This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Go to /pro/cpd-dashboard page

This page is worth 0.05 CPD credits. CPD dashboard

Go to /account/subscription-details page

This page is worth 0.05 CPD credits. Upgrade to Pro

Management of lumbar spinal stenosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Management of lumbar spinal stenosis can be divided into:

  • non surgical options
    • usually recommended before surgical options
      • due to the lack of consensus, a specific type of non-surgical treatment cannot be recommended for LSS

    • main categories include:
      • drugs
        • several drugs are used for the treatment of LSS, their efficacy remains unclear
        • e.g. -,
          • NSAIDs
          • prostaglandins E1, gabapentin, and vitamin B1 - has been shown to improve pain and walking distance
          • corticosteroids
          • antidepressant

      • physiotherapy
        • is an accepted treatment for LSS
        • e.g. -
          • exercise (aerobic, strength, flexibility)
          • specific exercises in lumbar flexion (cycling)
          • body weight supported treadmill walking
          • muscle coordination training
          • balance training
          • lumbar semi-rigid orthosis
          • braces and corsets
          • spinal manipulation

      • injections
        • evidence shows that epidural steroid injections helps in providing  limited short term and long term improvement in pain and walking distance in patients with LSS
        • another systemic review concluded that epidural injections with local anesthetic alone, or local anesthetic with steroids provide some relief of low back pain and lower extremity pain for central LSS

      • others
        • although there is lack of evidence, alternative treatment methods have been used by patients with LSS
        • e.g. - flexion distraction manipulation, acupuncture

  • surgical options
    • carried out when bothersome symptoms persists despite treatment with less invasive methods
    • helpful in relieving the leg symptoms (claudication or radiculopathy) associated with LSS than improving any accompanying back pain.
    • decompression
      • main aim is to decompress the neural structures to relieve symptoms and improve function
      • options include traditional laminectomy, bilateral laminotomies, bilateral decompression through unilateral laminotomy, and different forms of laminoplasty
      • postoperative active rehabilitation after decompression surgery helps in improving both short term and long term (back related) functional status
    • interspinous spacer devices
      • a device inserted between the spinous processes to separate the spinous processes at the stenotic levels
      • may provide some benefit with fewer major medical complications than decompression surgery, but is associated with higher rates of re-operation (1)

Notes:

  • when comparing surgical or nonoperative treatment for lumbar spinal stenosis:
    • relative benefit of initial surgical treatment diminished over time, but outcomes of surgery remained favorable at 2 years in comparison to nonoperative treatment (2)
  • a systematic review concluded (3):
    • surgery for radiculopathy with herniated lumbar disc and symptomatic spinal stenosis is associated with short-term benefits compared to nonsurgical therapy, though benefits diminish with long-term follow-up in some trials

Reference:


Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.