What Is the Best Treatment for Spinal Stenosis?

Spinal stenosis is a narrowing of the spaces in the spinal canal, which is the space that contains the vertebrae, spinal cord, spinal discs, nerves, and other tissues. The narrowing is typically caused by arthritis or injury.

Spinal stenosis is treated with medications, lifestyle options, and surgery.

Spinal stenosis does not always cause symptoms, especially early on. When symptoms do occur, they may include: 

• Back pain 
• Tingling, numbness, or cramping that spreads down the legs
• Usually affects both legs, but symptoms may be worse in one leg 
• Sharp pain from the buttocks going down into the legs (sciatica)
• Loss of sensation in the feet
• Foot weakness that causes the foot to slap down when walking (foot drop)
• Loss of sexual ability

Symptoms usually worsen when walking or standing upright and improve when sitting or bending forward at the waist.

Symptoms of severe cases of spinal stenosis (cauda equine syndrome) that require immediate medical attention include:

• Leg weakness 
• Trouble controlling the bowels or bladder 
• Severe or increasing numbness between the legs, inner thighs, and back of the legs
• Severe pain and weakness spreading into one or both legs that cause difficulty walking or getting up from a chair

Spinal stenosis may be caused by:

• Osteoarthritis
  • The most common cause of spinal stenosis
  • Most people who develop spinal stenosis are age 50 and older
• Narrow spinal canal
• Spinal injury
• Spinal tumor
• Certain bone diseases such as Paget’s disease
• Scoliosis
• Birth defects of the spine
• Past spinal surgery
• Rheumatoid arthritis
• Herniated disks
• Thickened ligaments 

Spinal stenosis is diagnosed with a physical exam and imaging and other tests, such as:

• X-ray
• Magnetic resonance imaging (MRI)
• Computerized tomography (CT) scan
• Myelogram (a CT taken after injecting dye)
• Electromyography (EMG)
• Nerve conduction studies
• Bone scan

Spinal stenosis is treated with medications, lifestyle options, and surgery. 

Medications used to treat spinal stenosis symptoms include: 

• Pain medications
• Muscle relaxants
• Injections of medicines that numb the back or reduce inflammation

Other nonsurgical treatments for spinal stenosis symptoms include:

• Physical therapy for strength and flexibility
• Spinal manipulation by a physical therapist or chiropractor 
• Acupuncture
• Massage

Surgery to treat spinal stenosis includes: 

• Laminectomy 
  • Most frequently used surgical procedure for lumbar spinal stenosis
  • Removes part or all of one or both lamina of the vertebra at the involved level 
• Intraspinous spacer implantation 
  • Less invasive treatment option 
  • Implantation of a device between the spinous processes at one or two vertebral levels, relieving compression 
  • Minimally invasive decompression 
• Newer types of procedures
  • Not yet clear if these procedures offer benefit in terms of improved symptoms and function or fewer complications compared with standard decompression with laminectomy

Complications of severe spinal stenosis may include:

• Numbness
• Weakness
• Incontinence
• Paralysis

Most people develop some osteoarthritis -- the main cause of spinal stenosis -- as they age, which is why spinal stenosis is most common among adults over age 50. However, you may be able to lower the risk of developing symptoms of spinal stenosis by keeping the spine healthy. 

Exercise regularly, including exercises to maintain strength and flexibility of the core muscles 

• Maintain good posture
• Lift heavy objects safely
• Sit in a chair that supports the back
• Sleep on a supportive mattress
• Maintain a healthy weight