Lumbar Spinal Stenosis: Should I Have Surgery?

Lumbar spinal stenosis is the narrowing of the spinal canal in the low back. It usually occurs when bone and other tissues grow inside the openings in the spinal bones. This can squeeze the nerves that branch out from the spinal cord. The squeezing can cause pain, numbness, or weakness, most often in the back, buttocks, legs, or feet.

Symptoms may be very bad at times and not so bad at other times.

Arthritis is the most common cause of spinal stenosis. There are a lot things that can help relieve your symptoms, but they won't make your arthritis go away. Over time, your arthritis may get worse, and symptoms of spinal stenosis may come back.

There are several treatments that don't involve surgery that can help you feel better, be more active, and avoid surgery. These include:

• Changing the way you do your activities. This means trying other ways of doing your activities that don't cause pain or make other symptoms worse. For example, this might mean using a tall stool for tasks that you would normally do standing up. Or you could use a shopping cart or a wheeled walker so that you're leaning forward a little when you walk.
• Taking medicines to manage pain. These include acetaminophen (such as Tylenol) and nonsteroidal anti-inflammatory drugs like ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve). Be safe with medicines. Read and follow all instructions on the label.
• Doing exercise. Aerobic exercise can help your symptoms. You can try walking on a treadmill with a slight incline. Or you could ride a stationary bike. In both of these types of exercise, your spine tilts forward a little as you work out. So they might be more comfortable for you than other exercise.
• Getting physical therapy. This helps you learn stretching and strength exercises that may reduce pain and other symptoms. The goal of physical therapy is to make your daily tasks and activities easier.
• Getting steroid injections. These are shots that are sometimes tried to help leg pain by reducing inflammation in the nerve root if other nonsurgical treatments haven't worked. These shots may work for some people. But they help relieve symptoms for only a short time.

Decompressive laminectomy is the most common type of surgery to treat lumbar spinal stenosis. This surgery is done to relieve pressure on the spinal nerve roots. It removes bone (parts of the vertebrae), thickened tissue, or both to keep them from narrowing the spinal canal and squeezing or irritating the spinal nerves.

In some cases, spinal fusion may be done at the same time to help keep the spine stable. This surgery joins, or fuses, two or more bones so that the joints can no longer move. This surgery is more complicated and has more risks. And it's usually not needed unless you have other back problems along with spinal stenosis.

Some surgeons are doing newer, less invasive procedures. They are inserting small metal devices-called interspinous process devices-between the bones of the spine, near where the nerve roots leave the spinal cord. The idea is to create more space between the bones to take pressure off the nerve roots. This may be an option for some people. But not all surgeons do the procedure. And studies haven't yet shown how well the devices work over the long term.

Research shows that:

• Surgery may work better than nonsurgical treatments to relieve pain and help you move better. If nonsurgical treatments have not worked well enough, surgery might be able to help you.^{footnote 1}
• By 3 months, people who had surgery notice more improvement in their symptoms and can be more active than people who did not have surgery.^{footnote 1} This difference continues for at least 4 years after surgery.^{footnote 2}
• The benefits of surgery appear to last for many years. After 8 to 10 years^{footnote 3}:
  • People treated with surgery were as satisfied as those treated without surgery.
  • People who had surgery were generally able to be more active and had less leg pain than those who had nonsurgical treatment.
• Surgery appears to work better for leg pain than for back pain, but it may help your back pain too.^{footnote 4}

Surgery may not be an option if you have other serious health problems that make surgery too risky.

All surgery has risks. These risks may be more serious for an older adult. Possible problems from surgery include:

• Problems from anesthesia.
• A deep infection in the surgical wound.
• A skin infection.
• Blood clots.
• Nerve injury, including weakness, numbness, or paralysis.
• Tears in the fibrous tissue that covers the spinal cord and the nerve near the spinal cord. These tears may require more surgery.
• Trouble passing urine, or loss of bladder or bowel control.
• Long-term (chronic) pain, which happens after surgery in some cases.
• The chance that the surgery won't relieve your symptoms. And even if you get better with surgery, there is a chance that you may get new symptoms in the future.
• Death from problems caused by surgery, but this is rare.

Symptoms may return after several years. A second surgery may be needed if:

• Spinal stenosis develops in another area of the spine.
• An earlier surgery didn't control symptoms.
• Tissue regrows and presses on the spinal cord or spinal nerve roots.

For most people, it's safe to try nonsurgical treatments for several months before thinking about surgery. Many people are able to manage their symptoms with things like changing the way they do their activities, taking medicines to manage pain, doing exercise, or getting physical therapy.

But if these other treatments don't work, not having surgery means that you may still have pain or other symptoms that make it hard for you to do your daily activities.

There is little or no risk in not having surgery unless you have serious symptoms. These symptoms include having trouble controlling your bladder or bowels, numbness or weakness, and sudden changes in the way you walk or move. These symptoms aren't likely to get better on their own, and they could get worse.

Your doctor might recommend surgery if:

• Your pain and weakness are bad enough to get in the way of your normal activities and have become more than you can manage.
• You've tried other treatments-changing the way you do your activities, taking medicines to manage pain, doing exercise, or getting physical therapy-for at least a few months, and they haven't worked.
• You are less able to control your bladder or bowels than usual.
• You notice sudden changes in your ability to walk in a steady way, or your movement becomes clumsy.