Lumbar Spinal Stenosis Treatment and Surgery

Once a doctor has made a conclusive diagnosis of lumbar spinal stenosis, non-surgical or surgical treatment should be implemented, depending on the severity of the spinal stenosis.

There are several options for conservative (non-invasive) treatments for lumbar stenosis, all of which are examined in more detail below.

Non-Surgical Treatments for Lumbar Spinal Stenosis

Conservative lumbar stenosis treatments may include one or more of the following:

• Activity modification. Patients are usually more comfortable when flexed forward and, for example, can ease discomfort when walking by leaning on a cane, walker or shopping cart.
• Exercise. Though not a cure, a suitable program of spinal stenosis exercises may be beneficial with guidance from a physical therapist and prevent further debilitation arising from inactivity. Stationary biking can be a good lumbar spinal stenosis treatment option because patients are sitting and positioned in a flexed-forward position while exercising.
• Non-steroidal anti-inflammatory drugs (NSAIDs). Since inflammation is a common component of spinal stenosis, anti-inflammatory drugs, such as ibuprofen or aspirin, may be an effective lumbar stenosis treatment.
• Epidural injections. These injections are given on an out-patient basis and usually take 15 to 30 minutes. The physician guides a needle into the epidural space (located within the spinal canal between the vertebrae and the tough inner membrane called the dura mater or dura). Once the needle is in proper position, the epidural steroid solution is slowly injected. Epidural injections use steroids as an anti-inflammatory agent, and often include a fast-acting local anesthetic for temporary pain relief.

Spinal Stenosis Surgery

Spine surgery is the only way to change the anatomy of the spine and give the nerves more room. Choosing whether or not to have spinal stenosis surgery as a treatment for lumbar stenosis depends on the degree of physical disability and pain the patient is experiencing. The two currently available surgical treatments for lumbar spinal stenosis are:

• Decompression surgery. An open laminectomy or microdiscectomy decompresses the nerves by removing a portion of the enlarged facet joint, preventing the nerve from being pinched when the patient stands up. This surgical lumbar stenosis treatment is effective in reducing pain and improving function in approximately 80% of cases. Over a 5-year period, the results tend to deteriorate, primarily due to the overall aging process and the progressive nature of osteoarthritis.
• Interspinous process device surgery (e.g., the commercially available X-STOP and others in development, such as the Wallis® Posterior Dynamic Stabilization System). Interspinous process devices are designed to open the space through which nerve endings pass, and limit backward extension of the spine, ideally relieving pressure on the nerves and alleviating pain. This surgical treatment for lumbar stenosis is relatively new, and the effectiveness of the procedure is still a matter of some debate.

Although lumbar laminectomy is the current gold standard for surgical treatments of lumbar spinal stenosis and X-stop is now in use, new implantable devices are undergoing research and clinical testing:

• Facet joint replacement, during which a reconstruction of the facet joint is implanted after decompression and removal of the degenerated facet (e.g., the Anatomic Facet Replacement System™ and Total Facet Arthroplasty System®).
• Total element replacement devices, during which a device designed to preserve motion is implanted after decompression. For an in-depth discussion of new technologies and procedures being investigated for stenosis surgery, see Posterior Motion Preservation Spine Surgery: Alternative to Spinal Fusion.

• Article written By:
• Peter F. Ullrich, Jr., MD

August 10, 2009

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