Lumbar Stenosis (cont.)
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Lumbar spinal stenosis facts
- What is the lumbar spine, and what is lumbar spinal stenosis?
- What causes lumbar spinal stenosis?
- What are risk factors for lumbar spinal stenosis?
- What are the signs and symptoms of lumbar spinal stenosis?
- How is lumbar spinal stenosis diagnosed?
- What is the treatment for lumbar spinal stenosis?
- What can be done to prevent lumbar spinal stenosis?
- What is the outlook (prognosis) for lumbar spinal stenosis?
What is the treatment for lumbar spinal stenosis?
In most situations, the treatment for lumbar spinal stenosis begins with conservative (nonoperative) treatments. This can include medications to reduce inflammation, even short courses of oral cortisone medication, and pain medications. There are also several medications directed specifically at nerve pain that are helpful in lumbar spinal stenosis, including gabapentin (Neurontin) and pregabalin (Lyrica). Physical therapy can help for many. Cortisone (steroid) injections in the lumbar spine, referred to as epidural injections, can also reduce the symptoms by decreasing inflammation and swelling around the nerve tissue. These are sometimes repeated up to three times per year.
Surgery may be indicated for those who do not improve with the above treatments or if there is severe or progressive weakness or loss of bowel or bladder function (cauda equina syndrome). Depending on the examination findings and imaging studies, there are various surgical procedures available to treat lumbar spinal stenosis, ranging from laminectomy to fusion procedures.
The main goal of surgery is to remove the structures that are compressing the nerves in the spinal canal or vertebral foramen. This is referred to as lumbar decompression surgery (laminectomy, laminotomy, foraminotomy). In some patients, this can be performed alone, but in other patients, it must be combined with lumbar fusion. If too much of the compressive structures need to be removed to free the nerve, the vertebrae may become unstable (spinal instability). This leaves the vertebrae with abnormal motion. If this occurs, a spinal fusion can be performed to attach the vertebrae together and eliminate the motion at that level. Sometimes this requires metallic hardware to be installed in the vertebrae to adequately support and fix the involved bone.
Surgery for lumbar spinal stenosis can be very successful in most patients in relieving the leg symptoms of ambulatory pain, sciatica, and numbness. However, depending on the severity of the nerve compression and the length of time the nerve have been compressed, there may be some permanent damage that is not relieved with surgery. The success for back pain relief is less reliable with surgery than the relief of leg symptoms.
More recently, surgical procedures that are somewhat less invasive than traditional lumbar decompression have become available. Interspinous devices that have been used in certain patients for this purpose include X-Stop and Coflex devices.
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