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:
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 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:
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:
|Have surgery||Don't have surgery|
|What is usually involved?|
|What are the benefits?|
|What are the risks and side effects?|
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
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
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:
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
1. If your symptoms aren't very bad, should surgery be your first choice of treatment?
2. Will surgery help your leg pain?
3. If you have surgery, will the results last for a long time?
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
3. Use the following space to list questions, concerns, and next steps.
|Primary Medical Reviewer||William H. Blahd, Jr., MD, FACEP - Emergency Medicine|
|Specialist Medical Reviewer||Robert B. Keller, MD - Orthopedics|
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.