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What is the treatment for spinal stenosis?

Dr. Brett Taylor
St. Louis, MO

Nonoperative treatments such as activity modification, medications, injections and physical therapy can improve the symptoms related to spinal stenosis. If these nonoperative treatments fail, then surgery can be performed to make the spinal canal bigger by removing the bone that is compressing the nerves. In certain circumstances we also fuse the spine if there is evidence of instability prior to surgery or, if during surgery following the decompression, we are concerned about instability.

Dr. Paul J. Slosar
Daly City, CA

Epidural injections can be very helpful if the patient's leg symptoms are disabling. Occasionally, patients will need a laminectomy to decompress the nerves. A laminectomy is an operation to remove the bone-spurs and reduce the pressure on the nerves and eliminate the leg pain.

Dr. Kenneth A. Pettine
Loveland, CO

The treatment for spinal stenosis involves exercises, including stretching the quadriceps, psoas and hamstring muscles to put less stress on the spine to help increase the motion in that portion of the spine. Typically, patients who have spinal stenosis are elderly and very stiff. Medically, anti-inflammatory medications and/or steroid injections can be helpful. Ultimately, similar to the roots growing in a sewer pipe, the definitive treatment would be a nerve decompression, or roto-rooter, surgery to remove abnormal bone and soft tissue build up around the nerves.

Dr. Reginald Knight
Seattle, WA

Treatment for spinal stenosis often includes moderate rest, exercise, non-steroidal anti-inflammatory medications (NSAIDS), altering your activities and possibly a spinal decompression.

Dr. Jeffrey C. Wang
Los Angeles, CA

The initial treatment is physical therapy, strengthening, epidural steroid injections, and activity modifications to alleviate the stress on the spine and to strengthen and stabilize the muscles supporting the spine. If this conservative treatment fails, we will often have to perform a decompression. A decompression is a general term where all of the elements that are placing pressure on the nerves are removed in order to increase the space for the nerves and remove the pressure from the nerves; many times this entails removing bone spurs, parts of the disc, as well as the bony covering of the spine which is termed, the "lamina."

Dr. Jeffrey Goldstein
New York, NY

The treatment for spinal stenosis is to decompress the nerves. This is done by trimming away the overgrown bone spurs, ligaments and discs to relieve the compression of the nerves. This is often referred to as a spinal decompression, laminotomy or laminectomy. This may often be completed by a minimally-invasive approach. In some cases the decompression needs to be combined with a fusion.

Dr. Kambiz Hannani
Los Angeles, CA

The narrowing of the spinal canal causes pressure on the nerves. Removing ligaments and parts of the disc that have caused the spinal canal to narrow can open up the canal and improve spinal stenosis. The surgery can be done in a minimally invasive fashion when administered by a properly trained spinal surgeon. This allows patients to return to their daily activities as quickly as within a few days.

Dr. Thomas Kleeman
Bedford, NH

Spinal stenosis is a slowly progressive condition. Symptoms develop over many years and are often overlooked. Walking in particular becomes more difficult. The loss of this activity in elderly people may have a profound effect on their overall health. The goal of treatment is to maintain function, particularly walking. The initial treatment may include physical therapy and anti-inflammatory medication. The inability to walk may interfere with the success of therapy and epidural steroid injections can be extremely helpful in controlling leg symptoms. When these treatments fail, surgical decompression can lessen and in some cases permanently eradicate the symptoms of neurogenic claudication. In a recent article in Spine, Kleeman, et. Al. showed that by preserving the posterior elements of the spine, a successful decompression could be performed with a low risk. At four years after surgery 98% of the patients continued to do well.

Dr. Thomas Zdeblick
Madison, WI

The treatment for spinal stenosis includes physical therapy for flexion exercises and the use of epidural steroid injections. Should the symptoms remain, surgery may be indicated to improve the room for the nerves in the spine.

Dr. Jorge E. Isaza
Baton Rouge, LA

Spinal stenosis can be treated initially by decreasing the inflammation and the swelling on the nerves so that they fit a little bit better in the space that is still available. When there is no response to conservative treatment, then surgical treatment may be required. Surgical treatment for spinal stenosis consists of removing the material that is producing the stenosis, such as bone spurs or pieces of bone from fractures.

Dr. George Frey
Englewood, CO

Spinal stenosis is initially treated with a physical therapy program for strengthening and stabilization of the lumbar spine and muscles. Cortisone injections, called epidural steroid injections, around the area of the nerves may be of benefit. Nonsteroidal anti-inflammatory medications are also helpful. Should these measures fail or should the individual develop progressive numbness or weakness, usually surgery is recommended. This surgery involves the removal of the arch of bone over the top of the spinal canal, called the lamina. This bone removal will then in turn open up space for the nerves, which removes the pressure.

