Your doctor may recommend one or more types of medication to relieve pain associated with nerve compression.
Nonsteroidal Anti-inflammatory Drugs
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.
If over-the-counter medications aren’t strong enough to relieve your pain, your doctor may prescribe a stronger dose.
Corticosteroids
Corticosteroids are anti-inflammatory medications that can reduce swelling and irritation in nerves and the spinal cord, relieving pain.
Doctors typically prescribe a course of corticosteroids taken by mouth for five or six days and reassess your symptoms before recommending further treatment. Many people experience relief from arm or leg pain within a few days.
Neuroleptics
Doctors may recommend neuroleptic medications, which stabilize overactive neurons within the spinal cord, to relieve arm or leg pain associated with nerve compression. How neuroleptics relieve this pain is not well understood, but some people find that taking a neuroleptic every day by mouth alleviates discomfort caused by spinal stenosis.
The length of time a doctor prescribes neuroleptics varies and is determined by the severity of your arm or leg pain, the presence of unusual sensations such as tingling or numbness, and whether the medication provides relief in the first four weeks.
Physical therapy designed to modify your posture may help reduce compression of nerves in the lumbar spine and alleviate pain. At NYU Langone, therapists who specialize in treating people with spine conditions can demonstrate simple exercises for strengthening the core muscles in the abdomen and thighs and stretching muscles in the back.
These exercises help to slightly modify the spine’s lumbar curve in a way that opens up the spinal canal. Any exercises that require bending backward should be avoided, as extension may make the symptoms of spinal stenosis worse.
Exercise also strengthens the core muscles in the back, abdomen, and buttocks that provide structural support for the spine. If these muscles are weak, it takes more energy for the body to stand and walk, which can cause muscle pain, in addition to the pain caused by spinal stenosis.
Exercise also strengthens and stabilizes the neck, which may reduce pain caused by cervical stenosis. Our physiatrists—doctors who specialize in rehabilitation medicine—and therapists can show you simple exercises you can do at home, even while sitting in an office chair.
Though physical therapy may relieve spinal stenosis symptoms, it is generally not a long-term treatment. Exercise does not address the anatomical cause of stenosis in the spinal canal.
Integrative Therapies
Our physiatrists offer integrative services to complement physical therapy, relieve pain, and improve your sense of wellbeing. These include heat, massage, acupuncture, and meditation. Transcutaneous electrical nerve stimulation, or 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.
Spinal stenosis occurs when the space around your spinal cord narrows and causes pressure on your nerve roots. The main cause is wear-and-tear arthritis (osteoarthritis). As cartilage wears away, bone rubs against bone. This can result in an overgrowth of bone (bone spurs) that intrudes into spinal cord space.
Other causes of spinal stenosis include herniated disks, thickened ligaments, and abnormal growths. Paget’s disease or major trauma to the spine can also lead to spinal stenosis.
When this condition is due to back problems present at birth, it’s called congenital spinal stenosis. You’re more likely to develop spinal stenosis as you age, however. According to the American Academy of Orthopaedic Surgeons, it usually occurs in people over 60 years old.
General symptoms include back pain and numbness or weakness of the legs.
After a physical examination, your doctor will likely want to order some tests to determine the cause of your symptoms. Imaging tests, such as X-rays, MRI scans, and CT scans can provide detailed pictures of your spine.
There is no cure for spinal stenosis, but there are treatments to help relieve symptoms. Over-the-counter anti-inflammatory medications can ease swelling and pain. If they don’t do the trick, your doctor can prescribe higher-dose medication.
Your doctor may also recommend cortisone injections. This anti-inflammatory drug is injected directly into the area of the spinal stenosis. Cortisone can significantly ease inflammation and pain. Its effects may be temporary, however, and you shouldn’t have more than three injections in a single year.
You might feel as though you’re in too much pain to exercise, but movement is crucial to your overall health. Try to perform some stretching exercises several times a day.
If you haven’t exercised in awhile, start slowly, even if it’s only a few minutes a day. Ideally, you should exercise for 30 minutes at least three times a week.
If exercise is particularly difficult, try exercising in a pool. The buoyancy of the water makes it easier to move and get full range of motion.
Regular exercise can help improve flexibility and balance, enabling you to move better. Not only is it good for your physical health, but it can also improve your sense of well-being.
