Managing Spinal Stenosis: Treatment Options

Spinal stenosis is the term used to describe a narrowing spine. Treatments vary because everybody’s case is different. Some individuals experience mild symptoms, while others experience severe symptoms. Can knowing treatment options help the patient and healthcare team customize and personalize a treatment plan to the individual’s condition?

Spinal Stenosis Treatments

Spaces within the spine can become narrower than they’re supposed to be, which can cause pressure on nerve roots and the spinal cord. Anywhere along the spine can be affected. The narrowing can cause pain, burning, and/or aching in the back and weakness in the legs and feet. Spinal stenosis has several primary treatments. When working through spinal stenosis treatments, a healthcare provider will assess symptoms and start treatment with first-line therapy, such as pain medication and/or physical therapy. These are often the first among individuals with the disease.

Medication

Chronic pain is one of the main symptoms. The first-line treatment often involves using pain-relieving medication/s. Commonly prescribed medications are nonsteroidal anti-inflammatories or NSAIDs. These medications reduce pain and inflammation. However, NSAIDs are not recommended for long-term use, and other medications may need to be used to relieve pain that includes: (Sudhir Diwan et al., 2019)

• Tylenol – acetaminophen
• Gabapentin
• Pregabalin
• Opioids for severe cases

Exercise

Exercise can reduce spinal stenosis symptoms by taking pressure off the nerves, which can reduce pain and improve mobility. (Andrée-Anne Marchand et al., 2021) Healthcare providers will recommend the most effective exercises for the individual. Examples include:

• Aerobic exercises, such as walking
• Seated lumbar flexion
• Lumbar flexion in lying
• Sustained lumbar extension
• Hip and core strengthening
• Standing lumbar flexion

Physical Therapy

Another primary spinal stenosis treatment is physical therapy, which is often used alongside pain medications. Typically, individuals undergo six to eight weeks of physical therapy, with sessions two to three times a week. Utilizing physical therapy has been shown to (Sudhir Diwan et al., 2019)

• Reduce pain
• Increase mobility
• Reduce pain medications.
• Reduce mental health symptoms like anger, depression, and mood changes.
• For severe cases, physical therapy following surgery can reduce recovery times.

Back Braces

Back braces can help reduce movement and pressure on the spine. This is helpful because even small spinal movements can lead to nerve irritation, pain, and worsening symptoms. Over time, the bracing can lead to a positive increase in mobility. (Carlo Ammendolia et al., 2019)

Injections

Epidural steroid injections may be recommended to relieve severe symptoms. Steroids act as anti-inflammatories to reduce pain and swelling caused by inflammation and irritation of the spinal nerves. They are considered nonsurgical medical procedures. According to research, injections can effectively manage pain for two weeks and up to six months, and some research has found that after a spinal injection, relief can last 24 months. (Sudhir Diwan et al., 2019)

Thickened Ligaments Decompression Procedure

Some individuals may be recommended to undergo a decompression procedure. This procedure involves using a thin needle tool inserted into the back. The thickened ligament tissue is removed to reduce the pressure on the spine and nerves. Research has found that the procedure can reduce symptoms and the need for more invasive surgery. (Nagy Mekhail et al., 2021)

Alternative Treatments

In addition to first-line treatments, individuals may be referred to alternative therapies for symptom management, including:

Acupuncture

• This involves the insertion of thin-tipped needles into various acupoints to relieve symptoms.
• Some research has found that acupuncture may be more effective at reducing symptoms than physical therapy alone. Both options are viable and can improve mobility and pain. (Hiroyuki Oka et al., 2018)

Chiropractic

• This therapy reduces pressure on nerves, maintains spinal alignment, and helps to improve mobility.

Massage

• Massage helps to increase circulation, relax the muscles, and reduce pain and stiffness.

