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Lumbar Spinal Stenosis: Should I Have Surgery?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Lumbar Spinal Stenosis: Should I Have Surgery?
Get the facts
- Have surgery to relieve your symptoms.
- Don't have surgery. Try medicine, exercise, and/or physical therapy instead.
Key points to remember
- If your symptoms from lumbar (low back) spinal stenosis are mild to moderate, then medicine, physical therapy, and exercise may be all you need.
- You may want surgery if you have tried other treatment for a while and your pain is still so bad that you can't do your normal activities.
- Your symptoms may come back a few years after surgery, and you may need surgery again.
- Surgery will probably help leg pain. But it may not help back pain as much.
Lumbar spinal stenosis is the narrowing of the spinal canal in the low back (lumbar). This usually occurs when bone and other tissues grow inside the openings in the spinal bones. This can squeeze the nerves that branch out from the spinal cord. The squeezing can cause pain, numbness, or weakness, most often in the legs, feet, or buttocks.
Symptoms may be very bad at times and not so bad at other times.
Before you decide about surgery, you may need to have an X-ray, an MRI, or a CT scan. These imaging tests can find any narrowing of your spinal canal and the exact location of any problems.
In addition to the imaging test results, you need to consider how severe your symptoms are and how they affect your quality of life.
If your symptoms are mild or moderate, they can most likely be relieved with nonsurgical treatment. This includes:
- Medicines. Acetaminophen, such as Tylenol, and nonsteroidal anti-inflammatory drugs like ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve) may help your pain.
- Exercise. Aerobic exercise—especially riding a stationary bike (which allows you to lean forward)—can help your symptoms.
- Healthy body weight. Getting to and staying at a healthy body weight may help your symptoms and keep the stenosis from getting worse.
- Physical therapy. This helps you learn stretching and strength exercises that may reduce pain and other symptoms.
- Steroid injections. These are shots that may help relieve pain if other nonsurgical treatments haven't worked.
The purpose of surgery to treat spinal stenosis is to relieve pressure on the spinal nerve roots. The main type of surgery for spinal stenosis is decompressive laminectomy. It removes bone (parts of the vertebrae) and/or thickened tissue that is narrowing the spinal canal and squeezing the spinal nerves.
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.
Research shows that:
- Surgery may work better than nonsurgical treatments to relieve pain and help you move better. If nonsurgical treatments have not worked well enough, surgery might be able to help you.1
- By 3 months, people who had surgery notice more improvement in their symptoms and can be more active than people who did not have surgery.1 This difference continues for at least 4 years after surgery.2
- The benefits of surgery appear to last for many years. After 8 to 10
- People treated with surgery were as satisfied as those treated without surgery.
- People who had surgery were generally able to be more active and had less leg pain than those who had nonsurgical treatment.3
- Surgery appears to be more effective for leg pain than for back pain, but it may help both.4
Surgery may not be an option if you have other serious health problems that make surgery too risky.
All surgery has risks. These risks may be more serious for an older adult. Possible problems from surgery include:
- Problems from anesthesia.
- A deep infection in the surgical wound.
- A skin infection.
- Blood clots.
- An unstable spine.
- Nerve injury, including weakness, numbness, or paralysis.
- Tears in the fibrous tissue that covers the spinal cord and the nerve near the spinal cord, sometimes requiring more surgery.
- Trouble passing urine, or loss of bladder or bowel control.
- Long-term (chronic) pain, which develops after surgery in some cases.
- Death from problems caused by surgery, but this is rare.
Symptoms may return after a few years. Some people have repeat surgery.
If you have mild or moderate symptoms, there is very little or no risk in not having surgery. Your symptoms can most likely be relieved with nonsurgical treatment.
Experts agree that the course of spinal stenosis varies—it may stay the same, get better, or get worse. But if symptoms are very painful or uncomfortable, they usually don't improve on their own. If you have very bad symptoms, not having surgery means that your normal daily activities may be limited and you will have to live with the pain and discomfort.
Your doctor might recommend surgery if:
- Your pain and weakness are bad enough to get in the way of your normal activities and have become more than you can manage.
- You've tried other treatments—medicine, exercise, physical therapy—for at least a few months and they haven't worked.
- You are less able to control your bladder or bowels than usual.
- You notice sudden changes in your ability to walk in a steady way, or your movement becomes clumsy.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You are asleep during the operation.
