Spinal Stenosis: Non-Operative Treatment

Stewart G. Eidelson, MD
SpineUniverse Founder, Orthopaedic Surgeon
South Palm Orthospine Institute
Delray Beach, FL, USA

Can Spinal Stenosis be treated without surgery?
Yes - in fact, less than 5% of patients with a spinal disorder ever require spine surgery!

What types of non-surgical treatments are available?
There are several non-surgical options your doctor may recommend to treat your spinal stenosis. Often, treatment combines more than one type of therapy. For example, medication may be combined with physical therapy. Let's review a few of the non-surgical therapies one by one.

Medication: There is a wide variety of medications available to relieve inflammation, pain, and muscle spasm. Although some drugs are available over-the-counter (OTC), it is wise not to combine these with prescription drugs your doctor provides unless it is under his direction. Just like prescription medications, OTC drugs can cause serious side effects.
Injections: The most common type of injection used to help alleviate the symptoms of spinal stenosis is an epidural injection. This type of injection places medication (usually a steroid) into the space that surrounds specific nerve roots (the epidural space). The medication helps to reduce inflammation and acute pain that radiates into the arms or legs. Usually a course of three injections are given over a period of several weeks.
Physical Therapy (PT): PT usually combines inactive therapy and therapeutic exercise. Inactive therapy includes heat or ice packs, ultrasound, electrical stimulation, and massage. These treatments help to ready the patient for active therapy by relaxing tight muscles and easing pain or discomfort. Therapeutic exercise includes stretching and prescribed exercises to help stabilize the spine, build strength and endurance, and increase flexibility.

What happens if I'm one of the 5% that needs surgery?
Surgery, any kind of surgery is a serious decision. Your doctor will take sufficient time to thoroughly explain your surgical options with you. You might consider bringing a family member or friend along for an added set of 'ears'.

A few patients do require spine surgery to treat the symptoms caused by spinal stenosis. The goal of surgery is to relieve the pressure on the spinal cord and/or nerve roots. This is accomplished by enlarging the spinal canal and/or neuroforamen. The type of surgical procedure performed depends on the type, location, and cause of the spinal stenosis.

Continue this article...

Article written 04/14/2004
Published online 04/21/2004
Last updated 05/15/2007

I had a great pleasure reading Dr. Stewart Eidelson's 5-part article on spinal stenosis. The information included in this article is accurate and informative. I would like add a few comments for the benefit of the readers or potential patients. First, spinal stenosis is indeed most common in the lumbar spine, followed by the cervical spine. However, occasionally, the thoracic spine is affected as well. Spinal stenosis in the thoracic spine can present with pain radiating around the rib (thoracic radiculopathy) or numbness, spasm, and weakness of the legs (myelopathy). Sometimes, lumbar stenosis and cervical stenosis co-exist, and the astute doctor will pickup both diagnoses and render appropriate treatment for both conditions. Also, leg symptoms and walking difficulty may be due to clogging of the leg vessels (vascular claudication) rather than due to lumbar spinal stenosis (neurogenic claudication). Sometimes, both vascular and neurogenic claudication conditions may co-exist. Again, making the correct diagnosis is important for subsequent treatment.

As Dr. Eidelson mentioned, lumbar stenosis is largely due to "wear and tear" or degenerative changes in the joints and intervertebral discs in the spine over many years, but some patients are born with smaller spinal canal (congenital stenosis). Congenital stenosis patients typically show symptoms in their 40s and 50s rather than in their 60s and beyond. Because of smaller canals at birth, minor bulging discs and degenerated joints tend to affect the nerves earlier in life in these patients. Some patients with congenital stenosis may undergo discectomy alone without decompressive procedures for the narrowed canal, and surgical outcomes may be compromised. Again, correct and precise diagnosis leads to correct treatment.
Again, Dr. Eidelson did an excellent job describing the spinal stenosis condition, and the reader should have a good understanding of the definition, clinical presentation, diagnosis, and available nonoperative and operative treatment options. However, one patient with spinal stenosis is slightly or vastly different from another, and it is up to the treating doctor to make the precise diagnosis and make the most appropriate recommendations for that specific patient.

Howard S. An, MD

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