- Physical Therapy
The most common initial step in treatment of spinal stenosis is physical therapy. Emphasis in physical therapy is placed on strengthening the muscles of the back, stretching these muscles, and improving posture. By better supporting the spine, symptoms of nerve compression are often improved.
- Weight Loss
Losing weight is a difficult task in patients who have back and leg problems. However, losing even a small amount of weight is often a sufficient step in relieving pain. By removing even 10 pounds or more, the spine supports less of a load, and pain may be relieved sufficiently.
- Nonsteroidal Anti-Inflammatory Medications
Nonsteroidal anti-inflammatory medications (NSAIDs) are commonly prescribed, and often help relieve the pain associated with spinal stenosis. By reducing inflammation, these medications can relieve some pressure on the compressed nerves. NSAIDs should be used under your doctor's supervision.
- Oral Steroid Medications
Oral steroid medications can be very helpful in episodes of an acute (sudden) flare-up of symptoms. Medications used include Prednisone and Medrol. Like NSAIDs, these powerful anti-inflammatory medications reduce inflammation around the compressed nerves, thereby relieving symptoms.
- Alternative Treatments
Alternative treatments include acupuncture, massage, magnet therapy, natural remedies, and others. There is no doubt that many patients find significant relief from these types of treatments. While the scientific studies are lacking to support these treatments, most have few side effects, and are reasonable treatments to attempt.
- Epidural Steroid Injections
Injections of cortisone can be administered directly in the area of compression. Like oral anti-inflammatory medications, the idea is to relieve the compression on the nerves. When the injection is used, the medication is delivered to the area of the spinal stenosis, rather than being taken orally and traveling throughout your body.
Spine surgery may be considered if all other treatments fail to alleviate your symptoms. When surgery is performed for spinal stenosis, the nerves are decompressed. This means that excess bone, ligament, and soft-tissue is removed to allow more room for the nerves. The procedure performed depends on precisely where the compression is taking place. Depending on what tissue is removed, the procedure may be called a laminectomy (removal of the bone behind the spinal cord), foramenotomy (removing bone around the spinal nerve), or a discectomy (removing the spinal disc to relieve pressure).
Depending on the extent of the spinal stenosis, surgery may remove enough of the supporting structures of the spine that support needs to be added. In these cases, a spine fusion procedure will also be performed in order to prevent problems with instability of the spine.
Possible complications of spinal stenosis surgery include tears in the sac that surrounds the spinal cord (dural tears), infections, and instability of the spine. Furthermore, because spinal arthritis the most common cause of spinal stenosis, the problems may reappear years after surgical treatment as the arthritis worsens over time.
Shen FH, et al. "Nonsurgical Management of Acute and Chronic Low Back Pain" J. Am. Acad. Ortho. Surg., August 2006; 14: 477 - 487.
AS Hilibrand and N Rand "Degenerative lumbar stenosis: diagnosis and management" J. Am. Acad. Ortho. Surg., Jul 1999; 7: 239 - 249.