Surgical vs. Non-Surgical Approaches to Treatment of Lumbar Spinal Stenosis

Lumbar spinal stenosis is a painful, often debilitating condition affecting the lower back. It involves the narrowing of the lumbar spine, potentially causing nerve impingement and persistent back pain. Individuals diagnosed with lumbar spinal stenosis may be faced with two distinct treatment routes: surgical and non-surgical. 

In this article, we’ll explore the surgical and non-surgical approaches to lumbar spinal stenosis, including what you can expect from each. 

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Can Lumbar Stenosis Be Treated Without Surgery?

Lumbar stenosis can be treated without surgery in some cases. 

Surgery is the only way to cure spinal stenosis by creating more space in the spinal canal. However, in mild cases of spinal stenosis, non-surgical treatments can help alleviate pain, stiffness, and other symptoms. While these therapies won’t open the spinal canal, they can reduce inflammation, promote optimal spinal alignment, and strengthen the muscles that support the spine. 

What Are the Non-Surgical Treatments for Spinal Stenosis?

The non-surgical treatments for spinal stenosis include physical therapy, chiropractic care, pain medications, epidural steroid injections, and lifestyle changes. 

Physical Therapy

In physical therapy for spinal stenosis, your PT will first evaluate your spinal mobility, muscle strength, posture, balance, and gait. Then, they may implement a variety of exercises and techniques to resolve your symptoms through:

  • Reducing muscle tension around the spine
  • Boosting the spine’s range of motion
  • Resolving nerve compression
  • Alleviating pain and stiffness
  • Improving the alignment of the spine
  • Strengthening the core and back muscles

Chiropractic Care

Chiropractic care centers around manual, non-invasive therapies to support the body’s natural repair process. It focuses primarily on the spine and how optimal spinal alignment can promote greater overall health. 

Through manual spinal adjustments, non-surgical decompression therapy, flexion-distraction therapy, and/or traction therapy, your chiropractor will work to:

  • Reduce inflammation
  • Restore proper spinal alignment
  • Alleviate pressure on the spinal nerves or discs
  • Minimize impact on the spinal structures with day-to-day movements

Pain Medications for Spinal Stenosis

Pain medications can help patients manage the discomfort of spinal stenosis. Sometimes, over-the-counter medications are sufficient for pain and inflammation, such as ibuprofen and aspirin. In other cases, physicians may prescribe stronger medications to help their spinal stenosis patients get through the day. 

Due to the risk of side effects and complications from medications, they’re not used as a long-term solution for spinal stenosis. Additionally, instead of working to resolve the root cause of spinal stenosis, they temporarily cover up its symptoms.  

Epidural Steroid Injections

Epidural steroid injections deliver corticosteroid medication to the area around an impinged nerve, where it leaves the spine in the epidural space. The epidural space is found between the spinal cord and the vertebral canal. 

Corticosteroid medication is a powerful anti-inflammatory. When it’s injected directly around the impinged nerve, it alleviates pain and swelling. Unfortunately, this relief isn’t permanent and usually only lasts for around three months.

Additionally, as the steroid medication works by reducing the immune response, it can lead to soft tissue atrophy if it’s used too frequently. So, physicians limit patients to three to four steroid injections per year. 

Lifestyle Changes

Lifestyle changes can effectively reduce spinal stenosis symptoms. The goal of the following adjustments is to naturally reduce inflammation, lessen the impact on the spine, and improve and preserve mobility:

  • Reach and maintain a healthy weight
  • Adopt an anti-inflammatory diet, such as the Mediterranean diet, which is rich in vegetables, fruits, whole grains, fish, and olive oil
  • Engage in low-impact exercise regularly
  • Quit smoking and limit alcohol intake
  • Use heat and cold therapy on the spine
  • Improve your posture
  • Avoid sitting for prolonged periods
  • Invest in a supportive desk chair if you have a sedentary occupation 

What Is Non-Surgical Treatment for Spinal Stenosis of L4-L5?

Non-surgical treatment for spinal stenosis of L4-L5 may include:

  • Physical therapy
  • Chiropractic care
  • Pain medications
  • Epidural steroid injections
  • Lifestyle changes

L4 and L5 are the lowest vertebrae of the lumbar spine. The L4-L5 spinal segment facilitates spinal motion in multiple directions. It also offers stability for the entire spinal column and bears the majority of your body weight with daily motions. 

Considering its flexibility and weight-bearing function, the L4-L5 segment is particularly vulnerable to injury and degeneration. It’s also the most common segment for spinal stenosis. The possible symptoms of L4-L5 spinal stenosis include:

  • Pain in the lower back
  • Sciatica (burning pain that moves from the lower back through the buttocks and into the legs)
  • Numbness, tingling, weakness, and/or cramping in the legs
  • “Foot drop”, which is a weakness in the foot causing it to slap on the ground while walking

What Is the Best Treatment for Spinal Stenosis in the Elderly?

The best treatment for spinal stenosis in the elderly is physical therapy, lifestyle adjustments, anti-inflammatory medications, and other conservative therapies. 

Conservative treatments are the preferable option for elderly patients because this demographic is at an increased risk of surgical complications. The aging process leads to an increased risk of underlying health problems, like high blood pressure, heart disease, lung disease, and clogged arteries, among others. These issues can lead to complications and adverse effects from surgery and anesthesia. 

Surgical treatment for spinal stenosis in the elderly should only be considered if all conservative therapies have been unsuccessful. Additionally, surgery should only be pursued if the patient is in good enough overall health to safely undergo the procedure. 

Which Surgical Procedure Is Effectively Used to Treat Lumbar Spinal Stenosis?

Lumbar spinal decompression is the surgical procedure effectively used to treat lumbar spinal stenosis. 

Spinal decompression surgery is used to treat spinal nerve compression. It’s the primary surgical treatment for spinal stenosis, as it can create more space in the spinal canal, allowing the affected nerve tissue to heal. There are a few different types of lumbar decompression, including:

  • Laminectomy is a procedure that involves removing a portion of the lamina. The lamina is a piece of bone that covers and protects the back of the spinal cord. In removing some or all of it, your spinal surgeon can create more space in the spinal canal. 
  • Discectomy involves removing part of a damaged intravertebral disc. This can alleviate pressure on the impinged nerve. 

Conventionally, decompression surgery is followed by spinal fusion. This procedure involves permanently fusing the affected spinal segments to prevent instability. Unfortunately, it also reduces motion in the lumbar spine and can trigger degeneration at the neighboring spinal segments (known as adjacent segment disease, or ASD). 

To prevent the downsides and complications of fusion for spinal stenosis, patients can consider non-fusion implants, like the TOPS System. The TOPS System is a mechanical implant device designed to treat lumbar spinal stenosis and degenerative spondylolisthesis of the L2 to L5 spinal segments. 

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TOPS restores a controlled range of motion in the lumbar spine after decompression without compromising its range of motion. With the device, you can bend, flex, twist, and participate in all types of activities without pain and neurological symptoms. Additionally, by preserving the motion of the affected vertebrae, the TOPS System prevents adjacent segment degeneration after spinal stenosis surgery. 

Reach out to a spine specialist in your area to learn more about the surgical and non-surgical treatment options for spinal stenosis.