Treatment of Lumbar Spinal Stenosis

It’s common for office and remote workers to suffer from back pain, and some of them even consider it an inevitable part of their lives. Most people think those problems are just bad posture issues and try to solve them with home methods, like using ergonomic chairs or applying ice. But what if the problem is more serious than having bad posture?

If this is the case, you’d be letting your back problems get worse each day while increasing your risk of lasting conditions. One such condition is lumbar spinal stenosis, which narrows the space within your spinal canal, inhibiting the adjacent nerves from working as they should.  

It’s crucial to take care of this issue as soon as you notice it, so we’re here to provide you with all the information you need to know about this condition’s symptoms and available treatments. Your priority must be your safety, so make sure to learn as much as you can about lumbar spinal stenosis and how to resolve it. 

Causes of Lumbar Spinal Stenosis 

Possible causes of lumbar spinal stenosis include thickened ligaments, spinal injuries, bone overgrowth, herniated discs, spinal tumors, and genetic spinal abnormalities. 

As we mentioned before, when you talk about lumbar spinal stenosis, you’re talking about the compression or narrowing of the space within your spinal canal. Since many factors can cause this condition, your physician will likely aim to understand its root cause and recommend a corresponding treatment plan. 

To understand the problem and how to treat it, you need to understand what triggers it, so here is a list of the most common causes of lumbar spinal stenosis:

Spinal Injuries

It’s typically straightforward to identify lumbar spinal stenosis if it originates from spinal injuries, since these problems don’t stem from indirect issues or congenital conditions. Direct accidents, such as car crashes, falls, or any heavy hit to the spine, can dislocate your bones, fracture them, or cause extreme inflammation. This can damage your spinal canal and potentially place a lot of pressure on your spinal nerves. 

Thickened Ligaments

Your ligaments are an essential part of your body since they hold your bones together, including, of course, your spinal cord. However, issues like arthritis and normal age-related tissue changes can cause your ligaments to thicken and, consequently, bulge into the space within your spinal canal. This issue not only contributes to lumbar spinal stenosis, but also mobility concerns if it’s not treated promptly. 

Bone Overgrowth 

If you have a case of bone spurs and bone overgrowth within the spinal canal, you’re prone to lumbar spinal stenosis. This issue relates to osteoarthritis, also known as “wear and tear” arthritis, which breaks down the protective covering of your joints (called cartilage), making your bones rub against each other. This friction can lead to bone spurs that may narrow the spinal canal.

Herniated Disc

Whether due to age-related spinal degeneration, ongoing wear and tear, or a sudden trauma to the spine, the discs between each vertebra of the spine can become herniated. Also known as a slipped or ruptured disc, this occurs when a tear develops in the tougher disc shell, causing the softer interior to press outward into the spinal canal. The damaged disc may take up excess space in the spinal canal, contributing to spinal stenosis. 

While it doesn’t always lead to spinal stenosis, herniated disc is a common condition, impacting approximately one to five percent of the population every year. Older adults, overweight individuals, smokers, and people in jobs that involve repetitive bending, twisting, or lifting are at a heightened risk. 

Tumors 

Tumors, whether cancerous or benign, can form within the space in your spinal cord. The abnormal growth can limit the space for your nerves and spinal cord, causing spinal stenosis. You should make a doctor’s appointment as soon as you feel any unusual sensation or pain in the back, since certain tests are required to detect spinal tumors and determine the best course of treatment. 

Genetic Abnormalities

Though it’s less common than degenerative spinal stenosis, congenital spinal stenosis is a possibility. This means that some people are naturally born with an abnormality that causes a narrow spinal canal. Since it’s present at birth, symptoms can appear in childhood, adolescence, or early adulthood.

20.1% of congenital spinal stenosis cases occur in the lumbar spine, compared to 16.6% in the cervical spine and 11.5% in the thoracic spine, according to a study published in World Neurosurgery.  

What Are the Symptoms of Lumbar Spinal Stenosis? 

The best way to prevent major, potentially detrimental health issues is to detect their symptoms on time and treat them properly. However, it’s not always so simple to recognize which illness or condition the symptoms correspond to, since many diseases share the same symptoms. Oftentimes, your symptoms may point to more than one issue. 

