What's the treatment for spinal stenosis?
Mild cases of spinal stenosis may be treated with rest, nonsteroidal anti-inflammatory drugs (such as aspirin) and muscle relaxants. Symptoms can usually be controlled using medication to relieve pain, exercise to maintain strength and flexibility, physical therapy, or injections of medications (corticosteroids) that reduce inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) - aspirin, naproxen (Naprosyn), ibuprofen (Motrin, Nuprin, Advil), celecoxib (Celebrex) are examples of
nonsteroidal anti-inflammatory drugs used to reduce inflammation and relieve pain. Analgesics, such as acetaminophen (Tylenol), can relieve pain but don't have the anti-inflammatory effects of NSAIDs. Long-term use of analgesics and NSAIDs may cause stomach ulcers as well as kidney and liver problems. Steroids can be used to reduce the swelling and inflammation of the nerves.
Severe symptoms that are getting worse or restrict normal daily activities usually will not improve with nonsurgical therapy and may require surgery. In these cases, surgery to remove bone and tissue that are squeezing the spinal cord (decompressive laminectomy) is usually successful in relieving leg pain and allowing you to resume normal daily activities. The surgery to widen the spinal canal is termed a "decompression". The procedure is performed through an incision on your back. During the procedure, the orthopaedic surgeon removes the laminae (bony arches of the spinal canal), and the ligaments between these arches which may be contributing to the stenosis. Occasionally, a portion of the damaged disk joint itself may need to be removed. If a sufficient amount of tissue is removed, then it may be necessary to perform a fusion operation as well, in order to prevent the occurrence of spinal deformity and pain post-operatively.
The surgical procedure removes bone and other tissues that have entered the spinal canal or put pressure on the spinal cord. Two vertebrae may be fused, to eliminate improper alignment, such as that caused by spondylolisthesis. For surgery, patients lie on their sides or in a modified kneeling position. This position reduces bleeding and places the spine in proper alignment. Alignment is especially important if vertebrae are to be fused. Surgical decompression can eliminate leg pain and restore control of the legs, bladder, and bowels, but usually does not eliminate lower back pain. Typical hospital stays for a simple decompression surgery usually range from 1 to 3 days. After surgery, you may need to wear a light-weight brace for comfort, however, most patients are not required to wear a brace.
Physical therapy and massage can help reduce the symptoms of spinal stenosis. An exercise program should be developed to increase flexibility and mobility. A brace or corset may be worn to improve posture. Activities that place stress on the lower back muscles should be avoided. Exercise is important in managing pain from spinal stenosis. Regular back exercises can strengthen muscles that support your spine, easing pain and preventing further injury (see Exercise for a Healthy Back). Your physical therapist will show you how to make modifications to your daily standing, sitting, and sleeping habits-for example, learning how to lift properly or sitting for shorter periods of time. |
