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Spinal Stenosis Treatment, Medications and Surgery

By Editorial Team (2)
May 17, 2021

Spinal stenosis is a condition that happens when the spaces in your backbone (vertebrae) become narrowed. When this occurs, your spinal cord and its nerves can get pinched. More than 50% of the time, spinal stenosis affects the lumbar spine, the lower part of the back. Narrowing of the spine that goes along with this condition can cause pain that shoots down the back of the leg. It is important to get treatment for spinal stenosis diagnosis, especially when severe symptoms are present.

Non-Surgical Treatment for Spinal Stenosis

Medications for spinal stenosis treatment

Few patients who have spinal disorders require surgery on their spine. There are several different spinal stenosis treatment options that your doctor may recommend. Many of these treatments involve a combination of therapies. For instance, your physician may combine physical therapy with a prescription for medication to relieve your pain as a treatment for spinal stenosis approach. Some medications for pain are also available without a prescription.

Over-the-counter Medications

Your spinal stenosis treatment program will probably start with medication unless your symptoms are extremely serious. The main goal of treatment is usually to reduce inflammation and the pain it causes. Analgesics (pain pills) like acetaminophen work to relieve discomfort, but they cannot reduce inflammation, so they are not always the first choice for spinal stenosis medications. If you do not have any allergies or other health problems to prohibit their use, your doctor will probably recommend nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, or aspirin. These medications are able to relieve pain, and they also decrease inflammation.

Prescription Medications

If over-the-counter medications are not effectively controlling your pain, the next step your doctor might recommend in your treatment for spinal stenosis is prescription medications. Muscle relaxants are sometimes prescribed for the pain caused by spinal stenosis, and medicines that are used for other conditions, such as antidepressants and seizure medications, are also sometimes beneficial. Part of your treatment for spinal stenosis plan might include prescription-strength NSAIDs to help relieve your pain.

Spinal Injections for pain control

In some severe cases of spinal stenosis, epidural injections of corticosteroids are given directly into the space that surrounds the membrane covering the spinal cord. Corticosteroids are powerful anti-inflammatory agents, and administering them at the source of pain may provide pain relief for weeks or even months. Epidural injections are especially helpful as a treatment for spinal stenosis in cases where the pain shoots down the back of the leg. Many patients report almost instant relief. Since steroids are so powerful, they also carry a risk of side effects, some of which are significant. Potential side effects from epidural injections include:

  • An increase in pain at the site of the injection
  • Fever following the injection
  • Anxious feelings
  • Weight gain following the spinal stenosis treatment
  • Insomnia
  • Increased blood glucose levels following the spinal stenosis treatment
  • Increased blood pressure (hypertension)
  • Lowered immunity
  • Peptic ulcers
  • Joint damage in large bones, such as in the hip joints
  • Cataracts

If you receive an epidural injection as part of your treatment for spinal stenosis, notify your physician right away if:

  • Develop a severe headache when you stand or sit up, and the only thing that relieves it is lying down
  • Develop severe pain that is not relieved by typical measures
  • Cannot control your bowels or bladder
  • Experience loss of sensation or function in your legs or arms

Because steroids carry the risk of these dangerous side effects, the number of injections a patient can receive as part of their treatment for spinal stenosis is usually limited. Be sure to discuss the side effects with your doctor.

Exercises for spinal stenosis

When people are having pain, they do not like to think about exercising. However, stretching and exercising are important parts of treatment for spinal stenosis. In addition, moving can help relieve your pain.
Before you begin, make a note of the following:

  • Talk to your physician before you begin any activity or exercise program as part of treatment for spinal stenosis. Your doctor might have specific recommendations regarding what form of exercise will benefit you the most and may also tell you if there are certain activities to avoid. Your physician is your best source of information.
  • Avoid any activity that over-stresses your spine.
  • Know yourself and pay attention to your body. If your pain gets worse, or if you have new pain, stop your spinal stenosis treatment and call your physician.

Types of Exercise for People with Spinal Stenosis

  • Walking is a good exercise for the treatment of spinal stenosis. You can vary your pace, and walking is low-impact. In addition to being good for your spine, it helps to relieve mental stress. Try to walk every day.
  • Swimming is also an excellent treatment for spinal stenosis. It puts all the muscles of the back to work safely. The water serves as a support for your body weight, taking the stress off your spine.
  • As part of your spinal stenosis treatment, you can combine swimming and walk-in water-walking

If your physician has recommended physical therapy as part of your spinal stenosis treatment, you will be instructed in stretches and exercises that help build endurance, flexibility and help strengthen your spine. These exercises will also help strengthen the abdominal muscles, which will help support your spine.

Physical Therapy for Spinal Stenosis

As part of the treatment for spinal stenosis, you may be referred to physical therapy. A skilled therapist can help with pain relief and can also help restore mobility.
Physical therapy includes passive treatment for spinal stenosis to help your body relax and therapeutic exercise, which is an active part of physical therapy.
Passive treatments you may receive as part of physical therapy for spinal stenosis might include:

  • Deep tissue massage: As part of your treatment for spinal stenosis, massage targets tension in the muscles. Direct pressure and friction are used to help release tension in the body’s soft tissues.
  • Cold and hot therapies: Heat brings more blood, nutrients, and oxygen to an area to help it heal as part of spinal stenosis treatment. Cold slows blood flow which can help decrease pain, inflammation, and muscle spasms. Typically, physical therapists alternate between cold and hot therapies.
  • Transcutaneous electrical nerve stimulation (TENS): In this spinal stenosis treatment, the muscles are stimulated with safe intensities of electric current. This may interrupt the body’s pain signals or stimulate the release of its natural painkillers. TENS is not recommended for treating chronic pain of the lower back.
  • Ultrasound: This form of therapy helps reduce pain, swelling, stiffness, and muscle cramps as a treatment for spinal stenosis through sound waves that create gentle heat.

