Spinal Stenosis Treatments: Current and Emerging Therapies (2024)

Spinal stenosis is the term used to describe a narrowing spine. There are spaces within the spine, and if they become narrower than they should be, it can cause pressure on nerve roots and the spinal cord. Anywhere along the spine can be affected.

This narrowing can lead to symptoms such as pain, burning, or aching in the back and weakness in the legs and feet. Several treatment options are available, each tailored to the individual depending on the symptoms' severity.

This article discusses the treatment options for spinal stenosis.

What Are the Common Spinal Stenosis Treatment Options?

Like many other conditions, spinal stenosis has several primary treatment options. These are often the first choice among people with the disease. They include:

Medications

Chronic pain is one of the main symptoms of spinal stenosis. Because of that, the first-line treatment often involves using analgesics or pain-relieving medications. One of the most commonly prescribed medications is nonsteroidal anti-inflammatories (NSAIDs). These medications reduce pain and inflammation in the body.

That said, NSAIDs are not suitable for long-term use. Other medications may need to be used to reduce pain. Alternatives include:

• Tylenol (acetaminophen)
• Gabapentin
• Pregabalin
• Opioids (in the most severe cases only)

Exercise

Lifestyle changes, including more exercise in your daily routine, can reduce spinal stenosis symptoms by taking pressure off the nerves. In turn, pain and mobility can be improved.

Healthcare providers will suggest the best possible exercises, but some include:

• Sustained lumbar extension
• Lumbar flexion in lying
• Seated lumbar flexion
• Standing lumbar flexion
• Hip and core strengthening
• Aerobic exercises, such as walking

Physical Therapy

Physical therapy is another primary treatment for those with spinal stenosis. It is often used alongside pain medications. Typically, people must undergo six to eight weeks of physical therapy, with sessions two to three times per week.

Utilizing physical therapy for spinal stenosis has been shown to:

• Reduce pain
• Increase mobility
• Reduce how many pain medications a person will need
• Reduce mental health symptoms, such as anger, depression, and mood changes

Back Braces

Back braces are wearable belt-like devices that help to reduce movement and pressure on the spine. This is helpful because small movements in the spine can lead to the irritation of nerves and more pain, and worsening symptoms.

Over time, back braces can lead to a positive increase in mobility for people with spinal stenosis.

Injections for Swelling and Pain

In some cases, epidural steroid injections may be needed to relieve symptoms of spinal stenosis. Steroids act as anti-inflammatories within the body to help reduce pain and swelling caused by inflammation and irritation to the spinal nerves.

They are considered nonsurgical medical procedures. According to research, injections are an effective way to combat pain for two weeks up to six months. Some research has found that relief after a spinal injection can last 24 months.

Decompression Procedure for Thickened Ligaments

Some people may undergo a decompression procedure for spinal stenosis. It involves the use of a thin needle-like tool. The needle is inserted into the body, and thickened ligament tissue is removed to reduce the pressure on the spine and nerves. Research has found that this procedure may reduce symptoms and the need for more invasive surgery.

Alternative Treatments for Spinal Stenosis

In addition to traditional first-line treatments, people may also explore alternative therapies for spinal stenosis, including:

• Acupuncture: This involves the insertion of thin-tipped needles into various pressure points on the body to relieve symptoms.
• Chiropractic care: This therapy is used to reduce pressure on nerves that cause pain while helping to improve mobility.
• Massage: This may be useful in reducing pain and stiffness.

Some research has found that acupuncture, specifically, may be more effective at reducing symptoms of spinal stenosis than physical therapy. That said, both options are viable and can improve mobility and pain.

New Spinal Stenosis Treatment Options

As research continues on spinal stenosis, new therapies continue to emerge to help combat symptoms in people that either don’t respond to traditional medicine or cannot partake in current therapies for individual reasons.

However, while some of the evidence presented by these treatments is promising, medical insurers may consider them experimental and not offer coverage until their safety has been proven compared to more established treatments. Some new treatments include:

Acupotomy

Acupotomy is a form of acupuncture that uses thin needles with a small, flat, scalpel-like blade at the end. The procedure is designed to relieve tension in certain areas. In spinal stenosis, the tension in the spine can lead to symptoms, so using acupotomy to ease that tension can help relieve symptoms.

Research is still limited on the effect of acupotomy on spinal stenosis, but preliminary data shows that it could be an effective complementary treatment.

Stem Cell Therapy

Stem cell therapy uses stem cells to help repair injured or diseased tissue within the body. When a person has spinal stenosis, it can lead to soft tissue damage within the body. Stem cell therapy can help repair or improve the damaged areas, leading to symptom relief.

