Conservative Treatment of Lumbar Spinal Stenosis

Conservative treatment of lumbar spinal stenosis is not only possible but can be very effective. Don’t take my word for it though, lets look at the published evidence for guidance. Before we get into the meat of this post give me a minute to describe what lumbar spinal stenosis is.Stenosis

Lumbar spinal stenosis (LSS) is a condition of the lower back (lumbar spine) in which the space that the spinal cord and nerves passes through becomes smaller.  This compression comes from two sources; from the spinal disc bulging into the space from the front and from arthritic bone growing into the space from the back. This compression can contribute or cause back pain, pain radiating down one or both legs, tinging/numbness in the legs and feet, or even loss of strength and coordination in the legs and feet. There are two main types of lumbar spinal stenosis (LSS); they are central canal stenosis and foraminal stenosis. Central canal stenosis is due to the disc pressing centrally pressing into the spinal cord forcing it directly posterior into arthritic bone at the back of the canal. In cases of central canal stenosis it is common to have symptoms in both legs and feet. Foraminal stenosis occurs in the opening (foramina) where the nerve root exists the spine. Pressure onto the never here comes from the disc bulging to the side and pressing the nerve root into arthritic bone at the back of the foramina. In cases of foraminal stenosis symptoms are typically in one leg or foot only. Both types of stenosis can be treated effectively with conservative care.

Despite bone and the disc shortening these openings it is not always the bone and disc that is to blame for your symptoms. In many cases the disc and bone have caused the openings to be smaller but by themselves, they do not cut the space off enough to cause symptoms. In many cases it is inflammation that places the added pressure on the nerve that causes the leg and foot symptoms. This inflammation comes from tissue surrounding the spine and is there because of some sort of injury, great or small, you had. This is why conservative can work by eliminating the cause of the inflammation. The disc bulge and arthritis is still present but with the inflammation gone the symptoms improve. In my opinion only the most severe cases, and cases that fail conservative care, should be considered for surgery.

This brings me back to my point, conservative care can be very effective for treating lumbar spinal stenosis. Since the stenosis is caused by a disc bulge and arthritic bone it is easy to think that surgery to remove one or both of these would be best but the research say otherwise. Or I should say the recent research says they don’t know. A recent study published in the July 2016 edition of the journal Spine looked at surgical versus nonsurgical care for lumbar spinal stenosis. The authors looked at 12,966 papers and could not conclude whether surgical or nonsurgical treatment was better for lumbar spinal stenosis. They did find, though, that there was a high rate of side effects after surgery (10-24%) and that nonsurgical care had no side effects. This paper could not find that either care was superior but they did note fewer side effects after conservative care. While not a glowing recommendation for conservative care it does help to support the idea that conservative care is better than surgical especially when combined with other studies such as this one where the authors admit that patients should expect to experience mild to moderate pain and disability 60 months after surgery. Even if you have surgery your pain and loss of function might never be completely gone. I have several patients who are in that boat right, years after surgery they continue to suffer from back pain.Posture 1

For us, conservative treatment of lumbar spinal stenosis should include care that improves the stability of the lumbar spine. This is not just core stability, which is important and a part of conservative care, but restoring the normal upright posture of the spine. From the front our spine should be straight and from the side there should be measurable normal curves. Any deviation from normal places an increased loading on the joints of the spine and a larger strain on muscles to work to hold us upright. By restoring your spine towards normal we can create better long term results than standard care. I can point you to this previous post for a few studies comparing standard care to our care. We also work with pain management specialists to assist in the most complex cases and even surgeons, because some cases are bad enough that surgery is the best option.

Conservative treatment of lumbar spinal stenosis can be effective for many patients and likely your best option for long term relief.

Read a previous post on conservative treatment of lumbar spinal stenosis here and a post on steroid injections for lumbar spinal stenosis by clicking here.

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Posted in Back Pain

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