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November 25, 2009
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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.



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