Lumbar spinal stenosis is a progressive condition that benefits from early intervention. To help you evaluate your symptoms and seek further care, here’s a list of the primary lumbar spinal stenosis symptoms:

  • Lower back pain
  • Neck pain
  • Numbness in your legs
  • Pain in your legs after standing for long periods
  • Foot weakness
  • Bladder or bowel incontinence
  • Pain in your buttocks and legs (also known as sciatica)
  • Leg cramping
  • Burning sensation in your lower back

There are two more types of spinal stenosis: Cervical and thoracic spinal stenosis. Both of them have different symptoms depending on the location of the spinal narrowing. Since all three diseases are directly related, here are the symptoms of thoracic and cervical spinal stenosis:

Thoracic Spinal Stenosis

  • Tingling, weakness, numbing, or pain in your stomach 
  • Balance problems

Cervical Spinal Stenosis

  • Tingling, numbness, or weakness in your legs, arms, or hands
  • Neck pain
  • Bladder or bowel dysfunction
  • Balance problems

Diagnosis: How Is It Detected?

Lumbar spinal stenosis is usually diagnosed and detected through a combination of a physical examination, medical history, discussion of symptoms, and imaging tests. You’ll need to visit a physician (ideally a spine specialist, known as an orthopedic surgeon) for a formal, accurate diagnosis. 

  • During a physical exam to diagnose spinal stenosis, your doctor may check your range of motion, movements that trigger your symptoms, reflexes, muscle strength, sensation, balance, and gait (the way you walk). This can help your doctor gauge the presence and extent of spinal nerve irritation. 
  • A medical history can help your doctor hone in on the root cause of your symptoms, such as age-related degeneration or an underlying medical condition. 
  • Discussing your symptoms helps your doctor determine whether they align with typical spinal stenosis symptoms and, if so, understand the condition’s severity. To provide an accurate symptom overview, it’s a good idea to record:
    • When your symptoms begin
    • How often your symptoms occur
    • What your symptoms feel like (burning, stinging, radiating, etc.)
    • If your symptoms occur or get worse after specific activities
  • Imaging tests like X-rays, MRIs, and CT scans allow your doctor to see your spine and directly identify spinal canal narrowing. Imaging tests that show soft tissue (like MRIs) may also reveal nerve damage, helping your doctor determine the best next steps in your spinal stenosis treatment process. 

What Is the Best Treatment for Spinal Stenosis?

When suffering from this condition, you might ask yourself: What’s the best treatment for spinal stenosis? Or what’s the latest treatment to solve it? While your safety is paramount, and personalized guidance from an orthopedic specialist is essential to your recovery process, this overview of spinal stenosis treatment options can give you an idea of what to expect along your path to back pain relief. 

The most effective solution for advanced or severe spinal stenosis is spinal surgery since it can physically open up the spinal canal and resolve issues contributing to the condition, like bone spurs and herniated discs. But most cases don’t require surgery and can be resolved with non-surgical treatment options.

Non-Surgical Treatment Options

Non-surgical treatment options for spinal stenosis include medications, physical therapy, heat/cold therapy, steroid injections, and lifestyle modifications.

  • Medications can help calm your symptoms while other treatments, like physical therapy, help resolve nerve compression for spinal stenosis. Over-the-counter medications (like ibuprofen and acetaminophen) are a good place to start, but in more advanced cases, you may need prescription-strength painkillers to make a meaningful difference. Additionally, certain types of medications that can help with spinal stenosis symptoms, like muscle relaxants and anticonvulsants, are only available with a prescription from your doctor.
    • Keep in mind: While medications can temporarily diminish your symptoms, they’re not generally intended to be taken long-term for spinal stenosis. 
  • Physical therapy can help you stay active with spinal stenosis and correct physical imbalances contributing to the condition. This is crucial for recovery, as spinal stenosis patients tend to be less active, losing strength and mobility along the way. Physical therapists are trained specialists who can help improve your flexibility, endurance, and balance while encouraging spinal healing. Many PTs also offer complementary treatments, like acupuncture, dry needling, and transcutaneous electrical nerve stimulation, to further reduce your pain.  
  • Heat/cold therapy: This is one of the most common methods for people who want to try self-help remedies for spinal stenosis. Applying heat to the areas where you feel the most pain relaxes your muscles while improving blood flow to the damaged tissue. Cold therapy, on the other hand, helps relieve inflammation, tenderness, and swelling. Your doctor or physical therapist can suggest a heat and ice schedule to best suit your needs. 
  • Steroid injections: While not recommended for frequent use, as they can lead to tissue atrophy and other complications, steroid injections help reduce inflammation and pain around the spinal nerves. The treatment consists of injecting corticosteroids in the area containing the nerve roots to bring down swelling and discomfort. But this effect is temporary and can’t eliminate spinal stenosis by itself. 
  • Lifestyle changes should be included in all spinal stenosis recovery plans, as they encourage overall wellness and naturally promote healing. Examples include:
    • Quitting smoking
    • Reducing alcohol consumption
    • Eating an anti-inflammatory diet 
    • Following a low-impact exercise routine
    • Improving posture
    • Limiting prolonged periods of sitting
    • Reaching and maintaining a healthy weight