Clinical studies performed using stem cell therapy for spinal stenosis report that it could be a viable treatment option for some with the condition. However, the research is so preliminary that more is needed to confirm whether this particular therapy is effective enough to be used widely.

LimiFlex

LimiFlex is a medical device being investigated for its ability to restore mobility and stability in the spine in people with spinal stenosis. The device is implanted into the back during a surgical procedure.

According to research, people with spinal stenosis who receive LimiFlex often experience a higher reduction in pain and symptoms than other forms of treatment.

Lumbar Interspinous Distraction Decompression

Another surgical procedure used for spinal stenosis is the lumbar interspinous distraction decompression. The surgery is performed by incision above the spine and placing a device between two vertebrae to space the two apart. This reduces movement which could put pressure on the nerves underneath the spine.

While preliminary results show promise in terms of short-term relief from the symptoms of spinal stenosis, long-term data is not yet available because it is a relatively new therapy option.

Surgery for Spinal Stenosis

There are several surgeries available for spinal stenosis. Some possible surgical routes of treatment include:

• Laminectomy: A laminectomy involves the removal of part or all of the lamina, which is the vertebral bone that acts as a roof to the spinal canal. The procedure is designed to reduce pressure on nerves and the spinal cord.
• Laminotomy and foraminotomy: Both surgeries are used if a person’s spinal stenosis negatively affects an opening in the vertebrae known as the foramen. To reduce pressure on the nerves that travel through the foramen, ligaments, cartilage, or other tissues that constrict the nerves are removed.
• Laminoplasty: A laminoplasty relieves pressure on the spinal cord by removing parts of the spinal canal's bony roof. This enlarges the spinal canal and relieves pressure on the nerves.
• Discectomy: This type of surgical procedure involves the removal of herniated discs or bulging discs that put pressure on the spinal cord and nerves.
• Spinal fusion: Spinal fusion involves joining two vertebrae in the spine using metal pieces, such as rods and screws. When secured, the vertebrae are more stable because the rods and screws act as a brace.

For some, minimally invasive surgery may help to relieve symptoms. These types of surgeries involve smaller incisions and a medical tube device. The tube is placed into the small opening to create a tunnel to the area of the spine affected.

Small tools are placed in through the tube where they can work on the site without cutting the entire back open. Types of surgeries mentioned above that can be minimally invasive include discectomy, laminectomy, and spinal fusion.

What Are the Risks of Surgery?

Spinal stenosis surgeries are often regarded as safe, but there are some risks to be aware of beforehand. They can include:

• Infection of the surgical wounds
• Skin infections
• Excess bleeding
• Pain at the site
• Damage to the nerves that can lead to numbness, paralysis, or weakness
• Tears in tissues that cover the spine
• Difficulty passing urine
• A loss of bladder or bowel control
• Blood clots
• Anesthesia complications
• Spinal fluid leaks, which can lead to other health issues such as headaches
• No or a little reduction in back pain

Which Treatment Is Right for Me?

There is no one-size-fits-all treatment. Because of that, determining which will work best for you is a task best suited for a healthcare provider. Each approach caters to the individual.

To decide what therapy is best for you, healthcare providers will assess:

• The severity of your symptoms
• The level of damage that’s occurring in your spine
• Your level of disability or how your mobility and quality of life are affected
• Your current level of overall health

They will also discuss your options with you to determine which one you’re most comfortable with based on your current condition.

Can Spinal Stenosis Get Better Without Treatment?

In some mild cases of spinal stenosis, people may not require any treatment at all because the condition can resolve itself over time. That said, if it is causing symptoms and other damage within the spine, treatment is necessary.

Questions to Ask a Healthcare Provider

When speaking to a healthcare provider about your concerns regarding a spinal stenosis diagnosis, you want to have some questions ready. Some things you should ask your healthcare provider include:

• What should I expect from my spinal stenosis treatments?
• What course of action is taken if the first therapies I try do not work for me?
• What alternative or complementary therapies would you suggest?
• What lifestyle changes do you recommend?

These questions will help you work with your healthcare provider to find a well-rounded and effective treatment for you and your specific case of spinal stenosis.

Summary

Spinal stenosis treatments vary widely because no two cases are the same. Some people may experience mild symptoms, while others will experience severe signs of disease that affect their daily lives and overall quality of life.

When working through treatments, a healthcare provider will assess your symptoms and start treatment with a first-line therapy, such as pain medication or physical therapy. You may also explore alternative therapies that can complement your treatment.

In the most severe cases, surgery is likely necessary to resolve any nerve compression and relieve symptoms. Your healthcare provider will determine your best treatment options after considering your symptoms, experiences in daily life, and concerns regarding medications or other forms of treatment.