What Is the Newest Treatment for Spinal Stenosis?

Conventionally, cases of spinal stenosis that can’t be resolved with non-surgical therapies have been treated with laminectomy and spinal fusion. Laminectomy creates more space in the spinal canal, while spinal fusion stabilizes the spine. 

Regrettably, spinal fusion is a major surgery that comes with many significant risks and downsides. Along with a sizable percentage of patients who require reoperation, fusion diminishes patients’ spinal flexibility, which can limit their mobility. 

Considering these risks and drawbacks, many medical professionals have been seeking out fusion alternatives that can effectively treat spinal stenosis patients. Here, we’ll discuss the newest treatment for spinal stenosis and how it may benefit the spinal stenosis recovery process.  

Spinal Stenosis Therapies

Spinal stenosis therapies include physical therapy, medications, epidural steroid injections, massage therapy, acupuncture, and chiropractic care. 

Physical Therapy

Physical therapy for spinal stenosis utilizes targeted movements, strengthening exercises, and stretches to alleviate pressure on the affected spinal nerves. These methods improve the spine’s range of motion and strengthen specific muscle groups to minimize impact on the spine. Physical therapy is often used as the primary treatment in people with mild to moderate spinal stenosis. 

Many physical therapists offer additional tools to support spinal health, including manual therapy, specialized equipment, and education. This education may include tips to adjust your lifestyle to reduce pressure on the spinal nerves and facilitate healing. 

Physical therapy has good success rates for spinal stenosis pain, especially when combined with other conservative therapies. In a trial that integrated physical therapy with superficial and deep heat therapy and inpatient rehabilitation with an intensive exercise program, 70% of patients showed positive outcomes.  

Medications

Various over-the-counter and prescription medications are used to treat spinal stenosis, including NSAIDs, analgesics, muscle relaxants, anticonvulsants, and antidepressants. NSAIDs, analgesics, and muscle relaxants are the most widely prescribed medications for spinal stenosis. 

Medications can provide short-term relief from spinal stenosis pain, inflammation, and muscle spasms. While they can help with symptom management while you recover from your symptoms, they’re not a long-term solution. Ask your doctor about the possible side effects and complications before starting spinal stenosis medications.

Epidural Steroid Injections

Epidural steroid injections involve injecting steroid medication into the area surrounding the spinal cord, known as the epidural space. Steroid medication curbs inflammation, which may relieve spinal nerve compression pain. Research shows that steroid shots can also improve overall function in spinal stenosis patients. 

Steroid injection success rates in spinal stenosis patients range from 20% to 100%, largely depending on the extent of spinal degeneration. A review published in Interventional Pain Medicine found that success rates ranged from 40% to 58% at three months, 25% to 67% at six months, and 58% to 61% at one year post-injection. 

Receiving too many steroid injections in a short period can contribute to tissue atrophy. Your doctor can help you understand if steroid injections are right for you and how to prevent complications. 

Alternative Therapies for Spinal Stenosis

Alternative therapies are a category of medicine involving non-conventional treatments that support the body’s healing capabilities. They may be used alongside conventional therapies, like medication, or on their own to encourage symptom relief. While alternative medicine is known to have less scientific research behind it, methods like massage, acupuncture, and chiropractic care are backed by promising evidence. 

Massage Therapy

Massage therapy is commonly considered an alternative treatment for spinal stenosis. This means that it may be used instead of traditional or conventional therapies, like medications. However, your doctor may incorporate massage therapy into your treatment plan to enhance the benefits of medication and physical therapy. 

A trained masseuse can manipulate the body’s soft tissues to reduce muscle tension, improve range of motion, and promote relaxation. These benefits may enhance your spinal stenosis recovery. Research shows that massage may help with chronic lower back pain caused by certain spinal conditions, including spinal stenosis. 