Your doctor or physical therapist can recommend exercises specifically designed to strengthen your back and abdominal muscles. They can also instruct you on how to do them safely. If your condition is severe, you may need a back brace for extra support.
If exercise is aggravating your condition, see your doctor.
Besides regular movement, massage therapy may help loosen up your back muscles and provide overall relaxation. Chiropractic manipulation is another option, but ask your doctor if it’s a good choice for your particular condition.
If nothing else helps and your quality of life is at stake, there are a few surgical options.
Laminectomy (decompression laminectomy)
In this technique, your surgeon makes an incision to access your spine. Then, bone spurs, ligaments, or anything else pushing on the nerves are trimmed or removed. There’s another version of this surgery in which multiple smaller incisions are used. Either way, the procedure gives your spinal cord more space.
Following the procedure, you may be able to go home the same day or the next day.
Discectomy
This procedure is used when part of a disk is compressing spinal nerves. Using a small incision, the surgeon removes the part of the disk causing the problem.
Spinal fusion
The goal of this surgery is to stabilize, or lock two or more bones so they can’t move. This is done with metal hardware or bone graft from your pelvic bone. It may be harder to bend after this procedure, but it’s intended to decrease pain. You may need to stay in the hospital for a few days following spinal fusion.
In a minimally invasive procedure, spacers can be inserted between the spinous processes. This keeps the vertebrae apart and the space open.
Other considerations
These surgeries may not be a cure, and symptoms can come back. As with any surgery, there are some risks. Some of these are infection, blood clots, and injury to the nerve roots.
After any type of back surgery, your doctor may recommend physical therapy for a time. The right exercises can help you gain strength and flexibility.
Though spinal stenosis isn’t always preventable, you have options for dealing with the symptoms. If simple treatments aren’t relieving your symptoms, talk to your doctor about advanced options.
Spinal stenosis, (also called spinal canal stenosis or lumbar spinal stenosis), is a narrowing of the canal in which the spinal cord sits. The narrowing can put pressure on the nerves in the back, which can cause pain and weakness in the arms or legs.
Surgery for spinal stenosis involves widening the canal to relieve the pressure on nerves.
What causes spinal stenosis?
Spinal stenosis is usually caused by arthritis, most often after the age of 50. Some people are born with a narrowed spinal canal, which puts them at greater risk. Spinal stenosis can happen after a disc prolapse (a ‘slipped disc’, or a problem with the spongy discs between the bones of the spine).
Spinal stenosis can also be caused when a thickened ligament bulges into the spinal cord, by a tumour, or by an injury to the back.
The most common form of spinal stenosis is in the lower back (called a lumbar stenosis). It can also happen at the top of the spine (called a cervical stenosis).
What are the symptoms of spinal stenosis?
Many people don’t experience any symptoms, even if the spinal stenosis shows up on a scan.
When symptoms start, they usually get worse over time. The symptoms depend on which nerves are affected. They include:
- numbness, weakness or tingling in a hand, arm, foot or leg
- problems with walking and balance
- neck pain or back pain, especially when standing upright
- pain going up and down the leg
- problems with the bowel or bladder
- difficulty having sex
Treatment for spinal stenosis
Spinal stenosis is usually diagnosed using an x-ray, MRI or CT scan.
Your doctor may recommend medicines to reduced pain, inflammation and swelling, and physiotherapy to build up your strength, flexibility and balance. Losing weight if necessary can help, as can exercise to strengthen muscles and improve endurance. Some people use devices such as a corset or a brace, or are recommended injections of steroids into the back to reduce pain and inflammation.
If you are very disabled by the symptoms or other treatments don’t work, surgery called a laminectomy may be an option. This operation removes part of the vertebra (spinal bone), along with some ligaments, to create space and take the pressure off the nerves. Sometimes it also involves a fusion (joining 2 bones together).
Most people are advised to try other treatments first before resorting to surgery.
What you can do
You may be able to control the pain with over-the-counter pain medicines or with hot or cold packs.
If your balance is affected, using a cane or walker will make you more stable and will help reduce the pain because you are leaning forward.
More information
About laminectomy
More information can be found at Neurosurgical Society of Australasia.
About surgical procedures
Visit the healthdirect surgical procedures page to learn more about surgical procedures in general, with information including: