Nonsurgical treatment options for lumbar spinal stenosis (2024)

June 10, 2022

Nonsurgical treatment options for lumbar spinal stenosis (1)

Lumbar spinal stenosis

Nonsurgical treatment options for lumbar spinal stenosis (2)

Lumbar spinal stenosis

Lumbar spinal stenosis is a narrowing of the spinal canal that often occurs as a result of disk degeneration or herniation, subluxation of the vertebrae, overgrowth of the facets, or thickening of the ligaments.

Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal that often occurs as a result of disk degeneration or herniation, subluxation of the vertebrae, overgrowth of the facets, or thickening of the ligaments. Additional, less common causes of narrowing include tumor, infection, fracture and epidural lipomatosis.


LSS seen on imaging can be asymptomatic. However, it can lead to chronic pain, disability and decreased quality of life. Women age 70 and older are the population most affected by LSS. In people over age 65, LSS is one of the most common reasons for surgery.

Symptomatic LSS typically starts gradually. As the spinal canal narrows, it can compress the nerve roots, causing pseudoclaudication. This compression can result in pain, heaviness, weakness, or paresthesia in the buttocks, legs and feet during walking or prolonged standing.

Pain caused by pseudoclaudication is typically relieved by sitting or by bending forward at the waist to reduce pressure on the affected nerves. In individuals with advanced stenosis, sitting or lying down may no longer provide symptom relief.

Medical management

Management options for LSS include watchful waiting, physical therapy, equipment and modalities, medications, injections, and surgical referral. According to Kimberly (Kim) L. Seidel-Miller, M.D., a physiatrist at Mayo Clinic's Spine Center in Rochester, Minnesota, there are several issues to consider that can help guide the medical management of LSS.

"It's important to assess the patient's severity of symptoms and level of disability," explains Dr. Seidel-Miller. "This assessment should include documenting the patient's pain level and identifying the degree to which LSS may affect various aspects of their life, including mobility, mood, and ability to participate in activities of daily living, work, hobbies or interest." Symptom longevity and progression as well as response to any past interventions, including physical therapy, medications or injections, can also help determine next steps.

  • Watchful waiting

    According to Dr. Seidel-Miller, watchful waiting may be appropriate for several types of patients with LSS. "This would include individuals with asymptomatic stenosis, individuals with mild or primarily axial symptoms, or individuals who prefer to wait before trying interventions."

  • Physical therapy, equipment and modalities

    Weight loss and physical therapy are common first line treatments recommended for reducing lumbar lordosis. "Physical therapy can introduce patients to a mix of exercises and movements that help correct posture, address radicular symptoms, stretch the low back and lower limbs, and strengthen the supporting core and trunk musculature," says Dr. Seidel-Miller. "Lumbosacral corsets and gait aids can also be used to reduce lumbar lordosis and improve mobility. Other modalities, such as transcutaneous electrical nerve stimulation, ultrasound, heat or cold therapy, and traction, can also be effective."

  • Medications

    The list of medications commonly used to treat LSS symptoms includes topical agents such as lidocaine, menthol, camphor and capsaicin, over-the-counter analgesics and anti-inflammatories, and neuropathic agents such as gabapentin and pregabalin. These medications are typically more beneficial for those with radicular symptoms as opposed to pseudoclaudication.

  • Injections

  • Intralaminar epidural injections can be used to treat symptoms related to neurogenic claudication. Patients with radicular symptoms often experience better symptom relief with transforaminal epidural injections. Effectiveness and longevity of benefit from these injections can vary depending on the cause and severity of the LSS.

    In an article published in Pain Practice in 2020, Dr. Jang and co-investigators followed 54 patients who were treated with transforaminal epidural steroid injections for lumbar radicular pain from spinal stenosis. At a 5-to-7-year follow-up, only about 15% of the patients reported complete resolution of the initial pain, while about 50% of the patients had significant pain and required additional injections every 2 to 6 months or oral medications.

  • Surgical referral

    Surgical referral should be considered when patients have persistent or progressive weakness or numbness, or changes in bowel or bladder function, or when significant symptoms persist despite the above medical management interventions.

Future treatment options

Dr. Seidel-Miller is hopeful that future research will yield improved data on patient outcomes associated with radicular versus claudicatory symptoms, to better guide clinicians in selecting appropriate treatment approaches. "Research focused on personalized medicine and regenerative medicine approaches could offer more-effective treatment options for LSS," notes Dr. Seidel-Miller. "Results of research exploring the use of stem cell therapies for degenerative disk disease and the search for genetic markers for spinal degeneration could facilitate early diagnosis and help identify patients who might benefit from these new therapeutic approaches."

