Non-surgical Treatments for Spinal Stenosis

Related Information: • When The Pain Keeps Coming Back • Herniated Discs • What is Spinal Stenosis? • How is Spinal Stenosis Diagnosed? • Non-surgical Treatments for Spinal Stenosis • Spine Specialist Explains When Surgery is Recommended

In the absence of severe or progressive nerve involvement, a doctor may prescribe one or more of the following conservative treatments:

1. Nonsteroidal anti-inflammatory drugs, such as aspirin, naproxen (Naprosyn),2 ibuprofen (Motrin, Nuprin, Advil), or indomethacin (Indocin), to reduce inflammation and relieve pain.
2. Analgesics, such as acetaminophen (Tylenol), to relieve pain.
3. Corticosteroid injections into the outermost of the membranes covering the spinal cord and nerve roots to reduce inflammation and treat acute pain that radiates to the hips or down a leg.
4. Restricted activity (varies depending on extent of nerve involvement).
5. Physical therapy and/or prescribed exercises to maintain motion of the spine and build endurance, which help stabilize the spine.
6. A lumbar brace or corset to provide some support and help the patient regain mobility. This approach is sometimes used for patients with weak abdominal muscles or older patients with degeneration at several levels of the spine.

When to consider surgery In many cases, the conditions causing spinal stenosis cannot be permanently altered by non-surgical treatment, even though these measures may relieve pain for a time. To determine the extent to which non-surgical treatment will help, a doctor seldom recommends surgery during the first three months of treatment.

However, surgery might be considered within the three-month period if a patient experiences numbness or weakness that interferes with walking, impaired bowel or bladder function, or other neurological involvement.

The purpose of surgery is to relieve pressure on the spinal cord or nerves and restore and maintain alignment and strength of the spine. This can be done by removing, trimming, or adjusting diseased parts that are causing the pressure or loss of alignment.

The most common surgery is called decompressive laminectomy: removal of the lamina (roof) of one or more vertebrae to create more space for the nerves. A surgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disk. Various devices may be used to enhance fusion and strengthen unstable segments of the spine following decompression surgery.

Patients with spinal stenosis caused by spinal trauma or achondroplasia may need surgery at a young age. When surgery is required in patients with achondroplasia, laminectomy (removal of the roof) without fusion is usually sufficient.

Long-term outcomes of surgical treatment
Removal of the obstruction that has caused the symptoms usually gives patients some relief; most patients have less leg pain and are able to walk better following surgery. However, if nerves were badly damaged prior to surgery, there may be some remaining pain or numbness or no improvement. Also, the degenerative process will likely continue, and pain or limitation of activity may reappear five or more years after surgery.

Source: National Institutes of Health (NAMSIC/National Institutes of Health)
1 AMS Circle
Bethesda, Maryland 20892-3675, and on the NIAMS Web site at
http://www.nih.gov/niams/healthinfo/