From the Guidelines
Treatment for moderate canal stenosis should initially focus on conservative management, including non-surgical interventions such as physical therapy, non-steroidal anti-inflammatory drugs, and activity modification, as these approaches have shown similar effects to surgical treatments in terms of pain intensity, physical function, and quality of life 1.
Conservative Management
Conservative management is the first line of treatment for moderate canal stenosis. This approach includes:
- Non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation
- Physical therapy to improve core strength, flexibility, and proper body mechanics
- Activity modification to avoid positions that exacerbate symptoms
Surgical Options
Surgical options, such as laminectomy, may be considered if conservative treatments fail after 6-12 months or if neurological symptoms worsen. However, the current evidence suggests that surgical procedures, including decompression, spinal fusion, and interspinous process device implantation, have similar outcomes in terms of pain intensity, physical function, and quality of life, with the exception of higher reoperation rates associated with interspinous process device implantation 1.
Treatment Goals
The primary goals of treatment for moderate canal stenosis are to reduce inflammation, strengthen supporting muscles, and relieve pressure on neural structures, thereby improving pain intensity, physical function, and quality of life. Regular follow-up with healthcare providers is crucial to monitor symptom progression and treatment effectiveness, and to determine the best course of treatment for each individual patient 1.
From the Research
Treatment Options for Moderate Canal Stenosis
- Conservative management is often the first line of treatment, which may include physiotherapy, occupational therapy, treatment of myofascial disorders, and oral medication/local injections 2
- Decompression surgery is considered for patients who fail to improve with conservative treatment, with the goal of relieving pressure on the spinal cord and nerves 3
- For central spinal stenosis, decompression is the surgical treatment of choice, while limited decompression with laminotomy may be indicated for lateral canal stenosis 3
- Intervertebral level of interlaminar epidural steroid injection (ILESI) can affect the efficacy of the treatment, with injections at the level of maximum stenosis leading to better pain relief and functional improvement 4
- Lumbar decompression surgery without fusion has been shown to improve quality of life in patients with degenerative lumbar spinal stenosis, including those over 80 years old 5
Surgical Treatment
- Spinal instability is a key factor in the pathogenesis of lumbar canal stenosis, and fixation of the involved spinal segments may be necessary to alleviate symptoms 6
- Decompression surgery should aim to preserve the facet joint and the pars interarticularis to avoid iatrogenic instability 3
- Fusion may be recommended for patients with instability, degenerative spondylolisthesis, deformity, postoperative instability, or recurrent stenosis 3
Non-Surgical Treatment
- Physiotherapy aims to stabilize the lumbar spine in a flexed posture and increase overall physical fitness 2
- Oral analgetic and/or anti-inflammatory medical management can be based on the three-step scheme of the World Health Organization 2
- Local injections, such as interlaminar epidural steroid injections, can help control symptoms 4