Mayo Clinic: Nonsurgical treatments may decrease pain from spinal stenosis

DEAR MAYO CLINIC: I was diagnosed with spinal stenosis about 12 years ago. I haven’t had many symptoms over the years, but about six months ago I started noticing increasing discomfort in my legs. Is surgery an option to treat spinal stenosis? If not, what else can I do? The leg pain is making it hard for me to walk.

ANSWER: Surgery usually isn’t necessary to treat spinal stenosis. Often a combination of lifestyle changes, physical therapy and medication can effectively decrease the pain and discomfort caused by this common back problem.

Spinal stenosis occurs when the open space within your spine narrows, causing pressure and irritation to the nerve tissue. It can happen for a variety of reasons, but most of the time spinal stenosis is a result of aging and the buildup of arthritis. In some cases, spinal stenosis does not cause any symptoms and may be found during a medical test done for another reason.

Spinal stenosis, and the nerve compression that is associated with it, tends to develop slowly. Over time, it can put pressure on your spinal cord and the nerves that travel through the spine to your arms and legs and possibly cause symptoms.

If the nerves affected are in your neck — the part of your spine called the cervical spine — that may cause numbness, weakness or tingling in an arm or hand, or trouble with coordination in a leg or foot. It often causes problems with walking and balance. Nerves to your bladder or bowel can be affected too.

When spinal stenosis affects nerves in your lower back, called the lumbar spine, that may lead to pain or cramping in your legs when you stand for a long time, or back discomfort when you stand up and when you walk. The discomfort usually eases when you bend forward or sit down.

When spinal stenosis causes symptoms that interfere with daily activities, treatment usually begins with self-care steps. For example, people with mild symptoms often benefit from changes to their diet and nutrition. A healthy weight loss can take some stress off the back, particularly the lumbar portion of the spine.

Working with a physical therapist can help too. He or she can teach exercises to help maintain the flexibility and stability of the spine, as well as build strength and endurance and improve balance.

Medications such as pain relievers and muscle relaxants can also temporarily ease the discomfort of spinal stenosis. They are typically recommended for a short time only, since there’s little evidence of benefit from long-term use.

If those measures aren’t enough, then injecting a corticosteroid medication into the spinal canal may be another option. Your nerve roots may become irritated and swollen at the spots where they are being pinched because of spinal stenosis. A corticosteroid can help relieve the pressure by reducing the inflammation. Corticosteroids are powerful drugs, however, so you can only get these injections a few times each year.

Surgery for spinal stenosis is used only after other treatment options have failed to provide relief. The goal of surgery is to create more space for the spinal cord.

During the procedure, a surgeon removes the bone that’s putting pressure on the spinal nerves. In some cases, no further intervention is needed. If removing the bone decreases the spine’s strength or stability, then the spine may need to be reinforced by linking two of the vertebrae together with metal implants and a bone graft.

Talk to your doctor about the treatment that’s best for your situation, and ask about choices that are less invasive than surgery, such as weight loss and exercise. Together, the two of you can create a treatment plan to fit your needs and help you feel better.

— Dr. Paul Huddleston, orthopedic surgery, Mayo Clinic, Rochester, Minn.

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