From the Guidelines
Treatment for spinal canal stenosis should begin with conservative approaches, including physical therapy and over-the-counter pain medications, before considering surgery, as the most recent and highest quality study shows similar effects for operative and non-operative interventions 1. The goal of treatment is to alleviate pain, improve mobility, and enhance quality of life. Conservative treatment options include:
- Physical therapy to improve flexibility and strengthen supporting muscles
- Over-the-counter pain medications such as NSAIDs (ibuprofen 400-800mg three times daily or naproxen 500mg twice daily) to reduce inflammation and pain
- Prescription medications like gabapentin (starting at 300mg daily and gradually increasing) or muscle relaxants like cyclobenzaprine (5-10mg three times daily) for more severe pain
- Epidural steroid injections containing corticosteroids like methylprednisolone or triamcinolone can provide temporary relief for 3-6 months Surgical options, such as laminectomy or spinal fusion, may be necessary if symptoms persist or worsen despite conservative treatment for 6-12 months, particularly when there's significant neurological impairment or cauda equina syndrome 1. Key considerations in treatment decisions include:
- Clinical correlation between symptoms and radiographic findings
- Severity of symptoms
- Patient preferences
- Surgical risks, including comorbid conditions
- Costs, which will generally require specialist input 1. It is essential to inform patients about the generally favorable prognosis of acute low back pain and the importance of remaining active, as well as providing information about effective self-care options 1.
From the Research
Treatment Options for Spinal Canal Stenosis
- Non-surgical interventions, such as multimodal care nonpharmacological therapies, education, advice, and lifestyle changes, may be initially selected for patients with lumbar spinal stenosis (LSS) causing neurogenic claudication 2
- Physical therapy and epidural steroid injections have been shown to be effective in improving pain and functional parameters in patients with LSS, with no significant difference noted between the two treatment groups 3
- Conservative management, including physical therapy, may be appropriate for many patients with LSS, minimizing invasive intervention and decreasing the risks of morbidity 4
Pharmacological Treatments
- Serotonin-norepinephrine reuptake inhibitors or tricyclic antidepressants may be considered for patients with LSS causing neurogenic claudication, although the evidence is very low-quality 2
- Limaprost, a pharmacological treatment, has been shown to have better efficacy in improving the Japanese Orthopaedic Association Score and decreasing the Oswestry Dysfunction Index, with a beneficial effect on decreasing the visual analog scale and improving the EuroQol Five Dimensions Questionnaire 5
Minimally Invasive Procedures
- Minimally invasive spine treatments, such as percutaneous image-guided lumbar decompression, may be used in a judicious and algorithmic fashion to treat LSS, based on the evidence of efficacy and safety in the peer-reviewed literature 6
- The use of spacers in LSS treatment has been supported by one randomized controlled trial, comparing two spacer products currently available 6