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Spinal stenosis - Treatment

Alternative Names

Pseudo-claudication; Central spinal stenosis; Foraminal spinal stenosis

Treatment:

When your back pain does not go away, or it gets more painful at times, learning to take care of your back at home and prevent repeat episodes of your back pain can help you avoid surgery.

Your doctor and other health professionals will help you manage your pain and keep you as active as possible.

  • Your doctor may refer you for physical therapy. The physical therapist will help you try to reduce your pain using stretches. The therapist will show you how to do exercises that make your neck muscles stronger.
  • You may also see a massage therapist, and someone who performs acupuncture. Sometimes a few visits will help your back or neck pain.
  • Cold packs and heat therapy may help your pain during flare-ups.
  • A number of different medications can help with your back pain. See also: Medicines for chronic pain

A type of talk therapy called cognitive behavioral therapy may be helpful if the pain is having a serious impact on your life. This technique helps you better understand your pain and teaches you how to manage back pain.

SURGERY

If the pain does not respond to these treatments, or you lose movement or feeling, you may need surgery. Surgery is done to relieve pressure on the nerves or spinal cord.

You and your doctor can decide when you need to have surgery for these symptoms. Spinal stenosis symptoms often become worse over time, but this may happen very slowly.

  • People who had long-term back pain before their surgery are likely to still have some pain afterwards. Spinal fusion probably will not take away all the pain and other symptoms.
  • Even when using MRI scans or other tests, it is hard for your surgeon to always predict whether you will improve and how much relief surgery will provide.

For more information about how surgery is done and who is most likely to benefit, see also:

Expectations (prognosis):

Many people with spinal stenosis are able to be active for many years with the condition, although they may need to make some changes in their activities or work.

Spine surgery will often partly or fully relieve symptoms. However, people who had long-term back pain before their surgery are still likely to have some pain afterward. Spinal fusion probably will not take away all of the pain and other symptoms.

Spine problems are possible after spine surgery. The area of the spinal column above and below a spinal fusion are more likely to be stressed when the spine moves. Also, if you needed more than one kind of back surgery (such as laminectomy and spinal fusion), you may be more likely to have future problems.

Complications:

A lack of feeling can make you more likely to injure your legs or feet. Infections may get worse because you may not feel the pain. Changes caused by pressure on the nerves may be permanent, even if the pressure is relieved.

Calling your health care provider:

Call your health care provider if you have symptoms of spinal stenosis.

More serious symptoms that need immediate attention include:

  • Difficulty or poor balance when walking
  • Problems controlling urine or bowel movements
  • Problems urinating or having a bowel movement
  • Reviewed last on: 6/4/2011
  • C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

References

Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008;358:794-810.

Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med. 2008;358:818-825.

Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis. Four-year results of the Spine Patient Outcomes Research Trial. Spine. 2010;35:1329-1338.

Chou R, Baisden J, Carragee Ej, Resnick DK, Shaffer WO, Loeser JD. Surgery for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34:1094-1109.

Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34:1078-1093.

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