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Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Spinal stenosis usually starts gradually and develops over a long period of time. It may cause pain, numbness, or weakness in the legs, which may stay the same, get better, or get worse. Because of the gradual and changing nature of spinal stenosis, you may have many questions about the right type and timing of treatment. Consider the following when making your decision:

• You may be able to relieve symptoms and maintain normal activities with regular nonsurgical treatment, including medicines to relieve pain and inflammation such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and exercise.
• You may want to consider surgery if you have tried nonsurgical treatment for a set period of time, perhaps months, and you still have intense pain and discomfort in your legs that interferes with your normal daily activities.
• If you have stenosis in the neck (cervical) area, you may want to have surgery to prevent worsening of the condition, which can cause spinal cord and nerve damage, and paralysis.
• If you have surgery to relieve spinal stenosis, symptoms may recur in a few years. You may need repeat surgery.
• You will probably have relief from leg pain if you choose to have surgery, but your back pain will probably not be relieved.

 Medical Information

What is spinal stenosis?

Spinal stenosis is the narrowing of the spinal canal, which occurs when growth of bone or other tissues reduces the size of the openings in the bones of the spine. This narrowing can squeeze (compress) and irritate the nerve roots that branch out from the spinal cord, or it can squeeze and irritate the spinal cord itself. This may cause pain, numbness, or weakness, most often in the legs, feet, or buttocks. Symptoms may be severe at times, and less severe at other times. Severe disability is not common. Spinal stenosis occurs most often in the lower back (lumbar) area. When it does occur in the neck area (cervical spinal stenosis), the spinal cord may become squeezed, which if untreated can lead to spinal cord and nerve damage and paralysis.

What tests may be helpful in choosing appropriate treatment?

Spinal stenosis is usually diagnosed through a history of your symptoms, physical examination, and imaging studies of your spine. Before making your decision about surgery, you may need to have an X-ray, magnetic resonance imaging (MRI), or a computed tomography (CT) scan. These imaging tests can identify any narrowing of your spinal canal and the exact location of any abnormalities in your spine. In addition to the imaging test results, the severity of your symptoms and the impact on your quality of life are important considerations before you make your final decision about surgery.

What nonsurgical treatment is used for spinal stenosis?

Nonsurgical treatment is usually successful in relieving mild to moderate symptoms, and it may be effective in managing symptoms for many years. Nonsurgical treatment includes:

• Medicines such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), to relieve pain and inflammation.
• Exercise, which is important for overall good health. Aerobic exercise—especially riding a stationary bicycle (which allows you to lean forward)—can relieve symptoms.
• Staying at a healthy body weight, which may relieve symptoms and slow progression of the stenosis.
• Physical therapy, which provides education, instruction, and support for your self-care. Physical therapy helps you learn stretching and strength exercises that may lead to a decrease in pain and other symptoms.
• Spinal injections of corticosteroids, which can be helpful in relieving pain if other nonsurgical treatments have not been effective.

What type of surgery is used to treat spinal stenosis?

The purpose of surgery to treat spinal stenosis is to relieve pressure on the spinal cord or spinal nerve roots. Decompressive laminectomy is major surgery to remove bone (parts of the vertebrae) and/or thickened tissue that is narrowing the spinal canal and squeezing the spinal cord and spinal nerve roots. This procedure is done by surgically cutting into the back. In some cases, spinal fusion (arthrodesis) may be done at the same time to help stabilize sections of the spine treated with laminectomy. Spinal fusion techniques vary from what type of bone or metal implants are used to whether the surgery is done from the front (anterior) or back (posterior) of the body.

When is surgery recommended for spinal stenosis?

Some people choose to have surgery as soon as symptoms begin to get in the way of their normal activities. But nonsurgical treatment is usually tried for a set period of time, perhaps months, before surgery is considered. If nonsurgical treatment does not relieve the symptoms of pain, numbness, or weakness in the legs, and these symptoms are severe enough to restrict normal daily activities, you may choose to have surgery. Surgery is clearly needed in some situations, such as when:

• Severe pain symptoms restrict normal daily activities and become more severe than you can manage.
• Nonsurgical treatment does not relieve pain, and severe nerve compression symptoms of spinal stenosis (such as numbness or weakness) are getting worse.
• 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.

If you have an unstable back, you may have a spinal fusion procedure along with laminectomy. To create spinal fusion, a surgeon uses metal pieces and bone graft material in and around your spine to help stabilize it. This can help prevent pain and movement problems.

What are the risks of having surgery for spinal stenosis?

Surgery may not be an option when other serious health problems are present that make surgery too risky. Complications from spinal stenosis surgery may result from the impact of other existing medical problems and the severity of the spinal problem.

All surgery poses risks of complications. These complications may be more serious in an older adult. Possible complications include:

• Problems from having general anesthesia.
• A deep infection in the surgical wound.
• A skin infection.
• Blood clots in the deep leg or pelvic veins (deep vein thrombosis), which in rare cases travel to the lungs (pulmonary embolism).
• An unstable spine (more common after multiple laminectomies are done without using spinal fusion).
• Nerve injury, including weakness, numbness, or paralysis.
• Tears in the fibrous tissue that covers the spinal cord and the nerve near the spinal cord, sometimes requiring reoperation.
• Difficulty passing urine or loss of bladder or bowel control.
• Death (rare) from surgical complications.

There is a risk of chronic pain developing in some cases where decompression surgery alone (with or without spinal fusion) is performed.

Symptoms may return after a few years. Some people have repeat surgery.

Surgery for lumbar spinal stenosis is most likely to relieve pain that is mostly in your legs. Surgery does not usually work as well for relieving back pain.¹

What are the risks of not having surgery for spinal stenosis?

If you have mild or moderate symptoms of spinal stenosis, there is very little or no risk involved in not having surgery. Your symptoms can most likely be relieved with nonsurgical treatment.

Experts agree that the course of spinal stenosis varies—it may stay the same, get better, or get worse. But if symptoms are severe, they usually do not improve on their own. If you have severe symptoms, not having surgery means that your normal daily activities may be limited and you will have to endure the pain and discomfort of the condition.

How effective is surgery for spinal stenosis?

In general, up to 80% of people are satisfied with the results of surgery for spinal stenosis.¹ For people with severe symptoms, surgery usually reduces leg pain and improves walking ability.² One study that followed up 8 to 10 years after treatment for lumbar spinal stenosis showed that people treated with surgery were as satisfied as those treated without surgery. These two groups also had similar decreases in symptoms. Those who had surgery were generally able to be more active and had less leg pain.³ But symptoms may return after several years. About 10% to 20% of people who have had surgery need to have surgery again.¹

If you need more information, see the topic Lumbar Spinal Stenosis.

 Your Information

Your choices are:

• Have surgery to relieve your symptoms.
• Use nonsurgical treatment for your symptoms.

The decision whether to have surgery for spinal stenosis takes into account your personal feelings and the medical facts.

These personal stories may help you make your decision.

 Wise Health Decision

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having surgery for spinal stenosis. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have surgery for spinal stenosis.

Check the box below that represents your overall impression about your decision.

Return to the topic Lumbar Spinal Stenosis.

 References

Citations

1. Isaac Z, et al. (2005). Lumbar spinal stenosis. In WJ Koopman, ed., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp. 2087–2092. Philadelphia: Lippincott Williams and Wilkins.

2. Sheehan JM, et al. (2001). Degenerative lumbar stenosis: The neurosurgical perspective. Clinical Orthopaedics and Related Research, 384: 61–74.

3. Atlas SJ, et al. (2005). Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8- to 10-year results from the Maine Lumbar Spine Study. Spine, 30(8): 936–943.

 Credits