Acupuncture

Acupuncture is a treatment rooted in ancient Chinese medicine that involves inserting tiny needles into specific points on the body. This is thought to reduce muscle tension and open up the body’s healing pathways. While research concerning the effectiveness of acupuncture for spinal stenosis varies, some studies show that it can help reduce lower back pain. 

Chiropractic Care

Chiropractic care centers around joint and soft tissue manipulation to support musculoskeletal and nervous system health. Chiropractors use a range of methods to improve spinal alignment, boost mobility, and increase circulation throughout the body. They also often provide lifestyle recommendations to support the body’s natural healing process. 

Adjustments from your chiropractor may help reduce nerve compression from spinal stenosis. Studies show that it can help reduce spinal stenosis pain, although further research is required to confirm its benefits. 

Spinal Stenosis Treatment

Spinal stenosis treatment may include non-surgical therapies and, in severe cases, surgery. 

Non-surgical spinal stenosis, as mentioned above, may include:

  • Physical therapy
  • Massage therapy
  • Acupuncture
  • Chiropractic care
  • Epidural steroid injections
  • Medications

Additionally, as part of your spinal stenosis treatment plan, your physician may recommend lifestyle adjustments, including:

  • Implementing a low-impact exercise routine to keep you active, mobile, and strong
  • Reaching and maintaining a healthy weight for your height, as extra pounds place more stress on your spine
  • Quitting smoking, as nicotine hinders your body’s natural healing process
  • Improving your posture, especially if you sit at a desk for much of the workday, to keep your spine in proper alignment
  • Taking breaks from prolonged periods of sitting, and investing in an office chair with lumbar support
  • Adjusting your sleep position to prevent straining your spine (sleeping on your side or back is ideal)
  • Managing your stress levels with methods like meditation, journaling, and breathing exercises, as stress can worsen back pain

Surgery for Spinal Stenosis

Surgical spinal stenosis treatment conventionally involves laminectomy with fusion. Together, these procedures create more space in the spinal canal and restabilize the affected spinal segment. 

Laminectomy is a spinal decompression procedure that involves removing some or all of the lamina. The lamina is a piece of bone that covers and protects the back of the spinal cord. If you have spinal bone spurs that are contributing to your spinal stenosis, your surgeon will likely also remove them during laminectomy. 

Spinal fusion is commonly used to stabilize the spine after tissues are removed in decompression surgery. It permanently fuses two or more vertebrae together, eliminating all motion at the fused segment. 

Unfortunately, while spinal fusion prevents instability after surgery, it comes with various risks and drawbacks. Most significantly, it can notably compromise your spinal mobility and involves a lengthy recovery period. After fusion, it can take six weeks to return to light physical activity, and six months to a year to make a complete recovery (often with permanent activity restrictions). 

Next, we’ll discuss available fusion alternatives for individuals with spinal stenosis. 

What Is the Newest Treatment for Severe Lumbar Spinal Stenosis?

The newest lumbar spinal stenosis treatment has been referred to with many different names, including non-fusion implant and dynamic stabilization system, among others. These names all refer to devices that are used in place of spinal fusion to provide stability and symptom relief. Premia Spine TOPS System is the best one.

Non-fusion implants establish a controlled range of motion in the affected vertebrae. They replace the tissue removed during decompression surgery, ensuring that the spine remains stable after the procedure. 

In addition to spinal stenosis, many dynamic stabilization systems can effectively treat spondylolisthesis and degenerative disc disease. But, as the newest treatment option for spinal stenosis, dynamic stabilization systems aren’t yet widely used throughout the U.S.

One example, the TOPS System from Premia Spine, received the breakthrough designation from the FDA, which allowed the start of an IDE investigation in 330 to 476 patients in the U.S. In June 2023, it received FDA approval for single-level spondylolisthesis between L3 and L5 with lumbar spinal stenosis. The system also earned a superiority-to-fusion claim for these spinal conditions, as it preserves motion in the lumbar spine.

The TOPS System’s success rate in a clinical study of 115 people was 76.7% after 24 months. In contrast, lumbar fusion success rates drop to 30% after a second spine surgery, 15% after a third surgery, and 5% after a fourth surgery. 

