On your first visit to a back specialist, the initial determination that must be made is the seriousness of the problem. Some problems need immediate attention-possibly even surgery. The vast majority of back problems do not require surgery. Spinal stenosis is a slowly progressive back problem that may respond to conservative care.
A variety of treatment options exists for spinal stenosis. In most cases, simple therapies such as mild pain medications and rest are effective in relieving the immediate pain. Physical therapy may be beneficial if symptoms are not relieved with simple measures. The overall goal of treatment is to make you as comfortable as soon as possible, and to get you back to normal activity in a timely manner.
Mild pain medications can reduce pain when taken properly. The medications will not cure or stop the progression of the problem, but they will help with pain control.
If your condition is causing only mild symptoms and does not appear to be getting worse, your doctor may have you work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.
Positions, movements, and exercises are prescribed to reduce pain. Treatments may also include lumbar traction to gently stretch the low back, easing pressure on the spinal nerves. Exercises are used to improve cardiovascular fitness and to tone the low back and abdominal muscles. Therapy sessions may be scheduled two to three times each week for up to six weeks.
The goals of physical therapy are to help you
learn to manage your condition and control symptoms
learn correct posture and body movements to reduce back pain
maximize flexibility and core strength
foster heart and lung fitness
An epidural steroid injection (ESI) can be used to relieve the pain of stenosis and irritated nerve roots, as well as to decrease inflammation. Injections can help reduce swelling from inflamed tissues in the spinal canal, which may result in less irritation on the nerves. The steroid injections are a combination of cortisone (a powerful anti-inflammatory steroid) and a local anesthetic that are given through the back into the epidural space. Epidural steroid injections are not always successful in relieving symptoms of inflammation. They are only used when conservative treatments have failed. Learn more about spinal injections.
Spinal stenosis may continue to get worse over time. Surgery may be considered as a treatment option if
you experience an increase in the weakness in your legs
you can no longer walk without leg pain
you begin to have trouble controlling your bowels or bladder
the pain becomes unbearable
Because spinal stenosis is more common in elderly people, one of the considerations for suggesting surgery is the overall physical condition of the patient. Back surgery is a major undertaking. If you have serious medical problems, the risks may be too great to have spine surgery. The decision is jointly made with your surgeon and your regular medical doctor.
The main goal of any surgical procedure used to treat spinal stenosis is to remove the pressure on the nerve roots in the lumbar spinal canal. This means that the tube of the spinal canal must be made larger, and any bone spurs that are pushing into the nerve roots must be removed. This type of surgical procedure is usually called a decompression of the lumbar spine, or a decompressive laminectomy of the lumbar spine.
In order to free up or “decompress” the nerves, the surgeon must remove a section of bone from the back of the spine (lamina). The surgeon may also have to remove a portion of the facet joints. The lamina and facet joints normally provide stability in the spine. Removal of either or both can cause the spine to become loose and unstable. When this occurs, doctors will include fusion as part of the procedure. Likewise, patients with spinal instability who need surgery for spinal stenosis will likely also need lumbar fusion.