What are Treatment Options?
When your doctor determines lumbar narrow canal (canal stenosis) as the source of your pain, he/she will first try non-surgical treatments. These treatments include antiinflammatory drugs (oral or injectable) or painkillers (analgesics). Physical therapy may be suggested to preserve and increase your flexibility, power, and conditioning. Also, spinal injections (such as epidural cortisone injections) may be recommended.
Non-surgical Treatment
1. Drugs and pain control. Your doctor may prescribe one or more drugs to decrease your discomfort and increase your functionality. Drugs used for the management of pain are called analgesics. In most cases the pain responds to commonly used (over-the-counter, available without prescription) analgesics such as aspirin or acetaminophen.
Some analgesics named non-steroidal antiinflammatory drugs (NSAIDs) may be added for control of irritation and inflammation. These include ibuprophen, naproxen, and various drugs sold with prescription. If your doctor gives you painkillers or anti-inflammatory drugs, you have to be cautious about gastric irritation or bleeding, and inform your doctor of problems that may occur in long-term use of painkillers sold with/without prescription and NSAIDs.
If your pain that is severe and persistent, and not relieved with other analgesics or NSAIDs, then your doctor may prescribe narcotic analgesics (such as codein) for a short period. You should use only the recommended amount. A higher dose will not accelerate your healing. Side effects include: nausea, constipation, dizziness, and vertigo, also may cause addiction. All drugs must be taken the way they are prescribed. Inform your doctor on all drugs you are using, and if you previously tried the drugs prescribed to you, tell your doctor whether they were effective.
There are other drugs with anti-inflammatory effects. Due to their anti-inflammatory properties, corticosteroids (tablet or injection) are sometimes prescribed in cases of very intense lower back and leg pain. Corticosteroids may have side effects like NSAIDs. Discuss the benefits and risks of these drugs with your doctor. Selective spinal injections or "blocks" may used to relieve very intense pain. These are corticosteroid injections made into the epidural space (space around the spinal nerves) or facet joints, by a doctor trained on this technique. Depending on the response to treatment, the first injection may be later supplemented by one or two injections. These are most commonly performed as a part of a comprehensive rehabilitation and treatment program.
2. Physical Therapy. People with narrow canals often avoid activities. This condition results in decreased mobility, flexibility, strength and cardiovascular conditioning. A physical therapy or exercise program often begins with stretching exercises aimed at making the tensed muscles more flexible. You may be asked to repeat the stretching exercises frequently to preserve your flexibility. Cardiovascular exercises using conditioning bicycles, walking tracks, or swimming may be added to increase your conditioning and to improve blood circulation in the nerves. Increased blood flow to the nerves may decrease some of the symptoms of narrow canal. Also, exercises for strengthening the back and abdominal muscles may be initiated.
Your daily activities will be easier if your flexibility, strength, and conditioning are preserved or increased. Your physiotherapist or your doctor can tell you how you can add a continous exercise program to your therapy by using simple tools at home or at a gym.
In some patients with narrow canal, modifications performed in the house or improvement of house safety are significantly important. Household devices such as the washing machine may need to be transferred to more practical spots. A console next to the bed may be useful. Safety tools in the bathroom may be recommended. The organization of cooking, timing of activities, and decreasing workload are otherpossibilities. It is important for canes or walkers to fit properly to the patient. Unless it causes significant or progressive weakness in the legs, or problems in urine or stool control, the presence of a narrow canal is not dangerous in adults. Therefore the goal of treatment is to decrease pain and increase the functionality of the patient.
Non-surgical therapies do not correct the stenosis in the spinal canal, however they provide long-term pain control and increased functionality without the need to undergo surgery. A comprehensive rehabilitation program requires a three-month or longer treatment under supervision.
What if Surgery is Necessary?
Surgery is recommended only to a limited number of patients whose pain cannot be treated with nonsurgical therapies. Surgery is also recommended for people with progressive leg weakness or problems in bladder and intestinal control. Surgery may be good option for patients whose walking distance is severely limited or whose life quality is low.
The objective of surgery in narrow canal is to widen the bony canal and provide adequate space for the nerves. This procedure is named lumbar decompression surgery or laminectomy.
Surgery will improve leg pain, and to a lesser extent, lumbar pain. Most patients are allowed to return to their normal activities within weeks. Postoperative rehabilitation may be recommended to assist in return to normal activities.
In narrow canal cases, the vertebrae may have slipped one over the other (spondylolisthesis). In that condition, there may be an abnormal movement (instability) between the vertebrae. In these cases, spinal fusion surgery should be added to decompression surgery.
Fusion is performed by placing bone fragments, bone substitutes between the vertebras that will be attached. Additionally metallic devices (instrumentation) may be used to stabilize the spinal column until fusion is achieved.
Fusion can be performed from the front, the back, or both. The approach in fusion surgery (from the front versus back) is determined according to numerous factors, such as: the need to remove bone spicules, the location of the bone spicules, and anatomic variations between patients, and the degree of instability. The success rate of fusion surgery is more than 65 percent.
After surgery, you will remain in the hospital at least for a few days. Most patients return to all previous activities within 6 or 9 months. A rehabilitation program is often initiated to ease return to daily activities and a normal life.