TOPS may also improve outcomes for older spinal stenosis patients. One study revealed an 18% complication rate for lumbar spinal surgery in patients 75 years and older. As a minimally invasive lumbar fusion alternative, TOPS lowers the risk of surgical complications and adjacent segment disease. 

Why Consider The Newest Spinal Stenosis Treatment?

Patients suffering from spinal stenosis symptoms have many factors to consider when choosing a treatment route. Although spinal fusion has been used since the early 1900s, it presents many notable downsides. Dynamic stabilization systems have a shorter history, but they were developed with the drawbacks of fusion in mind. Therefore, this route of treatment can help you avoid complications including:

  • Adjacent segment disease
  • Failed bone fusion (pseudoarthrosis)
  • Lost spinal mobility
  • Back muscle atrophy

Shorter recovery timelines are another key reason to consider innovative spinal stenosis treatments. The TOPS System can dramatically accelerate recovery compared to spinal fusion, with most patients experiencing immediate pain relief after the procedure. In most cases, they can also stand up and walk around the day after the procedure. 

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Post-Treatment Lifestyle Changes for Spinal Stenosis

Thoughtfully adjusting your lifestyle habits after spinal stenosis surgery can accelerate healing, prevent complications, and improve the procedure’s outcome. Key changes include:

  • Posture: Whether you’re sitting, standing, or working out, pay extra attention to your posture. Ideally, keep your head aligned with your shoulders and your shoulders over your hips, with a gentle curve in the lower spine. This encourages even weight distribution across your body, minimizing impact on the area affected by stenosis.
    • Bonus tip: Whenever you’re lifting a weighty object, bend at your knees and hips, engage your core, and keep your spine straight. 
  • Exercise: Long periods of bed rest aren’t ideal after spinal stenosis surgery—they often lead to stiffness and muscle weakness. Instead, stay mobile with gentle, low-impact workouts like walking, swimming, and aerobics. This promotes mobility, strength, and blood flow to your healing spine. 
  • Diet: Your post-surgery diet should be high in lean protein, fiber, and complex carbohydrates. Protein gives your body the support it needs to rebuild damaged tissue; fiber prevents constipation after surgery; and complex carbohydrates provide sustained energy to fuel your body. 
  • Support: Recovering from spinal stenosis surgery is stressful for the body and mind. Gathering a circle of support from loved ones can help you recover as effectively as possible. From driving you home from the hospital to helping with housework, your friends and family can bolster your healing process. 

Long-Term Spinal Stenosis Management

Spinal stenosis is a chronic condition with no known cure, so it often requires a long-term management plan. These plans aim to:

  • Stop the condition’s progression and deter further tissue degeneration
  • Prevent pain flare-ups
  • Preserve mobility
  • Maintain (or improve) quality of life

Your doctor may implement a combination of treatments to achieve these goals, including physical therapy, medication, alternative therapies, and (for severe cases) surgery. Healthy lifestyle adjustments like low-impact exercise, a healthy diet, quitting smoking, and improving posture are also crucial to long-term stenosis management. They create a well-rounded defense against spinal degeneration and inflammation, helping to calm your symptoms over time. 

Can Spinal Stenosis Get Better Without Surgery?

Non-surgical treatment options are often effective for spinal stenosis. Many patients with mild to moderate cases of spinal stenosis can improve their symptoms without going under the knife. This claim is supported by recent medical research. 

A 2022 paper published in the Journal of the American Medical Association evaluated patients with lumbar spinal stenosis and their condition after three years without operative intervention. About one-third of the patients’ conditions improved, about half of patients experienced no change in their symptoms, and 10% to 20% of patients’ symptoms worsened. 

With these results in mind, patients with moderate to severe cases of spinal stenosis often require surgery for lasting symptom improvement. 