New Treatment Options

As spinal stenosis research continues, new therapies are emerging to help relieve and manage symptoms in individuals who don’t respond to traditional medicine or cannot partake in conventional therapies for various reasons. However, some evidence presented is promising; medical insurers may consider them experimental and not offer coverage until their safety has been proven. Some new treatments include:

Acupotomy

Acupotomy is a form of acupuncture that uses thin needles with a small, flat, scalpel-type tip to relieve tension in painful areas. Research on its effects is still limited, but preliminary data shows it could be an effective complementary treatment. (Ji Hoon Han et al., 2021)

Stem Cell Therapy

Stem cells are the cells from which all other cells originate. They act as the raw material for the body to create specialized cells with specific functions. (National Institutes of Health. 2016)

• Individuals with spinal stenosis can develop soft tissue damage.
• Stem cell therapy uses stem cells to help repair injured or diseased tissues.
• Stem cell therapy can help repair or improve the damaged areas and provide symptom relief.
• Clinical studies for spinal stenosis report that it could be a viable treatment option for some.
• However, more research is needed to confirm whether the therapy is effective enough to be widely used. (Hideki Sudo et al., 2023)

Dynamic Stabilization Devices

LimiFlex is a medical device undergoing research and analysis for its ability to restore mobility and stability in the spine. It is implanted into the back through a surgical procedure. According to research, individuals with spinal stenosis who receive the LimiFlex often experience a higher reduction in pain and symptoms than with other forms of treatment. (T Jansen et al., 2015)

Lumbar Interspinous Distraction Decompression

Lumbar interspinous distraction decompression is another surgical procedure for spinal stenosis. The surgery is performed with an incision above the spine and places a device between two vertebrae to create space. This reduces movement and pressure on the nerves. Preliminary results show positive short-term relief from symptoms; long-term data is not yet available as it is a relatively new spinal stenosis treatment option. (UK National Health Service, 2022)

Surgical Procedures

There are several surgical procedures are available for spinal stenosis. Some include: (NYU Langone Health. 2024) Surgery for spinal stenosis is often reserved for individuals with severe symptoms, like numbness in the arms or legs. When these symptoms develop, it indicates a more notable compression of the spinal nerves and the need for a more invasive treatment. (NYU Langone Health. 2024)

Laminectomy

• A laminectomy removes part or all of the lamina, the vertebral bone covering the spinal canal.
• The procedure is designed to reduce pressure on nerves and the spinal cord.

Laminotomy and Foraminotomy

• Both surgeries are used if an individual’s spinal stenosis negatively affects an opening in the vertebral foramen.
• Ligaments, cartilage, or other tissues that constrict the nerves are removed.
• Both reduce pressure on the nerves traveling through the foramen.

Laminoplasty

• A laminoplasty relieves pressure on the spinal cord by removing parts of the spinal canal’s lamina.
• This enlarges the spinal canal and relieves pressure on the nerves. (Columbia Neurosurgery, 2024)

Discectomy

• This surgical procedure involves removing herniated or bulging discs that are placing pressure on the spinal cord and nerves.

Spinal fusion

• Spinal fusion involves joining two vertebrae using metal pieces like rods and screws.
• The vertebrae are more stable because the rods and screws act as a brace.

Which Treatment Is The Right One?

Because all treatment plans differ, determining the most effective is best suited for a healthcare provider. Each approach will be personalized to the individual. To decide what therapy is best, healthcare providers will assess: (National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2023)

• The severity of symptoms.
•  The current level of overall health.
• The level of damage that’s occurring in the spine.
• The level of disability and how mobility and quality of life are affected.

Injury Medical Chiropractic and Functional Medicine Clinic will work with an individual’s primary healthcare provider and/or specialists to help determine the best treatment options and concerns regarding medications or other forms of treatment.

