Spinal Stenosis

In most cases, stenosis will resolve on its own with minimally invasive therapies. Surgery is typically reserved for only the most intractable cases. Some of these less invasive procedures include:

• Lifestyle Changes such as exercise and weight loss
• Physical Therapy may include specific stretches to reduce pain and aid in recovery, and better motions may be taught to prevent exacerbation of existing problems. In addition, strengthening core muscles helps to compensate for spinal insufficiency.
• Medication – Several pharmacological treatments exist for the treatment of spinal stenosis, including the use of NSAIDs such as aspirin or ibuprofen, steroids for long term relief, and stronger narcotics for pain that does not respond to existing pain management. In the case of steroids, an injection is typically made at the level of the stenotic structure, limiting inflammation for months at a time and facilitating recovery.

In cases where conservative treatments are inadequate, a number of procedures exist for the alleviation of symptoms. Even so, surgery is not without its risks, and there is always the chance that the condition may prove worse following surgery. Some such procedures routinely performed include:

• Laminotomy – In this procedure, the back of the vertebra, the lamina, is removed to reduce pressure on local structures.
• Laminectomy – Similar to a laminotomy, but involving only the removal of a portion of the lamina.
• Laminoplasty – Performed in cervical cases of spinal stenosis, some tissue is removed, and a metal hinge is installed to compensate for the removed portion of vertebra.
• Percutaneous image-guided lumbar decompression – PILD is reserved for patients with spinal stenosis resulting from a thickened ligament at the back of the spine. A small incision is made, and the thickened portion may be removed to restore adequate space for the spinal cord and its nerves.
• Minimally invasive surgery – This approach minimizes the need for spinal fusion, and limits damage to surrounding tissues allowing for faster recovery and a reduced risk of complications.
• Fusion surgeries – Due to the removal of bone and tissues supporting vertebral stability, it is sometimes necessary to fuse vertebra to ensure structural integrity of the vertebral column. Some degree of motion is naturally lost, but typically the relief of pain makes this procedure worthwhile.