Lumbar Spinal Stenosis: Treatment Overview

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Treatment Overview

Lumbar spinal stenosis is narrowing of the spinal canal that usually starts gradually and develops over a long period of time. As the spinal canal narrows, it can squeeze (compress) and irritate the nerve roots that branch out from the spinal cord , or it can squeeze and irritate the spinal cord itself. The goals of treatment for spinal stenosis are to relieve pain, numbness, and weakness in the legs, to make it easier for you to move around (improve function), and to improve your quality of life. Treatment includes pain-relieving medicine, exercises, and other nonsurgical measures, and in some cases, surgical treatment.

Initial treatment

Unless your lumbar spinal stenosis is severe, initial treatment usually is aimed at relieving your symptoms without surgery. Most cases do not require surgery. Nonsurgical treatment often works to allow most normal activity and relieve mild to moderate symptoms of pain, numbness, and weakness in the legs.² Nonsurgical treatment includes:

• Education about the course of your condition and how to relieve symptoms.
• Medicines to relieve pain and inflammation, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).
• Exercise, to maintain or achieve overall good health. Aerobic exercise—especially riding a stationary bicycle (which allows you to lean forward)—can relieve symptoms.
• Weight loss, to relieve symptoms and slow progression of the stenosis.
• Physical therapy, to provide education, instruction, and support for your self-care. Physical therapy helps you learn stretching and strength exercises that may lead to a decrease in pain and other symptoms.

If you have symptoms of cervical spinal stenosis, testing and treatment may be done earlier than in treatment for lumbar spinal stenosis.

Ongoing treatment

Lumbar spinal stenosis often requires nonsurgical treatment on an ongoing basis. Treatment may include:

• Medicines to relieve pain and inflammation, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).
• Exercise, which is important for overall good health. Aerobic exercise—especially riding a stationary bicycle (which allows you to lean forward)—can relieve symptoms.
• Staying at a healthy body weight, which may relieve symptoms and slow the progression of the stenosis.
• Physical therapy, to provide education, instruction, and support for your self-care. Physical therapy helps you learn stretching and strengthening exercises that may lead to a decrease in pain and other symptoms.

If medicines, exercise, and physical therapy do not relieve your symptoms, your health professional may recommend an epidural steroid injection (ESI). This injection includes a combination of a corticosteroid and a local anesthetic pain relief medicine. These injections are used for pain that occurs mostly in the legs.

Treatment if the condition gets worse

The course of lumbar spinal stenosis varies: symptoms may be severe at times, and less severe at other times. If you feel numbness, weakness, or have trouble standing or walking, it may mean that your condition is getting worse. Problems with bladder and bowel control also may mean your spinal stenosis is getting worse.

If you are experiencing a flare-up of severe low back pain that is not relieved by other forms of treatment and you are unable to engage in daily activities, your health professional may prescribe hydrocodone or other opioid medicines.² But these medicines do not work well for symptoms that occur in the legs. Also, the side effects of opioids—such as mental confusion, drowsiness, and constipation—can be more of a problem than the pain of lumbar spinal stenosis.

If you have tried nonsurgical treatment for a period of time as determined by your health professional but your symptoms have not improved, you may want to consider surgery. Imaging tests (such as MRI) will be done to find out the amount and location of spinal canal narrowing. You and your health professional will want to discuss the severity of symptoms, along with imaging test results, before making a decision about surgery.

Back surgery (decompressive laminectomy with or without spinal fusion) may be considered when you:

• Have severe symptoms of pain, numbness, or weakness in the legs that restrict normal daily activities and have a negative impact on your quality of life.
• Are in otherwise good health and do not have other medical conditions that might make it harder for you to have and recover from surgery.

The goal of surgery for spinal stenosis is to relieve pain, numbness, or weakness in the legs—not to relieve back pain. People who are operated on solely for back pain are less satisfied with outcomes than are those who are operated on for nerve root symptoms and pain in both the back and legs. Back pain associated with spinal stenosis is often not relieved by surgery. In addition, numbness, weakness, and pain may return after surgery.³

Should I have surgery for spinal stenosis?

What To Think About

Epidural steroid injections (ESIs) are usually only used to treat symptoms of lumbar spinal stenosis that occur in the legs. This treatment only relieves symptoms for a short time, and experts are not sure about the long-term effects. Talk to your doctor about the risks related to the number of injections he or she expects you will need.

Surgery is usually not recommended for an older adult who is able to manage symptoms with nonsurgical treatment and is able to do normal daily activities. Surgery may be considered if the severity of symptoms and the decrease in quality of life outweigh the risks of the procedure. Surgery may not be an option for some older adults whose other serious health problems increase the risks from surgery.

Last updated:	February 21, 2008
Author:	Shannon Erstad, MBA/MPH
Reviewed By:	William M. Green, MD - Emergency Medicine, Robert B. Keller, MD - Orthopedics
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC