|
In the absence of severe or progressive nerve involvement, a doctor may
prescribe one or more of the following conservative treatments:
Nonsteroidal anti-inflammatory drugs, such as aspirin, naproxen (Naprosyn),
ibuprofen (Motrin, Nuprin, Advil), or indomethacin (Indocin), to reduce
inflammation and relieve pain. Analgesics, such as acetaminophen (Tylenol), to
relieve pain.
Corticosteroid injections into the outermost of the membranes covering
the spinal cord and nerve roots to reduce inflammation and treat acute pain that
radiates to the hips or down a leg.
Restricted activity (varies depending on extent of nerve involvement).
Physical therapy and/or prescribed exercises to maintain motion of the
spine and build endurance, which help stabilize the spine.
A lumbar brace or corset to provide some support and help the patient
regain mobility. This approach is sometimes used for patients with weak
abdominal muscles or older patients with degeneration at several levels of the
spine.
When Should
Surgery Be Considered and What Is Involved?
In many cases, the conditions causing spinal stenosis cannot be permanently
altered by nonsurgical treatment, even though these measures may relieve pain
for a time. To determine the extent to which nonsurgical treatment will help, a
doctor seldom recommends surgery during the first 3 months of treatment.
However, surgery might be considered within the 3-month period if a patient
experiences numbness or weakness that interferes with walking, impaired bowel or
bladder function, or other neurological involvement.
The purpose of surgery is to relieve pressure on the spinal cord or nerves
and restore and maintain alignment and strength of the spine. This can be done
by removing, trimming, or adjusting diseased parts that are causing the pressure
or loss of alignment. The most common surgery is called decompressive
laminectomy: removal of the lamina (roof) of one or more vertebrae to create
more space for the nerves. A surgeon may perform a laminectomy with or without
fusing vertebrae or removing part of a disk. Various devices may be used to
enhance fusion and strengthen unstable segments of the spine following
decompression surgery.
Patients with spinal stenosis caused by spinal trauma or achondroplasia may
need surgery at a young age. When surgery is required in patients with
achondroplasia, laminectomy (removal of the roof) without fusion is usually
sufficient.
What Are the Major Risks of
Surgery?
All surgery, particularly that involving general anesthesia and older
patients, carries risks. The most common complications of surgery for spinal
stenosis are a tear in the membrane covering the spinal cord at the site of the
operation, infection, or a blood clot that forms in the veins. These conditions
can be treated but may prolong recovery.
What
Are the Long-Term Outcomes of Surgical Treatment for Spinal Stenosis?
Removal of the obstruction that has caused the symptoms usually gives
patients some relief; most patients have less leg pain and are able to walk
better following surgery. However, if nerves were badly damaged prior to
surgery, there may be some remaining pain or numbness or no improvement. Also,
the degenerative process will likely continue, and pain or limitation of
activity may reappear 5 or more years after surgery.
Back to Spinal Stenosis |
