Lumbar Stenosis (cont.)
What is the treatment for lumbar spinal stenosis?
In most cases the treatment for lumbar spinal stenosis begins with conservative
(non-operative) treatment. This can include medications to reduce inflammation,
even short courses of oral cortisone medication, and
pain medications. There are
also several medications directed specifically at nerve pain that are helpful in
lumbar spinal stenosis, including gabapentin (Neurontin) and
pregabalin (Lyrica).
Physical therapy can help in some cases.
Cortisone (steroid) injections in the
lumbar spine can also reduce the symptoms by decreasing inflammation and
swelling around the nerve tissue. These can be repeated up to three times per
year.
Surgery
Surgery may be indicated for patients that do not improve with the above
treatments, or if there is severe or progressive weakness or loss of bowel or
bladder function (cauda equina syndrome). Depending on the examination findings
and imaging studies there are various operations available for lumbar spinal
stenosis.
The main goal of surgery is to remove the structures that are compressing the
nerves in the spinal canal or vertebral foramen. This is a lumbar decompression
surgery (laminectomy, laminotomy, foraminotomy). In some cases this can be
performed alone, but in other cases it must be combined with lumbar fusion. If
too much of the compressive structures need to be removed to free the nerve, the
vertebrae may become unstable (spinal instability). This leaves the vertebrae
with abnormal motion. If this occurs, a spinal fusion can be performed to make
the vertebrae attached together and eliminate the motion at that level.
Surgery for lumbar spinal stenosis can be very successful in most cases for the leg
symptoms. However, depending on the severity of the nerve compression and the
length of time the nerve have been compressed, there may be some permanent
damage that is not relieved with surgery. The success for back pain relief is
less reliable with surgery than the relief of leg symptoms.
Next: What can be done to prevent lumbar spinal stenosis? »
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