Alternative Treatment for Spinal Stenosis

Some people who have spinal stenosis seek the help of complementary and alternative medicine (CAM) practitioners for treatment for spinal stenosis. CAM therapies and practices are not considered to be a part of conventional treatment at this time. They may include treatments like massage, homeopathy, and acupuncture.
Even though alternative treatment for spinal stenosis is not considered to be traditional therapies, many people have reported that these treatments have helped them. Some of these CAM treatments include:

  • Acupuncture: Acupuncture as a treatment for spinal stenosis involves using ultra-fine needles inserted through the skin at specific sites in the body. It is based on an Eastern approach to healing that seeks to restore the body’s energy force known as the Chi. Some research indicates that acupuncture stimulates the body’s release of natural painkillers, known as endorphins.
  • Homeotherapy: This practice involves using herbal remedies and medications to reduce inflammation and pain as a treatment for spinal stenosis. Some remedies used in homeotherapy are glucosamine, chondroitin sulfate, and hyaluronic acid.
  • Massage: Massage may be beneficial as a therapy for spinal stenosis in relieving very tense muscles. 

As with any treatment or medication, be sure to speak with your physician before trying any new spinal stenosis treatment to make sure it is safe and appropriate for you.

Surgical Treatment of Spinal Stenosis

Many patients who have spinal stenosis are able to manage their symptoms with non-surgical spinal stenosis treatments successfully. There are some situations, though, in which surgery becomes necessary. These situations may include:

  • If a patient has attempted conservative treatments and they have been unsuccessful
  • If a patient has suffered severe pain for an extended period of time
  • If a patient has pain in the legs or arms, accompanied by numbness and tingling
  • If a patient has lost feeling in the legs or arms
  • If a patient has weakness or loss of function in the legs or arms
  • If a patient has lost control of their bladder or bowels

One of the primary goals of spinal stenosis surgery is to provide more room in the spinal canal for the nerve roots and the spinal cord. By making the spinal canal larger, it is hoped the pain caused by inflammation of the nerve will subside.
Another goal of surgical spinal stenosis treatment is to increase strength in your extremities and restore feeling in the legs or arms if this has been impaired. There are typically two different types of surgeries that are used in the treatment of spinal stenosis:

  • Decompression: During this procedure, the tissue that is compressing the nerve or spinal cord is removed. This creates more room in the spinal canal.
  • Stabilization: In this procedure for spinal stenosis treatment, the amount of movement between the bones of the spine is limited.

Decompression Surgery for the Treatment of Spinal Stenosis

Different types of surgery can be performed for decompression, depending on what is compressing a nerve. The types of procedures used as spinal stenosis treatments for decompression include:

  • Foraminotomy: In this operation, a bone spur or part of a vertebra is removed where the nerve exits the spine to make this opening larger.
  • Laminotomy: As part of a surgical spinal stenosis treatment, this operation removes a portion of a vertebra called the lamina to make more room in the spinal canal.
  • Laminectomy: This is similar to a laminotomy, but rather than just a portion of the lamina being removed, the entire lamina is taken out. 

If indirect decompression is performed, pressure on the spinal cord or nerve roots is removed by moving bones apart rather than by removing bone as spinal stenosis treatment.

Stabilization Surgery for Spinal Stenosis

If one or more vertebrae move out of their correct alignment, the spine can become unstable, in addition to becoming painful. Bones that slip out of position can pinch nerves. As part of spinal stenosis treatment in these cases, spinal fusion or stabilization surgery may be necessary. The need for this procedure depends on how many vertebrae have slipped and also on how extensive of operation you require as part of your spinal stenosis treatment. If your surgeon needs to perform a laminectomy on several vertebrae, for example, your spine will become very unstable without spinal fusion.
Spinal fusions have been common for several years. The procedure can be done with decompression surgery, or it can be done alone as a separate operation. A bone graft is inserted along with spinal instrumentation to help the bones grow together. The fusion provides spinal stability by preventing movement between the bones of the spine.

Open Spine Surgery or Minimally Invasive Spine Surgery?

Spinal stenosis treatment can be performed in some cases using minimally invasive techniques. This means the spinal stenosis surgery is completed using several small openings rather than a large incision. The surgeon uses very small instruments, a tiny camera or a microscope or endoscope to operate. Minimally invasive surgery is not always an option. If several vertebrae need to be worked on, open surgery will most likely be required for your surgical spinal stenosis treatment.

Risks of Surgery

If you have surgery as part of your spinal stenosis treatment, be sure to discuss the possible complications with your physician. Possible complications may include:

  • Complications related to the use of anesthesia,
  • Damage to your spinal nerves or spinal cord,
  • Failure of the fusion to heal,
  • Continued pain after surgery,
  • Failure or breakage of the instrumentation,
  • Infection.

Recovery After Spinal Stenosis Surgery

If you have surgery as a spinal stenosis treatment, chances are you will not feel better immediately. You will be helped to get out of bed within the first 12 to 24 hours, and you will most likely be on pain medications for several weeks. Your surgeon will give you specific instructions related to safety and how to stand, sit, and get up and down. You probably will need to restrict your activity for several weeks.

  • You should not lift anything and avoid twisting, bending, or reaching.
  • Be sure to report any increased pain, fever, or signs of infection to your doctor,
  • Practice good posture,
  • Maintain a healthy weight,
  • Follow a healthy diet,
  • Do not smoke,
  • Avoid excessive alcohol use.

Surgery as a spinal stenosis treatment is usually successful. In fact, up to 90% of patients obtain pain relief!

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