From the Guidelines
Treatments for spinal canal stenosis include surgical procedures such as decompression, spinal fusion, and laminectomy, as well as non-surgical treatments like physical therapy, exercise, and epidural steroid injections.
Treatment Options
- Surgical procedures: Decompression, spinal fusion, laminectomy, and interspinous process device implantation are common surgical options for spinal canal stenosis, with no significant differences in outcomes such as pain intensity, physical function, or disability status 1.
- Non-surgical treatments: Physical therapy, exercise, heat and cold therapies, transcutaneous electrical nerve stimulation, ultrasonography, analgesics, non-steroidal anti-inflammatory drugs, and cognitive-behavioral treatments are non-surgical options, with similar effects to surgical interventions in some cases 1.
- Epidural steroid injections: May be considered for patients with radiculopathy or spinal stenosis, especially if they are potential candidates for surgery 1.
Diagnostic Imaging
- MRI: The preferred imaging modality for evaluating patients with persistent back and leg pain, especially if they are potential candidates for surgery or epidural steroid injection 1.
- CT: May be useful in assessing the patency of the spinal canal/thecal sac and of the subarticular recesses and neural foramen, especially in patients with significant artifact from metallic surgical hardware on MRI 1.
Considerations
- Patient expectations: Should be considered when choosing interventions, as they seem to influence outcomes 1.
- Cost and availability: Of skilled providers for specific therapies should be taken into account when selecting treatments 1.
- Red flags: Patients with red flags, such as signs of spinal cord compression, should be evaluated and treated promptly 1.
From the Research
Treatment Options for Spinal Canal Stenosis
The treatment options for spinal canal stenosis can be divided into conservative and surgical approaches.
- Conservative treatment is often the initial approach, as rapid deterioration is unlikely and the majority of patients may either improve or remain stable over a long-term follow-up with nonoperative treatment 2.
- Surgical treatment is considered for patients who fail to improve after conservative treatment, and the choice of surgery depends on the degree of stenosis, spinal or anatomic level, architecture of the stenosis, severity of the symptoms, and patient comorbidities 2, 3, 4.
Surgical Treatment
Surgical treatment for spinal canal stenosis typically involves decompression, which can be performed through various approaches, including:
- Decompression via a posterior approach, which can be performed using microscopic decompression or other minimally invasive techniques 3, 5.
- Limited decompression with laminotomy, which may be indicated for lateral canal stenosis 2.
- Fusion, which is often recommended when spinal stenosis is associated with instability, degenerative spondylolisthesis, deformity, postoperative instability, or recurrent stenosis 2.
Minimally Invasive Treatment Options
Minimally invasive treatment options, such as percutaneous image-guided lumbar decompression and spacer use, have also been shown to be effective in treating lumbar spinal stenosis 4.
- These procedures should be used in a judicious and algorithmic fashion, based on the evidence of efficacy and safety in the peer-reviewed literature 4.
Diagnostic Evaluation
Diagnostic evaluation plays a crucial role in determining the optimal treatment approach for spinal canal stenosis.
- Radiological confirmation of spinal canal stenosis is essential, and can be achieved through computerized tomography, myelography, or magnetic resonance imaging 6.
- A thorough evaluation of neurological symptoms is also necessary to determine the severity of the condition and the most appropriate treatment approach 2, 3.