The degenerative process that leads to spinal stenosis generally cannot be treated. However, nonsurgical and surgical treatments can relieve the nerve compression that leads to pain suffered by those with spinal stenosis.

Nonsurgical treatments include:

• Over-the-counter medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen or naproxen can reduce inflammation and pain. Analgesics such as acetaminophen relieve pain but do not reduce inflammation.
  
  Supplements such as glucosamine and chondroitin have been shown to have a positive effect for pain relief in some cases of moderate to severe knee osteoarthritis. However, it is not known whether this benefit extends to osteoarthritis of the spine. As with all medications, patients should consult with a physician before using these supplements.
  
  

  

• Moderate exercise or rest. Moderate rest may improve symptoms but should not be overdone. Research shows that moderate exercise is even more beneficial to symptom relief. Walking can especially benefit patients with neurogenic claudication (pseudoclaudication). Biking may also be beneficial, as it keeps the back in a flexed rather than extended position. Patients may be referred to physical therapy for supervised exercise and for pain-relieving modalities such as thermotherapy (heat), hydrotherapy or electrical therapy.
  
  
• Back brace or corset. This can provide support to the spine, and may particularly benefit patients who have weak abdominal muscles or degeneration in more than one area of the spine.
  
  
• Nonsurgical spinal decompression. The U.S. Food and Drug Administration has approved systems in which the patient lies on a special mechanical table designed to relieve pressure on the discs. A patient may have sessions of up to an hour most days of the week for several weeks to relieve conditions such as spinal stenosis, herniated discs or sciatica. But more research is needed on this modality at this point.
  
  
• Injection therapy. Anesthetic injections, also known as nerve blocks, can be used near affected nerves to temporarily relieve pain. With epidural corticosteroid injections, the medication is injected into the spinal fluid around the spinal cord and nerve roots. Corticosteroids suppress inflammation and may be especially beneficial in treating pain that radiates down the back of the leg. However, they must be taken in limited doses to avoid potentially serious side effects, such as osteoporosis. In patients who are not candidates for surgery or do not want surgery, sometimes having epidural steroid injections at reasonable intervals may be the best option.  

In some cases, spine surgery will be necessary to address spinal stenosis. The goal of surgery is to relieve pressure on the spinal cord or nerves while maintaining the integrity and strength of the spine. Examples of surgery include:

• Decompressive laminectomy. Removal of the back part of the bony arch over the spinal canal (lamina) to open more space for the spinal nerves. This procedure also allows the surgeon to access bone spurs or herniated discs that may be removed. In some cases, the procedure is performed through a single incision. In other instances, it may be performed though a series of small incisions in a technique known as laparoscopy (similar to arthroscopy).
  
  
• Laminotomy. Partial removal of the lamina to remove or relieve pressure to allow access to a disc or bone spur that is pressing on a nerve.

Risks associated with laminectomy and laminotomy include infection, a tear in the membrane that covers the spinal cord (the dura), bleeding, a blood clot in a leg vein, decreased intestinal function (paralytic ileus) and neurologic deterioration.

Fusion is another form of surgery used to treat spinal stenosis. In this procedure, two or more vertebrae are permanently connected. It is often used when stenosis causes one vertebra to slip over another. The extra bone may come from a bone bank or from the patient’s own body. A section of pelvic bone is often used when the patient is a self-donor.

Surgery can help relieve pressure in the spine, but patients frequently continue to feel pain for weeks or months after the procedure. In addition, surgery does not halt the degenerative process, and patients may find that their symptoms return within a few years.

In many cases, successful treatment of spinal stenosis will be followed or accompanied by physical therapy. Such treatments can increase strength and endurance, and help maintain the flexibility and stability of the spine. Occupational therapy can benefit patients who have difficulty performing daily tasks.