How to Prevent Spinal Stenosis

The best way to avoid surgery for spinal stenosis is to prevent spinal conditions before they develop. Consider these spinal stenosis prevention strategies:

  • Exercise regularly to maintain your range of motion and muscle strength while limiting activities that can lead to spinal overuse, like contact sports, heavy weightlifting, and gymnastics. 
  • Improve your posture to distribute impact evenly across the spine. Take frequent breaks from sitting and consider using a standing desk to avoid being sedentary throughout the workday. 
  • Quit smoking and reduce your alcohol intake, as both may accelerate spinal degeneration. 
  • Adopt a proactive approach to your health by addressing pain that doesn’t resolve within a week or two with your doctor. Attend your annual physicals and stick to any prescribed treatment plans. 

Spinal Stenosis Severity Gradation and Corresponding Treatment Options for Every Grade

Physicians evaluate the severity of spinal stenosis using a grading system. There are three different grading systems that they may choose between: the Lee system, the Schizas system, and the Miskin system. 

The Lee and Schizas systems are the most popular spinal stenosis grading systems. The Miskin system was more recently developed but has proven to reduce inconsistencies between neuroradiologists and musculoskeletal radiologists. 

Patients diagnosed with mild to moderate spinal stenosis based on one of the systems listed below can consider non-surgical treatment options. However, patients with moderate to severe and extreme stenosis will likely need to consider surgery to attain significant relief. 

The Lee Grading System

The Lee grading system is based on the amount of separation of the cauda equina using axial T2-weighted images. 

  • Grade 0 or No Stenosis: No obliteration of the anterior CSF (cerebrospinal fluid) space
  • Grade 1 or Mild Stenosis: Mild obliteration of the anterior CSF space, but the cauda equina are distinctly separated
  • Grade 2 or Moderate Stenosis: Moderate obliteration of the anterior CSF space, and some cauda equina can’t be visibly separated
  • Grade 3 or Severe Stenosis: Severe obliteration of the anterior CSF space, and no cauda equina can be visibly separated 

The Schizas Grading System

The Schizas grading system features seven grades based on the shape, size, and structure of the dural sac, as well as the proportion of rootlets to cerebrospinal fluid. Physicians use axial T2-weighted images to determine a grade using the Schizas system. 

  • Grade A (No Stenosis or Minor Stenosis): Evident CSF in the dural sac, but the CSF distribution is uneven
    • Grade A1: The rootlets are positioned dorsally and take up less than half of the dural sac region.
    • Grade A2: The rootlets are positioned dorsally in a horseshoe shape and are touching the dura.
    • Grade A3: The rootlets are positioned dorsally and take up over half of the dural sac region. 
    • Grade A4: The rootlets are positioned in the center of the dural sac region and take up over half of this area. 
  • Grade B (Moderate Stenosis): The rootlets take up the entire dural sac region but can be differentiated. The sac has a gritty appearance with some CSF. 
  • Grade C (Severe Stenosis): No rootlets can be identified and no CSF is apparent. The sac has an even, gray appearance with posterior epidural fat. 
  • Grade D (Extreme Stenosis): No rootlets can be identified and the posterior epidural fat has been destroyed.   

The Miskin Grading System

The Miskin grading system is an adapted version of the Schizas grading system. It was altered based on information from radiologists and non-radiologist spinal specialists. 

  • Normal Spine: The nerve roots are openly spread out, not crowded, and the thecal sac’s anterior margin is flat or convex
  • Mild Spinal Stenosis: The nerve roots are mildly crowded and the thecal sac’s anterior margin is flat or a little concave. The nerve roots can be differentiated from the CSF. 
  • Moderate Spinal Stenosis: The nerve roots are crowded, giving the CSF a grainy appearance. The thecal sac’s anterior margin is concave. 
  • Severe Spinal Stenosis: The nerve roots can’t be differentiated from the CSF. The thecal sac’s anterior margin is concave or indistinguishable.

Spinal stenosis patients should speak with an experienced spine specialist to find the right treatment option for their needs.