When Surgery Is Recommended

While conservative methods are often sufficient for symptom relief, surgery is often recommended for spinal stenosis when:

  • Your symptoms aren’t responding to non-surgical treatments. Your doctor will likely advise you to stick with conservative methods for six months to a year, as they can take time to work. But if your symptoms haven’t significantly improved after this time frame, or if they’ve gotten worse, it may be time to consider surgery. 
  • You’re dealing with severe neurological symptoms, like lasting numbness in the extremities or difficulty walking and balancing. These symptoms indicate serious nerve compression that may require surgery to avoid lasting damage.
    • Certain neurological symptoms (like loss of bowel or bladder control and severe weakness or numbness in the lower extremities) can point to a serious condition called cauda equina syndrome, which is considered a medical emergency. It requires prompt treatment (usually surgical spinal decompression) to prevent permanent nerve damage. 

Patients often ask for surgery when they can’t stand the pain anymore, and the disease is becoming a setback to their daily activities. This method is delicate and must be done very carefully, but it’s an effective option to free yourself from spinal stenosis. 

Understanding Decompression Surgery

Most surgical procedures used to treat spinal stenosis fall under the category of decompression surgery. This refers to any procedure that alleviates pressure on the spinal cord or spinal nerve roots. This may involve extracting bone spurs, damaged spinal disc tissue, enlarged ligaments, or part of the lamina (the bony ridge covering the back of the spinal canal). 

The umbrella of decompression surgery includes traditional (open) surgeries, as well as minimally invasive procedures. In the modern age, minimally invasive decompression is heavily favored because it allows for smaller incisions, less tissue damage, shorter recovery times, and a lower risk of complications. Minimally invasive spinal decompression has also been found to help reduce reliance on opioid medications.

Types of spinal decompression procedures include:

  • Minimally invasive lumbar decompression, also known as MILD, is used to treat stenosis resulting from thickened spinal ligaments. It’s an outpatient procedure that doesn’t require general anesthesia or a hospital stay, with a generally low risk of complications. Through a small incision in the back, the surgeon removes small portions of the thickened ligaments to release pressure on the nearby nerves. 
  • Cervical laminoplasty: This procedure is for patients suffering from cervical spinal stenosis, and it aims to remove the pressure on the portion of the spinal cord located in the neck. To accomplish this, surgeons make an incision in the back of your neck and open up space in the spinal canal by creating a hinge on the lamina.
  • Laminotomy: Laminotomy is performed in other parts of your spinal cord, differing from cervical laminoplasty. This surgery is simple in theory, involving a small incision through which the surgeon removes just enough of the lamina to relieve pressure from the spinal cord.
  • Laminectomy is similar to laminotomy in that it involves the lamina, but it typically requires a larger incision, and the surgeon removes a larger portion of the lamina (if not the entire lamina). It’s typically implemented in more severe cases.
  • Discectomy involves removing some or all of a damaged spinal disc that’s pressing on nearby nerves. It may be implemented in cases of spinal stenosis caused by a herniated disc. 
  • Foraminotomy is a type of spinal decompression that involves widening the foramen – the bony openings through which nerves leave the spinal canal. Your surgeon may suggest this procedure in cases of foraminal stenosis, a type of spinal stenosis that occurs when the foramen narrow due to bone spurs, disc damage, thickened ligaments, or spinal injuries. 

The TOPS™ System: A Motion-Preserving Alternative

Decompression surgery is conventionally paired with spinal fusion to prevent instability. While it’s a time-tested approach, fusion comes with numerous downsides, including permanent mobility restrictions, a lengthy recovery period, and the risks of failed fusion and adjacent segment degeneration. The TOPS™ System is a motion-preserving alternative for lumbar spinal stenosis and degenerative spondylolisthesis. 

TOPS™ is a spinal implant device that replaces the tissues removed during spinal decompression surgery. Designed for use at the L3 to L5 spinal levels, it establishes a controlled range of motion in the spine, allowing it to move in all directions without the risk of instability. As a result, patients can return to an active lifestyle after surgery without the pain of spinal stenosis dragging them down. 

By facilitating spinal motion within a controlled range, TOPS™ also prevents excessive impact on the adjacent spinal levels – a significant concern with spinal fusion. This mitigates the risk of adjacent segment disease, helping to keep the rest of the spine healthy in the months, years, and decades after surgery. 

