Treatment

Spinal stenosis surgery Spinal stenosis surgery

Treatment for spinal stenosis depends on the location of the stenosis and the severity of your signs and symptoms.

Talk to your doctor about the treatment that's best for your situation. If your symptoms are mild or you aren't experiencing any, your doctor may monitor your condition with regular follow-up appointments. He or she may offer some self-care tips that you can do at home. If these don't help, he or she may recommend medications or physical therapy. Surgery may be an option if other treatments haven't helped.

Medications

Your doctor may prescribe:

  • Pain relievers. Pain medications such as ibuprofen (Advil, Motrin IB, others), naproxen (Aleve, others) and acetaminophen (Tylenol, others) may be used temporarily to ease the discomfort of spinal stenosis. They are typically recommended for a short time only, as there's little evidence of benefit from long-term use.
  • Antidepressants. Nightly doses of tricyclic antidepressants, such as amitriptyline, can help ease chronic pain.
  • Anti-seizure drugs. Some anti-seizure drugs, such as gabapentin (Neurontin) and pregabalin (Lyrica), are used to reduce pain caused by damaged nerves.
  • Opioids. Drugs that contain codeine-related drugs such as oxycodone (Oxycontin, Roxicodone) and hydrocodone (Norco, Vicodin) may be useful for short-term pain relief. Opioids may also be considered cautiously for long-term treatment. But they carry the risk of serious side effects, including becoming habit forming.

Physical therapy

It's common for people who have spinal stenosis to become less active, in an effort to reduce pain. But that can lead to muscle weakness, which can result in more pain. A physical therapist can teach you exercises that may help:

  • Build up your strength and endurance
  • Maintain the flexibility and stability of your spine
  • Improve your balance

Steroid injections

Your nerve roots may become irritated and swollen at the spots where they are being pinched. While injecting a steroid medication (corticosteroid) into the space around impingement won't fix the stenosis, it can help reduce the inflammation and relieve some of the pain.

Steroid injections don't work for everyone. And repeated steroid injections can weaken nearby bones and connective tissue, so you can only get these injections a few times a year.

Decompression procedure

With this procedure, needle-like instruments are used to remove a portion of a thickened ligament in the back of the spinal column to increase spinal canal space and remove nerve root impingement. Only patients with lumbar spinal stenosis and a thickened ligament are eligible for this type of decompression.

The procedure is called percutaneous image-guided lumbar decompression (PILD). It has also been called minimally invasive lumbar decompression (MILD), but to avoid confusion with minimally invasive surgical procedures, doctors have adopted the term PILD.

Because PILD is performed without general anesthesia, it may be an option for some people with high surgical risks from other medical problems.

Surgery

Surgery may be considered if other treatments haven't helped or if you're disabled by your symptoms. The goals of surgery include relieving the pressure on your spinal cord or nerve roots by creating more space within the spinal canal. Surgery to decompress the area of stenosis is the most definitive way to try to resolve symptoms of spinal stenosis.

Research shows that spine surgeries result in fewer complications when done by highly experienced surgeons. Don't hesitate to ask about your surgeon's experience with spinal stenosis surgery. If you have any doubts, get a second opinion.

Examples of surgical procedures to treat spinal stenosis include:

  • Laminectomy. This procedure removes the back part (lamina) of the affected vertebra. A laminectomy is sometimes called decompression surgery because it eases the pressure on the nerves by creating more space around them.

    In some cases, that vertebra may need to be linked to adjoining vertebrae with metal hardware and a bone graft (spinal fusion) to maintain the spine's strength.

  • Laminotomy. This procedure removes only a portion of the lamina, typically carving a hole just big enough to relieve the pressure in a particular spot.
  • Laminoplasty. This procedure is performed only on the vertebrae in the neck (cervical spine). It opens up the space within the spinal canal by creating a hinge on the lamina. Metal hardware bridges the gap in the opened section of the spine.
  • Minimally invasive surgery. This approach to surgery removes bone or lamina in a way that reduces the damage to nearby healthy tissue. This results in less need to do fusions.

