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
- 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
- Spinal injections of corticosteroids, which can be
helpful in relieving pain if other nonsurgical treatments have not been
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.
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.
notice sudden changes in your ability to walk in a steady way, or your movement
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
- 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
- Nerve injury, including weakness, numbness, or
- Tears in the fibrous tissue that covers the spinal cord
and the nerve near the spinal cord, sometimes requiring
- Difficulty passing urine or loss of bladder or bowel
- 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 for lumbar spinal stenosis relieves pain that is
mostly in your legs. It may also relieve back pain. But surgery does not
usually work as well for 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?
general, up to 80% of people are satisfied with the results of surgery for
spinal stenosis.1 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.
People who have surgery can feel and move better in 6 weeks to 6 months after
surgery. The benefits of surgery appear to last for many years.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.