For more information

Jang SH, et al. At least 5-year follow-up after transforaminal epidural steroid injection due to lumbar radicular pain caused by spinal stenosis. Pain Practice. 2020;20:748.

Refer a patient to Mayo Clinic.

Nonsurgical treatment options for lumbar spinal stenosis (2024)


What is the best non-surgical treatment for spinal stenosis? ›

Non-Surgical Treatment for Spinal Stenosis
  • Self-Care. Sometimes making small adjustments in a daily routine can reduce your symptoms. ...
  • Take a warm bath or use a heating pad. ...
  • Change your sleeping position. ...
  • Create a more supportive work station. ...
  • Physical Therapy. ...
  • Medication. ...
  • Steroid Injections. ...
  • Chiropractic Treatment.

What is the newest treatment for lumbar spinal stenosis? ›

A new surgical technique, known as lumbar interspinous distraction decompression (IDD), is gaining attention for its approach to easing nerve compression by placing a spacer between the vertebrae.

How can I improve my spinal stenosis naturally? ›

Examples of integrative therapies for cervical spinal stenosis include heat, massage, meditation, and acupuncture. Transcutaneous electrical nerve stimulation (TENS), which uses a low-voltage electrical current to stimulate the production of endorphins— the body's natural pain relievers— may also be an option.

What is the most successful treatment for spinal stenosis? ›

Laminectomy is a surgery that doctors perform to treat spinal stenosis by removing the bony spurs and the bone walls of the vertebrae. This helps to open up the spinal column and remove the pressure on the nerves.

What is the best treatment for spinal stenosis in the elderly? ›

The first-line treatment for spinal stenosis in people aged 75+ includes physical therapy, anti-inflammatory medications, and epidural steroid injections. Non-surgical treatments are almost always recommended first for spinal stenosis.

What is the least invasive surgery for spinal stenosis? ›

Our spine surgeons have developed expertise in some of the most advanced minimally invasive surgery for spinal stenosis: Endoscopic Decompression: The least invasive option available, this advanced technique requires only the tiniest of incisions (7 mm, or less than a quarter of an inch).

How do you stop spinal stenosis from progressing? ›

Although spinal stenosis may be associated with aging you can still prevent it from progressing. Chiropractic and physiotherapy care are two of the most effective ways to manage this condition.

What is the first line of treatment for lumbar stenosis? ›

First-line pharmacotherapy for lumbar spinal stenosis (LSS) includes nonsteroidal anti-inflammatory drugs (NSAIDs), which provide analgesia at low doses and quell inflammation at high doses. An appropriate therapeutic NSAID plasma level is required to achieve anti-inflammatory benefit.

What not to do with spinal stenosis? ›

Here are some things to avoid with spinal stenosis.
  • High-impact Sports. Road running and other high-impact activities can shock your spinal cord leading to inflammation and pain. ...
  • Hyperextension Stretches. ...
  • Carrying Heavy Loads. ...
  • Sudden Movements. ...
  • Remaining Still. ...
  • Pushing Through The Pain.
Jul 28, 2022

What is the single best exercise for spinal stenosis? ›

#1 Walking For Spinal Stenosis

Walking is good, for spinal stenosis. Once your posture is changed enough the distance that you can walk will increase. If you can walk without pain with your new posture you are ready for the next step.

What foods make spinal stenosis worse? ›

On the other hand, certain foods, such as those high in refined sugars, trans fats, and highly processed ingredients, can contribute to inflammation and worsen spinal stenosis pain.

How can I get immediate relief from spinal stenosis? ›

Nonsteroidal anti-inflammatory drugs—commonly called NSAIDs—relieve pain by reducing inflammation of nerve roots and spine joints, thereby creating more space in the spinal canal. Types of NSAIDs include ibuprofen, aspirin, and naproxen.

Can you fix spinal stenosis without surgery? ›

Although spinal stenosis patients often don't require surgery, prompt treatment is essential to recovering from this condition. Patients generally need a combination of conservative therapies, such as physical therapy, anti-inflammatory medications, lifestyle changes, and steroid shots, to recover.

What is the new procedure for spinal stenosis? ›

Weill Cornell Medicine Pain Management offers a new technology to treat spinal stenosis and minimize the painful symptoms. Vertiflex superion is a device that is implanted into the area of the spine causing pain and relieves pressure on the affected nerves.

At what point does spinal stenosis require surgery? ›

Usually, our spine specialists consider surgery only if symptoms such as weakness, numbness, or pain in the arms or legs indicate severe or progressive nerve or spinal cord compression.

What happens if you have spinal stenosis and don t have surgery? ›

Not only does spinal stenosis have a number of unpleasant symptoms, but they will also likely worsen over time without treatment and can lead to more serious issues, like nerve damage and paralysis.


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