7 Ways to Treat Lumbar Spinal Stenosis

Spinal stenosis is a condition that causes compression of the spinal nerves in the spinal canal. Typical symptoms of lumbar spinal stenosis (when the narrowing is in the lower part of the spinal column) include pain, numbness, and tingling in the lower extremities. Patients often fatigue very easily and find they can only walk a short distance without resting—this is a symptom called claudication. Usually, spinal stenosis is caused by a gradual degenerative process (arthritis) in the lower spine. Bone spurs, inflammation, and malalignment can cause the narrowing around the nerves.

Typical treatment of spinal stenosis starts with simple steps, including physical therapy, medications, and rest. If these treatments fail to alleviate pain, some patients may choose spine surgery to find relief from their symptoms of stenosis. These are the most common treatments for spinal stenosis.


Physical Therapy

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The most common initial step in the treatment of spinal stenosis is physical therapy. The emphasis in physical therapy is placed on strengthening the muscles of the back, improving core muscle strength, and improving posture. By better supporting the spine, symptoms of nerve compression are often improved. Studies have repeatedly shown that patients with spinal stenosis who complete manual physical therapy programs have less pain and better function.


Weight Loss

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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.


Anti-Inflammatory Medications

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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 healthcare provider's supervision as side-effects are common, especially in elderly individuals. Gastrointestinal problems are the most common side-effect, but there is also increasing concern about possible cardiovascular side-effects associated with long-term use of NSAIDs.


Other Medications

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Oral steroid medications can be helpful in episodes of an acute (sudden) flare-up of symptoms. Medications used include prednisone and Medrol (methylprednisolone). Like NSAIDs, these powerful anti-inflammatory medications reduce inflammation around the compressed nerves, thereby relieving symptoms.

Narcotic medications are powerful pain relievers but should be used sparingly. These medications can have more serious side-effects, and can also cause patients to become dependent on the medication.


Alternative Treatments

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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

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Injections of cortisone can be administered directly in the area of compression. As with oral anti-inflammatory medications, epidural steroids help to reduce inflammation of the nerves, which can relieve pain. 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

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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 that forms the roof of the spinal canal), foraminotomy (removing bone around the spinal nerve), or a discectomy (removing the spinal disc to relieve pressure).

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By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.