The TOPS™ System is FDA-approved for degenerative spondylolisthesis with moderate to severe lumbar spinal stenosis. It also earned a superior to fusion claim from the FDA, cementing it as a minimally invasive, motion-preserving alternative to conventional fusion procedures. 

TOPS™ vs. Spinal Fusion: Key Differences

Key differences between TOPS™ and spinal fusion include motion preservation, potential risks, and recovery times.

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Motion preservation is the primary difference between the TOPS™ System and spinal fusion. Spinal fusion uses bone graft material to stimulate new bone growth between two or more vertebrae. Within about a year, this causes the vertebrae to permanently fuse together. 

While this method effectively prevents instability, it also wipes out all mobility in the fused segment. The result? Mobility limitations (especially for multi-level fusions), excessive impact on the adjacent segments (which can lead to adjacent segment disease), and the risk of failed fusion. 

The TOPS™ System allows the treated segment to move in all directions: flexion, extension, lateral bending and axial rotation, or twisting. This allows patients to bounce back faster with fewer activity restrictions. It also prevents excessive stress on the adjacent segments. 

While the TOPS™ System doesn’t come without risks, it mitigates many of the risks involved in spinal fusion, including failed fusion and adjacent segment disease. Research also shows that it has a significantly lower reoperation rate than fusion: One study found that TOPS™ has a reoperation rate of 5.9% after two years, compared to 8.8% with transforaminal lumbar interbody fusion. 

Recovery and Outcomes with TOPS™

Since the TOPS™ System is implanted in a minimally invasive procedure and secures spinal mobility, it involves a significantly shorter recovery period than spinal fusion. Many patients are able to stand up and walk around the day after the procedure (or even the same day, in some cases). While the spinal fusion recovery process can span an entire year, many TOPS™ System patients make a full recovery within three to six months. 

After the TOPS™ procedure, patients can typically:

  • Return to light housework as soon as they feel able, often within a few weeks
  • Return to sedentary work within a few weeks, or more physically demanding work in six weeks to three months
  • Return to all regular activities within three to six months

Research shows high success rates and positive outcomes with the TOPS™ System. The TOPS™ U.S. Clinical Study showed that 77% of TOPS™ patients exhibited overall clinical success, compared to just 24% of their fusion counterparts. In a study evaluating long-term TOPS™ System outcomes published in World Neurosurgery, there were no failures at the five-year mark, and no patients required revision surgery. 

Conclusion

Your spinal cord is an essential part of your body that requires special care since, if damaged, it can cause concerning conditions. If you feel or notice any of the symptoms you read about in this article, schedule an appointment with your doctor as soon as possible to ensure the problem doesn’t progress, and that you can treat it on time. 

Frequently Asked Questions (FAQ)

Should you walk with spinal stenosis?

Yes, you should walk with spinal stenosis because it’s a gentle, low-impact way to stay active. Staying active is crucial to preserving muscle strength and mobility while you heal. However, if walking triggers your spinal stenosis symptoms, you should talk to your doctor and PT about how to exercise without experiencing pain. 

Does pain from spinal stenosis ever go away?

While spinal stenosis generally doesn’t go away on its own, spinal stenosis pain can go away with proper treatment. It’s best to see a doctor as soon as you start experiencing spinal stenosis symptoms to begin treatment, as this can help speed up your recovery and prevent severe pain. If conservative methods aren’t sufficient to resolve your pain, you may need surgery to correct the issue.  

What position is best for spinal stenosis?

The best position for spinal stenosis is typically forward bending (also called forward bending) because it opens up the spinal canal, providing a temporary respite from your pain. You can achieve this position with various stretches, including a child’s pose or knee-to-chest stretch.

The best sleeping position for spinal stenosis is on your back with a pillow under your knees, or on your side with a pillow between your knees. These positions keep your spine aligned and prevent stress on the lower back while you sleep. 

What not to do with lumbar spinal stenosis?

With lumbar spinal stenosis, it’s best to avoid:

  • Repetitive bending, twisting, and leaning
  • High-impact exercises, including heavy weightlifting, running, and contact sports
  • Prolonged periods of sitting or standing
  • Extreme stretching involving deep spinal twists or arches

What is the newest treatment for spinal stenosis?

The newest treatments for spinal stenosis include non-fusion spinal implants, like the TOPS™ System, and regenerative therapy, like stem cell therapy. These methods help resolve back pain and neurological symptoms from spinal stenosis without open back surgery or motion-limiting methods.