Many people with spinal stenosis can be effectively treated with
conservative measures. But if you have disabling pain or your ability to
walk is severely impaired, you may want to consider spinal surgery.
Acute loss of bowel or bladder function is usually considered a medical
emergency and requires immediate surgical intervention.
Before considering surgery, your doctor is likely to recommend trying
one or more of the following for at least three months:
anti-inflammatory drugs (NSAIDs).
These include over-the-counter and prescription medications such as
aspirin, ibuprofen (Advil, Motrin, others) or indomethacin (Indocin)
to reduce inflammation and pain. Although they can provide real
relief, NSAIDs have a "ceiling effect" — that is, there's a limit to
how much pain they can control. If you have moderate to severe pain,
exceeding the recommended dosage won't provide additional benefits.
What's more, NSAIDS can cause serious side effects, including nausea
and stomach ulcers that may bleed. If you take these medications,
talk to your doctor so that you can be monitored for problems.
This group of pain relievers includes acetaminophen (Tylenol,
others). Analgesics don't reduce inflammation, but they can
effectively treat pain. Yet chronic overuse of acetaminophen can
cause kidney and liver damage. Drinking alcohol increases your risk
of serious side effects.
Nonprescription supplements such as chondroitin sulfate and
glucosamine, either alone or in combination, have shown positive
effects on osteoarthritis. But it's not yet known whether they're
effective at treating or preventing osteoarthritis of the spine.
Talk to your doctor if you're interested in these supplements — they
may interfere with other medications you're taking, especially warfarin (Coumadin).
Moderate rest followed by a gradual return to activity may improve
symptoms. Walking is usually the best exercise, especially for
people with neurogenic claudication. But biking is also recommended
because it keeps your back in a flexed position rather than in an
Working with a physical therapist can build up your strength and
endurance and help maintain the flexibility and stability of your
A back brace or
This helps provide support and may especially benefit people who
have weak abdominal muscles or degeneration in more than one area of
In some cases, your doctor may inject a corticosteroid medication
into the spinal fluid around your spinal cord and nerve roots.
Corticosteroids suppress inflammation and can be especially helpful
in treating pain that radiates down the back of your leg — in fact,
a single dose may provide significant relief. But because
corticosteroids can cause a number of serious side effects, the
number of injections you can receive is limited, usually to no more
than three in one year.
The goal of surgery is two-fold: to relieve pressure on the spinal cord
or nerves, and to maintain the integrity and strength of your spine.
This can be accomplished in several ways, depending on the cause of the
problem. The most common surgical procedures include:
In this procedure, your surgeon removes all of the lamina — the back
part of the bone over the spinal canal — to create more space for
the nerves and to allow access to bone spurs or ruptured disks that
may also be removed. A laminectomy is often performed through a
single incision in your back (open surgery), although in some cases,
your surgeon may use a laparoscopic technique. In that case, a tiny
camera and surgical instruments are inserted through several small
incisions, and your surgeon views the operation on a video monitor.
Laparoscopic back surgery is complex and requires great skill. It's
also not appropriate for many people with spinal stenosis. When done
appropriately, however, you're likely to have less pain and to
recover from surgery more quickly with this technique.
laminectomy include infection, a tear in the membrane that covers
the spinal cord at the site of the surgery, bleeding, a blood clot
in a leg vein, decreased intestinal function (paralytic ileus) and
In this procedure, just a portion of the lamina is removed to
relieve pressure or to allow access to a disk or bone spur that's
pressing on a nerve. The risks are the same as for laminectomy.
This procedure may be performed on its own or at the same time as
laminectomy. It's used to permanently connect (fuse) two or more
vertebral bones in your spine and may be especially indicated when
one vertebra slips over another. To fuse the spine, small pieces of
extra bone are needed to fill the space between two vertebrae. This
may come from a bone bank or from your own body, usually your pelvic
bone. Wires, rods, screws, metal cages or plates also may be used,
especially if your spine is unstable or the operation takes place to
correct a deformity.
Back surgery can
relieve pressure in your spine, but it's not a cure-all. You may
have considerable pain immediately after the operation, and you
might continue to have pain for a period of time. For some people,
recovery can take weeks or months and may require long-term physical
therapy. What's more, surgery won't stop the degenerative process
and symptoms may return — sometimes within just a few years.
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