Nonsurgical treatment is appropriate when the symptoms of spinal stenosis are mild or if a person is not a good candidate for surgery—for example, an older adult who also has another serious illness. Treatment includes
Some success has been reported with the use of caudal epidural blocks—injections of pain relievers and a steroid directly into the base of the spine.
If these measures fail to control symptoms, surgery is considered. Surgery is necessary when severe neurological deficits or impaired bowel or bladder function develop.
Spinal Stenosis Surgery
Decompression surgery for spinal stenosis enlarges the spinal canal to relieve pressure on the spinal cord. After the spinal column is opened at the narrowed points, the bone or fibrous tissue responsible for the constriction is removed. At times, a disk or fragments of a disk also may be removed. If an extensive amount of bone is removed, it may be necessary to fuse together two or more vertebrae to stabilize the spinal column (this may slightly decrease a person’s flexibility).
The hospital stay for decompression surgery is typically three to five days. A person can get around using a walker the first or second day and then graduate to a cane, which he or she uses for six to 12 weeks. After that, walking without assistance is usually possible. Results tend to be excellent if the disease is limited to one or two vertebrae. Studies have shown that leg pain associated with stenosis significantly improves after surgery in 70 to 85% of people.
Older adults with spinal stenosis may have other health conditions, such as heart disease or arthritis, that increase the risk of surgical complications. These conditions do not necessarily rule out surgery as a treatment option, however.
In one study, investigators monitored 50 people, age 71 to 84, who had undergone decompression surgery. Half of the people had other disorders that severely limited their mobility. No complications involving anesthesia, the heart, or blood clots occurred during the procedure. After two years, 28 of the study participants (more than half) rated the procedure’s effect on their leg pain as excellent (almost or totally pain free); nine reported fair relief (improved but residual pain); and nine said their pain was unchanged. Although the operation provided some relief, the rates of excellent outcomes were not as high as researchers had hoped. Therefore, although having other health conditions did not cause additional complications, it appeared to reduce the chances of obtaining the best results.