PATIENT INFORMATION How well does surgery work? Research shows that:

■■ Surgery may work better than nonsurgical treatments to relieve pain and help you move better. If Lumbar Spinal Stenosis nonsurgical treatments have not worked well enough, surgery might be able to help you. 1 A MaineHealth Member ■■ By three months, people who had surgery notice more improvement in their symptoms and can be more active than people who did not have surgery. This difference continues for at least four years after 2 surgery. What is lumbar spinal stenosis? ■■ The benefits of surgery appear to last for many years. After eight to ten years: Lumbar spinal stenosis is a narrowing of the spinal canal in the lower back, known as the ■■ People treated with surgery were as satisfied as those treated without surgery. lumbar area. ■■ People who had surgery were generally able to be more active and had less leg pain than those who had nonsurgical treatment. 3 This usually happens when bone or tissue—or both—grow in the openings in the spinal bones. This growth can squeeze and irritate nerves that branch out from the spinal cord. ■■ Surgery appears to be more effective for leg pain than for back pain, but it may help both. 4 Figure 1 The result can be pain, numbness, or weakness, most often in the legs, feet, and buttocks. What is the surgery for lumbar spinal stenosis? Figure 3 Lumbar Laminectomy The purpose of surgery to treat spinal stenosis is to relieve Figure 1 Spinal Stenosis pressure on the spinal nerve roots. The main type of surgery for spinal stenosis is decompressive laminectomy. It removes Spinal bone (parts of the vertebrae) and/or thickened tissue that is canal Nerve narrowing the spinal canal and squeezing the spinal nerves. roots Figure 3 In some cases, spinal fusion may be done at the same time. This surgery joins, or fuses, two or more bones so that the joints can no longer move.

References | Citations Stenosis 1. Weinstein JN, et al. (2008). Surgical versus nonsurgical therapy for lumbar spinal stenosis. New England Journal of Medicine, 358(8): 794–810. (narrowing) 2. Weinstein JN, et al. (2010). Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine, 35(14): 1329–1338. 3. Atlas SJ, et al. (2005). Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8- to 10-year results from the Maine Lumbar Spine Study. Spine, 30(8): 936–943. 4. Pearson A, et al. (2011). Predominant leg pain is associated with better surgical outcomes in degenerative spondylolistheses and spinal stenosis: Results from the Spine Patient Outcomes Research Trial (SPORT). Spine, 36(3): 219–229. Current as of: June 4, 2014 Author: Healthwise Staff Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine & Robert B. Keller, MD - Orthopedics

What causes lumbar spinal stenosis? It’s most often caused by changes that can happen as people age. For example:

■■ Connective tissues called ligaments get thicker.

■■ Arthritis leads to the growth of bony spurs that push on the nerves that branch out from the spinal cord.

■■ Discs between the bones may be pushed backward into the spinal canal. mainemedicalpartners.org/neuroedu

141847 6/18 PAGE 1 OF 4 Lumbar Radiculopathy LUMBAR SPINAL STENOSIS DECISION GRID What nonsurgical treatments are used for spinal stenosis? Rest and Time Non-Surgical Care Surgery If your symptoms are mild or moderate, they can most likely be relieved with nonsurgical ■■ Your pain is bearable or ■■ Over the counter and ■■ You have significant or treatment. This includes: Why might I improving prescription medications keep progressively worsening leg pain choose this symptoms controlled or weakness ■■ Medicines. Acetaminophen, such as Tylenol, and nonsteroidal anti-inflammatory drugs like ibuprofen option? ■■ You can do most of your daily activities ■■ Your symptoms are controlled ■■ Your symptoms are preventing (such as Advil or Motrin) and naproxen (such as Aleve) may help your pain. with therapy and/or exercise participation in leisure or work ■■ You have other medical activities ■■ Exercise. Aerobic exercise—especially riding a stationary bike (which allows you to lean forward)— issues that make surgery ■■ Epidural steroid injections may can help your symptoms. or injections more risky reduce your pain symptoms for ■■ Your pain is severe and rest, time a period of time and/or non-surgical care has not ■■ Healthy body weight. Getting to and staying at a healthy body weight may help your symptoms and helped keep the stenosis from getting worse. ■■ In a recent study, one ■■ It is hard to say. One study found ■■ Benefits of surgery last for many ■■ Physical therapy. This helps you learn stretching and strength exercises that may reduce pain and other What are third of patients improved, 20% of people go on to surgery years (8–10 years for most symptoms. the success approximately 50% stayed the within 2 years people) rates of each same and just over 10% got worse over 3 years ■■ Physical therapy can teach ■■ Our own data suggests just over 7 ■■ Steroid injections. These are shots that may help relieve pain if other nonsurgical treatments haven’t option? exercises and movements that in 10 patients have expectations worked. Figure 2 may help symptoms met in the first 3–12 months

■■ It may take longer for ■■ Physical therapy and injection ■■ 1–3 out of 100 people who What are the symptoms to improve, they have very low risks have surgery may have a minor risks? may not improve at all, or complication such as an infection Figure 2 ■■ Steroid Injection they could get gradually worse Less than 1 in 1,000 people has a or spinal fluid leak complication after an injection. ■■ Risks are low unless your These may include infections, a ■■ 1 in 20 may need to come back symptoms progress and you temporary increase in pain or, into the hospital within 30 days notice more numbness and/or extremely rarely, nerve damage weakness. If this occurs, you ■■ Other risks including reactions should seek further medical to anesthesia, nerve injury or scar advice tissue with chronic nerve pain are rare

■■ If symptoms are not severe, ■■ Oral steroids or epidural steroid ■■ Improvement can be seen as soon How long you may perform activities injections can allow improvement as 4–6 weeks after surgery will it take as tolerated of symptoms sometimes within a to resume week, but long-term benefit for ■■ By 3 months, people who have ■■ Changing posture by leaning surgery notice more improvement my normal these treatments is difficult to forward, sometimes with use predict and are frequently more active activity? of a cane or hiking sticks, versus people who did not have often allows better tolerance surgery for activities

■■ It is always possible for ■■ Epidural injections can help keep ■■ Surgery relieves the narrowing of Can this symptoms to return. For the symptoms controlled, but it is the spinal canal, but it can return happen majority of patients, some always possible for symptoms to with time or develop at another again? symptoms persist so many return level as the spine ages people try to manage the symptoms

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