How is a spinal stenosis treated without surgery?
Nonsurgical treatments can help restore some function and relieve 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.
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.
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.
Chiropractic manipulation. Chiropractic manipulation is generally safe and can help with some of the pain from lumbar stenosis. Care should be taken if a patient has osteoporosis or disc herniation. Manipulation of the spine in these cases can worsen symptoms or cause other injuries.
How is a spinal stenosis treated with surgery?
If nonsurgical treatment does not work, surgery may be recommended.
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.
What is a laminectomy?
Laminectomy 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 best option for you.
What is spinal fusion?
If arthritis has progressed to spinal instability, a combination of decompression and stabilization or spinal fusion may be recommended.
What is the recovery like for spinal stenosis surgery?
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.
What are the risks of spinal stenosis surgery?
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
- Nerve injury
- Need for further surgery
- Failure to relieve symptoms
- Return of symptoms
How successful is spinal stenosis surgery?
Overall, the results of laminectomy with or without spinal fusion for 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.