Spinal Stenosis; Causes, Symptoms, Treatment & Prevention

Treatment of Spinal Stenosis

Spinal stenosis can present with many symptoms and with varying degrees of severity, and as such, different therapies exist for it. It is important to understand that the definitive treatment for most anatomical abnormalities in the body is surgery. However, surgery is invasive and has its risks and side effects and is therefore left for last and only resorted to when all other options fail.

The main focus of treatment is the improvement of symptoms and signs. Pain is the most bothersome of symptoms and its control using conservative and surgical options remains the focus of treatment. Pain, however, is not the most threatening complication, and neurological complications including muscle weakness and numbness can be permanent if not treated as soon as possible.

1) Conservative Treatment

Conservative treatment are all treatment options that either delay or spare the patient from undergoing surgery. In spinal stenosis, they include pharmacological treatment and physiotherapy. Physiotherapy consists of a variety of exercises and techniques that aim to decrease muscle spasm, which is the main cause of back pain in spinal stenosis.

Physiotherapy is effective in many patients and pain relief can be so significant that people can return to work, but it remains a temporary measure and cannot reverse the original disease.

Pharmacological therapy includes a multitude of medications including:

• Muscle relaxants: Muscle relaxants such as dantrolene can help control muscle spasm and improve pain.
• Non-steroidal analgesics: Non-steroidal analgesics work by decreasing both inflammation and pain. They include aspirin, ibuprofen, naproxen, and others. The main side effect of these medications is stomach inflammation and ulcers. This can be prevented if they are given along with other medications called proton pump inhibitors such as omeprazole.
• Opioids: Opioids are the most potent analgesics known to man. They are not routinely used in spinal stenosis for pain relief because of the risk of dependency and their side effects. They are, however, used for a short duration of time to control the pain that does not respond to other medications.
• Antidepressants: Some antidepressants such as selective serotonin reuptake inhibitors or SSRI can be used to control pain that result from nervous compression as that caused by spinal stenosis. The most famous of these medications is fluoxetine. Another class of antidepressants is tricyclic antidepressants or TCA such as amitriptyline.
• Anticonvulsants: Like antidepressants, there is more to anticonvulsants than their name suggests. They work by increasing certain chemicals that are also involved in pain. The most commonly used is gabapentin, which is an excellent medication for pain resulting from compression of nerves or the spinal cord.

Another therapy that is rapidly gaining popularity as an alternative to surgery in patients who do not respond to pharmacological treatment alone is epidural injections. The epidural space surrounds the spinal cord, and epidural anesthesia is the one performed by injection in this space such as during labor. Steroid injections can also be done in this space and can result in reduced inflammation and symptoms for up to 3 years in some patients. This procedure is done in a sterile environment by an anesthesiologist and has a few side effects compared to surgery. The main side effects include pain at the site of injection or, rarely, injury to the spinal cord.