The two main surgical procedures to treat lumbar spinal stenosis are laminectomy and spinal fusion. Laminectomy: This procedure involves removal of the bone, bone spurs, and ligaments that compress the nerves. Spinal fusion: In this procedure, two or more vertebrae are permanently fused together.
A decompression laminectomy is the gold standard of surgery for treating spinal stenosis. This surgery removes the bony spurs and buildup of bone in the spinal canal, giving more room for the spinal cord and nerves.
Exercises which flex, stretch or strengthen the back and neck can help to open up the spine, alleviating compression symptoms. Canes and walkers can also be used to walk in a forward flexed manner and provide some stability.
Many people with mild spinal stenosis find that nonsurgical treatments such as pain medication and physical therapy relieve symptoms and help them remain active. NYU Langone spine specialists work with experts in pain management, rehabilitation, and orthotics to create a treatment plan.
Walking, standing, or extending the lumbar area of the spine can cause symptoms to worsen. Sitting or flexing the lower back or neck may relieve symptoms. The flexed position “opens up” the spinal column, enlarging the spaces between vertebrae at the back of the spine.
Usually, our spine specialists consider surgery only if symptoms such as weakness, numbness, or pain in the arms or legs indicate severe or progressive nerve or spinal cord compression.
Contact sports like basketball, football, soccer, and martial arts are exercises to avoid with spinal stenosis. These activities can involve sudden trauma to the spine, which may lead to further injury. Activities that involve jumping, such as jumping rope, should be avoided with spinal stenosis.
In spinal stenosis, people typically experience less pain with leaning forward, and especially with sitting. Studies of the lumbar spine show that leaning forward can increase the space available for the nerves. Pain is usually made worse by standing up straight and walking.
Nutrition and Spinal Stenosis
In general, staying hydrated, eat plenty of fruits and vegetables, not smoking, and minimizing red meat, caffeine and alcohol are good dietary guidelines.
Most people have good results from surgery and are able to return to a normal lifestyle after they heal. People tend to have less leg pain and can walk better afterward. However, surgery doesn't cure arthritis or other conditions that might have caused the spinal canal to narrow in the first place.
A neurosurgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disk. A spinal fusion with or without spinal instrumentation may be used to enhance fusion and support unstable areas of the spine.
Minimally invasive spine surgery (MISS) is a type of surgery on the bones of your spine (backbone). This type of surgery uses smaller incisions than standard surgery. This often causes less harm to nearby muscles and other tissues. It can lead to less pain and faster recovery after surgery.
Back Pain Treatments and Therapies Not Covered by Medicare
Image-guided lumbar stenosis decompression is not a covered Medicare treatment. Discectomy is an operational procedure to correct a herniated disc and is not covered by Medicare.
Most patients with cervical or lumbar spinal stenosis respond well to non-surgical treatments (such as medication), so you may not need spine surgery. However, there are situations when you may want to go ahead with spine surgery.
Many people with spinal stenosis find the most comfort sleeping on their side in “fetal position” — that is, with knees curled up toward the abdomen. Another alternative is to sleep in an adjustable bed or recliner that allows the head and knees to remain elevated.
Bend forward, backward, and sideways. Your pain may worsen with these movements. Lift your legs straight up while lying down. If the pain is worse when you do this, you may have sciatica, especially if you also feel numbness or tingling in one of your legs.
Spinal stenosis in the lower back can cause pain or cramping in one or both legs. This happens when you stand for a long time or when you walk. Symptoms get better when you bend forward or sit. Some people also have back pain.
Avoid Long Walks or Running
The repeated trauma to the knees and spine is less than ideal. On the other hand, walking for long periods of time – or long distances, instead – can also exacerbate back pain.
If you have lumbar spinal stenosis, you may have trouble walking distances or find that you need to lean forward to relieve pressure on your lower back. You may also have pain or numbness in your legs. In more severe cases, you may have difficulty controlling your bowel and bladder.
As a result, climbing stairs reduces the amount of space in the spinal canal. This temporarily exacerbates the effects of spinal stenosis, potentially leading to worsened pain and other symptoms. If you've been diagnosed with spinal stenosis, it's wise to keep climbing stairs to a minimum.
Acetaminophen (eg, Tylenol), aspirin, ibuprofen (eg, Motrin, Advil), and naproxen (eg, Aleve) are examples of OTC analgesics that your doctor may recommend for spinal stenosis.
Disability: In severe cases of spinal stenosis, a patient can end up permanently disabled. This may be through paralysis, or weakness so severe that it is impossible to stand and move as normal. It is not unreasonable to expect severe stenosis to lead to a person being bound to a wheelchair.
Spinal stenosis can't be cured but responds to treatment.
Hennenhoefer says you can live a normal life with a spinal stenosis diagnosis and can work on improving your mobility and comfort.