A doctor may use a variety of approaches to diagnose spinal stenosis and rule out other conditions.
- Medical history. You tell your doctor details about symptoms and about any injury, condition, or general health problem that might be causing the symptoms.
- Physical examination. The doctor (1) examines you to determine the extent of limitation of movement, (2) checks for pain or symptoms when you hyper-extend the spine (bend backwards), and (3) checks for normal neurologic function (for instance, sensation, muscle strength, and reflexes) in the arms and legs.
- X ray. An x-ray beam is passed through the back to produce a two-dimensional picture. An x ray may be done before other tests to look for signs of an injury, tumor, or inherited problem. This test can show the structure of the vertebrae and the outlines of joints, and can detect calcification.
- MRI (magnetic resonance imaging). Energy from a powerful magnet (rather than x rays) produces signals that are detected by a scanner and analyzed by computer. This produces a series of cross-sectional images ("slices") and/or a three-dimensional view of parts of the back. An MRI is particularly sensitive for detecting damage or disease of soft tissues, such as the disks between vertebrae or ligaments. It shows the spinal cord, nerve roots, and surrounding spaces, as well as enlargement, degeneration, or tumors.
- Computerized axial tomography (CAT). X rays are passed through the back at different angles, detected by a scanner, and analyzed by a computer. This produces a series of cross-sectional images and/or three-dimensional views of the parts of the back. The scan shows the shape and size of the spinal canal, its contents, and structures surrounding it.
- Myelogram. A liquid dye that x rays cannot penetrate is injected into the spinal column. The dye circulates around the spinal cord and spinal nerves, which appear as white objects against bone on an x-ray film. A myelogram can show pressure on the spinal cord or nerves from herniated disks, bone spurs, or tumors.
- Bone scan. An injected radioactive material attaches itself to bone, especially in areas where bone is actively breaking down or being formed. The test can detect fractures, tumors, infections, and arthritis, but may not tell one disorder from another. Therefore, a bone scan is usually performed along with other tests.
Treatment of spinal stenosis may consist of nonsurgical treatments, alternative therapies, and surgery.
Nonsurgical Treatments
In the absence of severe or progressive nerve involvement, a doctor may prescribe one or more of the following conservative treatments:
- Nonsteroidal anti–inflammatory drugs (NSAIDs), such as aspirin, naproxen, ibuprofen, or indomethacin, to reduce inflammation and relieve pain. The longer a person uses NSAIDs, the more likely he or she is to have side effects, ranging from mild to serious. Side effects of NSAIDs include stomach problems; skin rashes; high blood pressure; fluid retention; and liver, kidney, and heart problems. Many other drugs cannot be taken when a patient is being treated with NSAIDs, because NSAIDs alter the way the body uses or eliminates these other drugs. Check with your health care provider or pharmacist before you take NSAIDs. NSAIDs should only be used at the lowest dose possible for the shortest time needed.
- Analgesics, such as acetaminophen, to relieve pain.
- Corticosteroid injections into the outermost of the membranes covering the spinal cord and nerve roots to reduce inflammation and treat acute pain that radiates to the hips or down a leg.
- Anesthetic injections, known as nerve blocks, near the affected nerve to temporarily relieve pain.
- Restricted activity (varies depending on extent of nerve involvement).
- Prescribed exercises and/or physical therapy to maintain motion of the spine, strengthen abdominal and back muscles, and build endurance, all of which help stabilize the spine. You may be encouraged to try slowly progressive aerobic activity such as swimming or using exercise bicycles.
- A lumbar brace or corset to provide some support and help you regain mobility. This approach is sometimes used for people with weak abdominal muscles or older patients with degeneration at several levels of the spine.
Alternative Therapies
Alternative (or complementary) therapies are diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Some examples of these therapies that can treat spinal stenosis include:
- Chiropractic treatment. This treatment is based on the philosophy that restricted movement in the spine reduces proper function and may cause pain. Chiropractors may manipulate (adjust) the spine to restore normal spinal movement. They may also employ traction, a pulling force, to help increase space between the vertebrae and reduce pressure on affected nerves. Some people report that they benefit from chiropractic care. Research thus far has shown that chiropractic treatment is about as effective as conventional, nonsurgical treatments for acute back pain.
- Acupuncture. This treatment involves stimulating certain places on the skin by a variety of techniques, in most cases by manipulating thin, solid, metallic needles that penetrate the skin. Research has shown that low back pain is one area in which acupuncture has benefited some people.
More research is needed before the effectiveness of these or other possible alternative therapies can be definitively stated. Health care providers may suggest these therapies in addition to more conventional treatments.
Surgery
In many cases, the conditions causing spinal stenosis cannot be permanently altered by nonsurgical treatment, even though these measures may relieve pain for a period of time. To find out how much nonsurgical treatment will help, a doctor may recommend such treatment first. However, surgery might be considered right away if you have numbness or weakness that interferes with walking, impaired bowel or bladder function, or other neurological involvement.
The decision to have surgery depends on:
- The effectiveness of nonsurgical treatments
- The extent of your pain
- Other diseases that you may have
- Your physical condition
- Your preferences.
The purpose of surgery is to:
- Relieve pressure on the spinal cord or nerves
- Restore and maintain alignment and strength of the spine.
This can be done by removing, trimming, or adjusting diseased parts that are causing the pressure or loss of alignment.
The most common surgery is called decompressive laminectomy: removal of the lamina (roof) of one or more vertebrae to create more space for the nerves. A surgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disk. He or she may use various devices to enhance fusion and strengthen unstable segments of the spine.
If you have spinal stenosis caused by spinal trauma or achondroplasia, you may need surgery at a young age. When a person with achondroplasia needs surgery, laminectomy (removal of the roof) without fusion is usually effective.
Major Risks of Surgery
All surgery, particularly that involving general anesthesia and older patients, carries risks. The most common complications of surgery for spinal stenosis are:
- A tear in the membrane covering the spinal cord at the site of the operation
- Infection
- A blood clot that forms in the veins.
These conditions can be treated but may prolong recovery.
Long-Term Outcomes of Surgical Treatment
Removal of the obstruction that has caused the symptoms usually gives a person some relief; most people have less leg pain and are able to walk better after surgery. However, if nerves were badly damaged before surgery, there may be some remaining pain or numbness or no improvement. Also, the degenerative process will likely continue, and pain or limitation of activity may reappear after surgery.
NIAMS-supported researchers have published results from the Spine Patient Outcomes Research Trial (SPORT), the largest trial to date comparing surgical and non-surgical interventions for the treatment of low back and associated leg pain caused by spinal stenosis. The study found that for people with spinal stenosis, surgical treatment was more effective than non-surgical treatment in relieving symptoms and improving function. However, the functional status of people who received non-surgical therapies also improved somewhat during the study.
Doctors who can provide nonsurgical treatment of spinal stenosis may be:
- Internists.
- General practitioners.
- Rheumatologists, who treat arthritis and related disorders.
- Neurologists, who treat nerve diseases.
- Orthopaedic surgeons.
- Neurosurgeons.
Orthopaedic surgeons and neurosurgeons also perform spinal surgery if you need it. Allied health professionals such as physical therapists may also help treat patients.