Overall Treatment Considerations for Lumbar Spinal Stenosis

Milder symptoms of lumbar spinal stenosis can be effectively managed through non-surgical means, such as pain medication, activity modification, physical therapy, and epidural steroid injections.

Most physicians recommend that patients try non-surgical treatments for lumbar stenosis for at least three to six months before considering lumbar stenosis surgery.

When Lumbar Spine Stenosis Surgery May Be an Option

Lumbar spine stenosis surgery should be reserved for significant functional disability that cannot be improved by nonsurgical treatments. Other medical problems such as heart disease, lung disease, or peripheral vascular disease may limit activity levels as well as the spinal stenosis. If that is the case, lumbar decompression surgery may offer limited benefit as the patient will not be able to be more active because the comorbidities will still be present and continue to limit the patient’s activity level.

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Lumbar Spine Stenosis Surgery Options

The surgical gold standard is a lumbar laminectomy that opens up the spinal canal and relieves pressure on the nerve. Depending on the characteristics of the spine (e.g. bone strength, bone slippage or spondylolisthesis orientation of the spinal facet joints, movement of that segment of the spine when bending back and forth), a spinal fusion may be necessary at the time of the decompression.

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There are also newer techniques available, including microendoscopic techniques and spinous process distracters (the X-STOP is the first that has been FDA approved). These newer techniques are less invasive than a traditional spinal stenosis surgery such as a fusion, although it is often similar in invasiveness as a one level decompression (laminectomy ).

While non-surgical approaches can manage inflammation and pain, only stenosis surgery can treat the cause of the problem by removing the source of pressure from the compressed lumbar nerve roots.

Written by Jack Zigler, MD