerves (dural tear)
Failure of the bone fusion to heal
Failure of screws or rods
Need for further surgery
Failure to relieve symptoms
Return of symptoms
Surgical outcomes. Overall, the results of laminectomy with or without spinal fusion for lumbar stenosis are good to excellent in the majority of patients. Patients tend to see more improvement of leg pain than back pain. Most patients are able to resume a normal lifestyle after a period of recovery from surgery.
New Surgical Options
Interspinous Process Devices
Interspinous process devices, or spacers, are inserted between the spinous processes in the back of the spine. These devices spread the vertebrae apart and keep the space for the nerves open and functioning. This procedure is a minimally invasive surgical option for lumbar spinal stenosis.
Interspinous process spacers were approved in 2005. Many procedures have been performed since then. In some studies, success rates are greater than 80 percent.
Numerous spacer devices are currently being evaluated. They may be a safe alternative to an open laminectomy for some patients. Limited bone (lamina) is removed with this procedure, and it may be performed under local anesthesia.
The key to success with this procedure is appropriate selection of the patients. The appropriate candidate must have relief of buttock and leg pain when sitting or bending forward. The pain returns upon standing.
Minimally Invasive Decompression
Decompression can be performed using smaller incisions. When using such minimally invasive techniques, there is less injury to the surrounding soft tissues, and recovery may be quicker.
With these minimally invasive techniques, surgeons rely more on microscopes to see the area for surgery. They may also take X-rays during the operation. A traditional open procedure requires more direct visualization of the patient's anatomy, and therefore requires a larger incision. This can be more painful for the patient.
The limitation of minimally invasive surgery is the degree of visualization available. If the spinal stenosis extends over a large area of the spine, an open technique is the only method that can address the problem.
The advantages of minimally invasive procedures include reduced hospital stays and recovery periods. However, both open and minimally invasive techniques relieve stenosis symptoms equally. Your doctor will be able to discuss with you the options that best meet your healthcare needs.