Spinal Stenosis Treatment

Non-surgical treatment for spinal stenosis

Depending on the severity of symptoms, spinal stenosis can often be managed through non-surgical means. The three most common treatments for spinal stenosis include:

• Exercise Program. Although a suitable exercise program in the hands of a good physical therapist may be helpful, it is not curative. Even though it is not a cure, however, it is very important for patients to remain active as tolerated and not additionally debilitated from inactivity, so an appropriate exercise program is a key part of any spinal stenosis treatment program.
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• Activity modification. Patients are usually counseled to avoid activities that cause the adverse symptoms of spinal stenosis. Patients are typically more comfortable while flexed forward. Examples of activity modification might include: walking while bent over and leaning on a walker or shopping cart instead of walking upright; stationary biking (leaning forward on the handlebars) instead of walking for exercise; sitting in a recliner instead of on a straight-back chair.
• Epidural injections. An injection of cortisone into the space outside the dura (the epidural space) can temporarily relieve symptoms of spinal stenosis. While these injections can seldom be considered curative, they can alleviate the pain in about 50% of cases. Up to three injections over a course of several months can be tried. Although they are not considered diagnostic in and of themselves, generally, if the pain caused by spinal stenosis is relieved by an epidural steroid injection, then the patient can also be expected to have a good result if they later choose surgery.

Anti-inflammatory medication (such as ibuprofen, aspirin) may be helpful in treating spinal stenosis. Some physicians recommend a multiple B-complex vitamin with 1200 mg of folic acid daily, but this has not been substantiated as an effective treatment in the medical literature.

Some people may successfully manage the symptoms of spinal stenosis with the non-surgical therapies either for a period of time or indefinitely. The key in choosing whether or not to have surgery is the degree of physical disability and disabling pain from lumbar spinal stenosis. As a guideline, when the (usually elderly) patient can no longer walk sufficiently to care for himself or herself (such as to go shopping for essentials), then spinal stenosis surgery is usually recommended.

Surgery for spinal stenosis is mainly designed to increase a patient’s activity tolerance, so he or she can do more activity with less pain.

• Article written By:
• Charles Ray, MD

April 3, 2007

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