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References

Diwan, S., Sayed, D., Deer, T. R., Salomons, A., & Liang, K. (2019). An Algorithmic Approach to Treating Lumbar Spinal Stenosis: An Evidenced-Based Approach. Pain medicine (Malden, Mass.), 20(Suppl 2), S23–S31. https://doi.org/10.1093/pm/pnz133

Marchand, A. A., Houle, M., O’Shaughnessy, J., Châtillon, C. É., Cantin, V., & Descarreaux, M. (2021). Effectiveness of an exercise-based prehabilitation program for patients awaiting surgery for lumbar spinal stenosis: a randomized clinical trial. Scientific reports, 11(1), 11080. https://doi.org/10.1038/s41598-021-90537-4

Ammendolia, C., Rampersaud, Y. R., Southerst, D., Ahmed, A., Schneider, M., Hawker, G., Bombardier, C., & Côté, P. (2019). Effect of a prototype lumbar spinal stenosis belt versus a lumbar support on walking capacity in lumbar spinal stenosis: a randomized controlled trial. The spine journal : official journal of the North American Spine Society, 19(3), 386–394. https://doi.org/10.1016/j.spinee.2018.07.012

Mekhail, N., Costandi, S., Nageeb, G., Ekladios, C., & Saied, O. (2021). The durability of minimally invasive lumbar decompression procedure in patients with symptomatic lumbar spinal stenosis: Long-term follow-up. Pain practice : the official journal of World Institute of Pain, 21(8), 826–835. https://doi.org/10.1111/papr.13020

Oka, H., Matsudaira, K., Takano, Y., Kasuya, D., Niiya, M., Tonosu, J., Fukushima, M., Oshima, Y., Fujii, T., Tanaka, S., & Inanami, H. (2018). A comparative study of three conservative treatments in patients with lumbar spinal stenosis: lumbar spinal stenosis with acupuncture and physical therapy study (LAP study). BMC complementary and alternative medicine, 18(1), 19. https://doi.org/10.1186/s12906-018-2087-y

Han, J. H., Lee, H. J., Woo, S. H., Park, Y. K., Choi, G. Y., Heo, E. S., Kim, J. S., Lee, J. H., Park, C. A., Lee, W. D., Yang, C. S., Kim, A. R., & Han, C. H. (2021). Effectiveness and safety of acupotomy on lumbar spinal stenosis: A pragmatic randomized, controlled, pilot clinical trial: A study protocol. Medicine, 100(51), e28175. https://doi.org/10.1097/MD.0000000000028175

Sudo, H., Miyakoshi, T., Watanabe, Y., Ito, Y. M., Kahata, K., Tha, K. K., Yokota, N., Kato, H., Terada, T., Iwasaki, N., Arato, T., Sato, N., & Isoe, T. (2023). Protocol for treating lumbar spinal canal stenosis with a combination of ultrapurified, allogenic bone marrow-derived mesenchymal stem cells and in situ-forming gel: a multicentre, prospective, double-blind randomised controlled trial. BMJ open, 13(2), e065476. https://doi.org/10.1136/bmjopen-2022-065476

National Institutes of Health. (2016). Stem cell basics. U.S. Department of Health and Human Services. Retrieved from https://stemcells.nih.gov/info/basics/stc-basics

Jansen, T., Bornemann, R., Otten, L., Sander, K., Wirtz, D., & Pflugmacher, R. (2015). Vergleich dorsaler Dekompression nicht stabilisiert und dynamisch stabilisiert mit LimiFlex™ [A Comparison of Dorsal Decompression and Dorsal Decompression Combined with the Dynamic Stabilisation Device LimiFlex™]. Zeitschrift fur Orthopadie und Unfallchirurgie, 153(4), 415–422. https://doi.org/10.1055/s-0035-1545990

UK National Health Service. (2022). Lumbar decompression surgery: How It’s performed. https://www.nhs.uk/conditions/lumbar-decompression-surgery/what-happens/

NYU Langone Health. (2024). Surgery for spinal stenosis. https://nyulangone.org/conditions/spinal-stenosis/treatments/surgery-for-spinal-stenosis

Columbia Neurosurgery. (2024). Cervical laminoplasty procedure. https://www.neurosurgery.columbia.edu/patient-care/treatments/cervical-laminoplasty

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2023). Spinal stenosis: Diagnosis, treatment and steps to take. Retrieved from https://www.niams.nih.gov/health-topics/spinal-stenosis/diagnosis-treatment-and-steps-to-take