    While fusions are a useful way to stabilize the spine and reduce pain, by avoiding them you can reduce potential risks, such as post-surgical pain and inflammation and disease in nearby sections of the spine. In addition to reducing the need for spinal fusion, a minimally invasive approach to surgery has been shown to result in a shorter recovery time.

In most cases, these space-creating operations help reduce spinal stenosis symptoms. But some people's symptoms stay the same or get worse after surgery. Other surgical risks include infection, a tear in the membrane that covers the spinal cord, a blood clot in a leg vein and neurological deterioration.

Potential future treatments

Clinical trials are underway to test the use of stem cells to treat degenerative spinal disease, an approach sometimes called regenerative medicine. Genomic medicine trials are also being done, which could result in new gene therapies for spinal stenosis.

Alternative medicine

Integrative medicine and alternative therapies may be used with conventional treatments to help you cope with spinal stenosis pain. Examples include:

  • Massage therapy
  • Chiropractic treatment
  • Acupuncture

Talk with your doctor if you're interested in these treatment options.

Aug. 04, 2017
References
  1. Spinal stenosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health_info/spinal_stenosis/. Accessed March 7, 2017.
  2. Goldman L, et al., eds. Mechanical and other lesions of the spine, nerve roots and spinal cord. In: Goldman-Cecil Medicine. 25th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. https://www.clinicalkey.com. Accessed March 7, 2017.
  3. Frontera WR. Lumbar spinal stenosis. In: Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2015. https://www.clinicalkey.com. Accessed March 7, 2017.
  4. Cervical stenosis, myelopathy and radiculopathy. North American Spine Society. http://www.knowyourback.org/pages/spinalconditions/degenerativeconditions/cstenosis_myelopathy_radiculopathy.aspx. Accessed March 7, 2017.
  5. Levin K. Lumbar spinal stenosis: Treatment and prognosis. http://www.uptodate.com/home. Accessed March 7, 2017.
  6. Kim K, et al. Nonsurgical Korean integrative treatments for symptomatic lumbar spinal stenosis: A three-armed randomized controlled pilot trial protocol. Evidence-Based Complementary and Alternative Medicine. 2016;2016:2913248. https://www.hindawi.com/journals/ecam/2016/2913248/. Accessed March 7, 2017.
  7. Dasenbrock HH, et al. The impact of provider volume on the outcomes after surgery for lumbar spinal stenosis. Neurosurgery. 2012;70:1346.
  8. AskMayoExpert. Lumbar spinal stenosis. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.
  9. AskMayoExpert. Minimally invasive lumbar decompression (MILD). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
  10. Abt NB, et al. Thirty day postoperative outcomes following anterior lumbar interbody fusion using the National Surgical Quality Improvement Program database. Clinical Neurology and Neurosurgery. 2016;143:126.
  11. Barbara Woodward Lips Patient Education Center. Spinal stenosis. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2003.
  12. Barbara Woodward Lips Patient Education Center. Minimally invasive lumbar decompression (MILD). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.
  13. Watson JC (expert opinion). Mayo Clinic, Rochester, Minn. March 28, 2017.
  14. Brown AY. Allscripts EPSi. Mayo Clinic, Rochester, Minn. Feb. 13, 2017.
  15. Bydon M (expert opinion). Mayo Clinic, Rochester, Minn. April 17, 2017.
  16. Onishi K, et al. Human adipose-derived mesenchymal stromal/stem cells remain viable and metabolically active following needle passage. Physical Medicine and Rehabilitation. 2016;8:844.
  17. Staats PS, et al. MiDAS ENCORE: Randomized controlled clinical trial report of 6-month results. Pain Physician. 2016;19:25.
  18. Chou R. Subacute and chronic low back pain: Nonsurgical interventional treatment. www.uptodate.com/home. Accessed March 22, 2017.
  19. Chou R, et al. Nonpharmacologic therapies for low back pain: A systematic review for an American College of Physicians Clinical Practice Guidelines. Annals of Internal Medicine. 2017;166:1.
  20. Morrey ME, et al. Molecular landscape of arthrofibrosis: Microarray and bioinformatics analysis of the temporal expression of 380 genes during contracture genesis. Gene. 2017;610:15.