Surgery for lumbar spinal stenosis should be considered only if regular physical exercise and drug treatment do not relieve symptoms.
What are the non-surgical treatment options for lumbar spinal stenosis?
In the absence of severe or progressive nerve involvement, a doctor may prescribe one or more of the following conservative remedies:
- A support corset for the back provides support and helps the patient to regain his mobility. This aid is sometimes used in patients with weak abdominal muscles or elderly patients with degenerative spinal changes.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen, ibuprofen or indomethacin reduce inflammation and pain.
- Analgesics such as acetaminophen are helpful for relieving the discomfort.
- Cortisone injections into the outermost membrane, which encloses the spinal cord and nerve roots, are designed to reduce inflammation and acute pain radiating to the hips or legs.
- Injections of a local anesthetic, for example into the nerve blocks near the affected nerves, temporarily reduce the excruciating symptoms.
- Restriction of activities (varies depending on the extent of nerve involvement).
- prescription of gymnastic exercises and/or physiotherapy to maintain extensive freedom of movement of the spine, strengthen the abdominal and lumbar muscles, improve resistance; these are all healing methods that help stabilize the spine.
- Some patients may be encouraged to slowly and gradually try aerobic activities such as swimming or cycling on the exercise bike.
Alternative (or complementary) therapies are various methods of health care, procedures and products that are currently not part of conventional medicine.
The following are some examples of these therapies used to treat spinal canal stenosis:
This treatment is based on the theory that the restriction of movement in the spine limits its proper functioning and can cause pain.
Chiropractors can manipulate the spine to restore normal spinal circulation.
You can also use traction and rotation to increase the intervertebral space and reduce pressure on the affected nerves.
Some authors believe that chiropractic may be beneficial.
So far, research has shown that chiropractic treatment is as effective as non-surgical therapies for acute back pain.
This treatment consists in the stimulation of certain points on the skin, into which fine metal needles are inserted.
Research has shown that the back is an area where acupuncture provides benefits to some patients.
General practitioners and specialists may suggest this therapy in addition to the conventional treatment method.
Surgery for lumbar spinal canal stenosis
Surgery may be indicated for those who do not improve with the therapies listed above, or who have severe progressive weakness or loss of function of the bowel or bladder (such as cauda equina syndrome).
Depending on the results of the instrumental examinations, various surgical techniques are available to treat spinal canal stenosis, ranging from laminectomy to the fusion of two or more vertebral bodies.
The main goal of neurosurgery is to remove the structures that put pressure on the nerves in the spinal canal or vertebral hole (foramen).
This technique refers to lumbar decompression surgery (laminectomy, foraminotomy).
For some patients, this approach may be sufficient, but for others, it must be combined with fusion of the lumbar vertebral bodies.
If too many of the compressing structures are removed to free the nerve, the vertebrae can become unstable.
This leads to abnormal movement of the bones.
To resolve the instability, the surgeon may perform spondylodesis (vertebral body blocking) to unite the vertebrae in this area and thus prevent movement at this level.
Sometimes this procedure involves inserting a metal prosthesis into the vertebral bodies to adequately fix the bones involved.
Spinal canal stenosis surgery in most cases is very effective in relieving the symptoms in the legs: pain, sciatica and numbness.
However, depending on the severity and duration of the nerve compression, some permanent damage can occur, which cannot be eliminated even by surgery.
The results of the operation are good for the legs, but the back pain benefits less.
New surgical options
The procedure with an interspinal device was developed as a surgical minimally invasive option for spinal canal stenosis.
It fits as a spacer between the spinous processes at the back of the spine.
Their job is to keep the space open for the nerves by separating the vertebral bodies from each other.
The interspinal spacers were approved in 2005.
From then on, many operations were performed with it.
In some studies, the success rate exceeds 80%.
These devices may be a safe alternative to laminectomy for some patients. With this surgical technique, a small part of the bone is removed and it can be performed under local anesthesia.
The key to success with this technique lies in the appropriate selection of patients.
The ideal candidate must experience relief from pain in the buttocks or legs when sitting and bending over, while the pain occurs while standing.
Minimally invasive pressure relief
The pressure relief can be created by small incisions. Recovery occurs much faster with the minimally invasive technique, because fewer lesions appear in the surrounding soft tissues.
In this low-invasive technique, surgeons use a microscope to see the operating area.
During the operation, an X-ray control can be performed.
A traditional open surgical procedure is performed through the direct anatomical view of the patient. This requires a larger cut.
This is more painful for the patient and leads to a longer convalescence.
The limits of minimally invasive surgery lie in the scope of the visible area.
If spinal canal stenosis extends over large parts of the spine, open surgery is the only method that can solve the problem.
Advantages of minimally invasive surgery are: shortened hospital stay and short convalescence. But both the minimally invasive and traditional technique relieve symptoms of stenosis.
The doctor can explain the options that are most suitable for the patient.
Postoperative recovery occurs faster with minimally invasive procedures. Within three days after the operation you can walk again.
Discharge from the hospital depends on the patient’s condition and the surgeon’s decision. It can take place the following day or five days after the operation.
For the restoration of movement and balance and pain relief, an appropriate program of postoperative rehabilitation is recommended.
All surgical procedures carry a risk, especially those performed under general anesthesia and performed on the elderly.
The most common complications of spinal stenosis surgery are damage to the membrane surrounding the spinal cord (dura mater or hard meninges) in the area of the procedure, an infection or a blood clot that forms in the veins. These diseases are curable, but they prolong the recovery time. The presence of other disorders and the physical condition of the patient are important factors to consider when deciding on surgical intervention.
What are the long-term results of surgical treatment of spinal canal stenosis?
Eliminating the narrowing that caused the symptoms gives patients relief. Most patients have less pain in their legs and are able to walk better after surgery.
However, if the nerves were severely damaged before surgery, pain or numbness may remain.
In addition, the degenerative process may continue and pain and restriction of movement may recur after surgery.
Published results of the Spine Patient Outcomes Research Trial (SPORT) study show that in patients with spinal canal stenosis, surgical treatment is more effective than conservative therapy in relieving symptoms and improving functionality.
However, during the same period, the conditions of patients who did not receive surgical therapy also improved somewhat.