Dr. Robert S. Pashman
Los Angeles, CA

Conservative therapy may relieve the symptoms of spinal stenosis. If not, spinal decompression is necessary. This is the removal of the bony narrowing around nerves. The operative strategy will depend not only on the location of the spinal narrowing, but the relative stability and condition of the spine as a whole.

Dr. Rick Sasso
Indianapolis, IN

If nerve compression is symptomatic, steroid medications and physical therapy may be tried. If this does not work, surgery to take the pressure off of the nerves is highly successful.

Dr. Thomas Zdeblick
Madison, WI

The treatment for spinal stenosis includes physical therapy for flexion exercises and the use of epidural steroid injections. Should the symptoms remain, surgery may be indicated to improve the room for the nerves in the spine.

Dr. Eung-Jun Cha
Bedford, IN

Physical therapy or surgery.

Dr. John S. Shiau
Staten Island, NY

The treatment of spinal stenosis should be directed at what causes the spinal stenosis. So if a fracture causes spinal stenosis, then you should fix the fracture. If it is because of a herniated disc, you should treat the herniated disc. Sometimes there can be a combination of arthritis and a herniated disc, and then you must decide what the main cause of the problem is. Should we take care of everything? Should we take care of the ligaments? Should we take care of the disc? Depending on how much you have to do to the spine, you may have to end up doing a bigger surgery just to make sure the spine does not become unstable.

Dr. Dennis G. Crandall
Mesa, AZ

Short term improvement can be achieved with physical therapy, medications, and epidural steroid injections. Symptomatic spinal stenosis does not often respond well to conservative care in the long term. Surgical treatment improves symptoms in 75% of patients.

Dr. Andrew Glass
Someras Pt., NJ

Some patients with spinal stenosis can effectively be treated simply with modification of physical activities. Others will require medication and/or physical therapy. Finally, some patients will require surgery to relieve the problem. In those instances where surgery is required, the primary goal is to remove pressure from the nerves.

Dr. Ezriel E. Kornel
White Plains, NY

Depending on the severity, it ranges from physical therapy and/or chiropractic treatments to epidural steroid injections and ultimately through surgery if the stenosis is severe enough and the symptoms persist despite efforts at more conservative treatment. The different surgical techniques all have to do with opening the spinal canal to give the nerves more room to pass through the canal.

Dr. Donald D. Dietze Jr.
Covington, LA

The primary treatment is education and alteration of lifestyle. If symptoms remain limiting enough to warrant more aggressive treatment, then intraspinal steroid injections can give temporary relief up to 6 mos. - 2 yrs. In selected patients, and surgical decompression to release the constriction around the nerves can give excellent relief up to 5 - 8 yrs.

Dr. Sean Salehi
Chicago, IL

Initially, conservative treatments - such as bed rest, aspirin or motrin, and physical therapy - should be utilized to treat spinal stenosis. If these treatments do not work, then surgery is recommended.

Dr. Mark Rosenthal
Baltimore, MD

If the symptoms are mild, non-steroidal anti-inflammatories and exercise are usually sufficient. For more advanced cases, epidural blocks may be helpful. Patients who have failed to respond to these methods usually respond well to surgery. The appropriate procedure is a laminectomy- the bone across the back of the spinal canal, causing the stenosis, is removed.

Dr. Sebastian Lattuga
Rockville Centre, NY

The majority of patients' spinal stenosis can be made better with many non-surgical remedies such as physical therapy, exercise, chiropractic, acupuncture, massage, all have been found to be effective in alleviating the symptoms. Other treatments include directed cortisone injections into area of the stenosis called epidural injections.

Dr. W. Christopher Urban
Glen Burnie, MD

Non-operative treatment for spinal stenosis includes medications, physical therapy, and epidural or nerve root injections. These treatments are often successful in relieving symptoms. In cases where conservative strategies fail, operative techniques have proven to be very effective. The goal of this surgery, which is called a laminectomy, is to decompress the nerve roots by removing bone and soft tissues that are narrowing the spinal canal. When there are structural abnormalities, such as scoliosis or instability associated with the stenosis, a fusion may be required to stabilize the spine after the decompression has been performed.

Dr. Sylvain Palmer
Mission Viejo, CA

The treatment for spinal stenosis is to trim away the excess bone and ligament and relieve the compression of the nerves. This can often be done minimally invasively as an outpatient. In some cases the decompression needs to be combined with a fusion.

The commentary above recounts the experiences of these physicians. Medtronic invited them to share their stories candidly. Keep in mind that results vary; not every patient's response is the same. Talk with your doctor to learn more about any products that are mentioned above.

It is important that you discuss the potential risks, complications and benefits of spinal surgery with your doctor prior to receiving treatment, and that you rely on your doctor's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.

  • Published: July 22, 2002
  • Updated: April 19, 2010