- You stay in the hospital for a few days.
- It can take up to several months before you return to your normal activities.
- Most people who have surgery are satisfied with the results.
- Surgery can relieve pain and improve walking ability.
- All surgery has some risks, including bleeding, infection, and risks from anesthesia.
- Risks from surgery for spinal stenosis include nerve injury, tissue tears, chronic pain, trouble passing urine, and an unstable spine.
- You may not be able to return to all of your normal activities for at least several months.
- Your symptoms may come back in a few years, and you may need surgery again.
- You can try other treatments to help your symptoms, including medicine, exercise, and physical therapy.
- Nonsurgical treatments usually work well for people with mild to moderate symptoms.
- You avoid the risks of surgery.
- Your symptoms may continue to bother you.
Personal stories about having surgery for spinal stenosis
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
The pain and numbness in my legs got to the point where I could hardly walk. After my MRI showed I had spinal stenosis, my doctor said that the final decision for treatment was up to me—I should consider how bad the pain is and whether I can do my normal daily activities. Since I could hardly do my simple everyday routines without pain, I figured that it was time for surgery.
Ed, age 62
I have been working with a physical therapist for several months now to relieve my leg pain that is caused by spinal stenosis. My doctor says surgery may be an option if my leg pain gets worse, but I want to wait and see if other steps help relieve the pain first. The physical therapy seems to be working, so I will stick with it for now.
Tom, age 52
I noticed the numbness and pain in my legs for a while. It came on gradually, and I could manage it with pain relievers. Over time, though, the symptoms got worse and worse. Eventually, the pain got so bad that walking was quite uncomfortable. Since I don't have any other major health problems, I decided to have surgery so I wouldn't have to deal with the leg pain and could start walking again!
Clare, age 70
The pain, numbness, and tingling in my legs started about 5 years ago. Luckily, I did not feel pain all of the time when I was walking. When I was diagnosed with spinal stenosis, my doctor said that there were several things I could do to keep my pain at a minimum, such as using pain relievers, exercising, and keeping my weight down. That's what I'm doing, and now I hardly ever get leg pain and am relieved that I avoided surgery.
Susan, age 64
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery for lumbar spinal stenosis
Reasons not to have surgery
I want surgery if there is a chance it will help me.
I want to avoid surgery at all costs.
My work and home life are flexible enough that I can take the time I need to recover after surgery.
I can't afford to take time off.
Nonsurgical treatments have not worked well enough for me.
I want to keep trying nonsurgical treatments and see if they help me feel and move better.
Getting relief from my pain and weakness will be worth it, even if I need to have the surgery again in a few years.
I'm not sure it's worth it to have surgery that might need to be repeated in a few years.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
NOT having surgery
What else do you need to make your decision?
Check the facts
If your symptoms aren't very bad, should surgery be your first choice of treatment?
- YesNo, that's not right. If your symptoms are mild to moderate, then medicine, physical therapy, and exercise may be all you need.
- NoThat's correct. If your symptoms are mild to moderate, then medicine, physical therapy, and exercise may be all you need.
- I'm not sureIt may help to go back and read "What nonsurgical treatments are used for spinal stenosis?" If your symptoms are mild to moderate, then medicine, physical therapy, and exercise may be all you need.
Will surgery help your leg pain?
- YesThat's right. Surgery can help leg pain. It may relieve back pain too, but it usually relieves leg pain more.
- NoSorry, that's wrong. Surgery can help leg pain. It may relieve back pain too, but it usually relieves leg pain more.
- I'm not sureIt may help to go back and read "How well does surgery work?" Although surgery may help leg and back pain, it usually relieves leg pain better than back pain.
If you have surgery, will the results last for a long time?
- YesThat's correct. When surgery helps relieve symptoms, the results appear to last for several years.
- NoNo, that's not right. When surgery helps relieve symptoms, the results appear to last for several years.
- I'm not sureIt may help to go back and read "How well does surgery work?" When surgery helps relieve symptoms, the results appear to last for several years.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||William H. Blahd, Jr., MD, FACEP - Emergency Medicine|
|Specialist Medical Reviewer||Robert B. Keller, MD - Orthopedics|
- Weinstein JN, et al. (2008). Surgical versus nonsurgical therapy for lumbar spinal stenosis. New England Journal of Medicine, 358(8): 794–810.
- 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.
- 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.
- 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.
Last Updated:February 13, 2012