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The course of Lumbar Spinal Stenosis varies: symptoms may be severe at times, and less severe at other times. If you feel numbness, weakness, or have trouble standing or walking, it may mean that your condition is getting worse. Problems with bladder and bowel control also may mean your spinal stenosis is getting worse.

If you are experiencing severe Low Back Pain that is not relieved by other forms of treatment and you are unable to engage in daily activities, your health professional may prescribe hydrocodone or other opioid medications.⁴ But these medications do not work well for symptoms that occur in the legs. Also, the side effects of opioids, such as mental confusion and drowsiness, can be more of a problem than the pain of Lumbar Spinal Stenosis.

If you have tried nonsurgical treatment for a period of time as determined by your health professional but your symptoms have not improved, you may want to consider surgery. Imaging tests (such as MRI) will be done to determine the amount and location of spinal canal narrowing. You and your health professional will want to discuss the severity of symptoms, along with imaging test results, before making a decision about surgery.

Back surgery (decompressive laminectomy with or without spinal fusion) may be considered when you:⁵

• Have severe symptoms of pain, numbness, or weakness in the legs that restrict normal daily activities and have a negative impact on your quality of life.
• Are in otherwise good health and do not have other medical conditions that might make it harder for you to undergo and recover from surgery.

The goal of surgery for spinal stenosis is to relieve pain, numbness, or weakness in the legs-not to relieve back pain. People who are operated on solely for back pain are less satisfied with outcomes than are those who are operated on for nerve root symptoms and pain in both the back and legs. Back pain associated with spinal stenosis is often not relieved by surgery. In addition, numbness and pain may return after surgery.²

 Should I have surgery for spinal stenosis?

What To Think About

Epidural steroid injections (ESIs) are usually only used to treat symptoms of Lumbar Spinal Stenosis that occur in the legs. This treatment only relieves symptoms for a short time and experts are not sure about the long-term effects. Talk to your doctor about the risks related to the number of injections he or she expects you will need.

Surgery is usually not recommended for an older adult who is able to manage symptoms with nonsurgical treatment and is able to do normal daily activities. Surgery may be considered if the severity of symptoms and the decrease in quality of life outweigh the risks of the procedure. Surgery may not be an option for some older adults whose other serious health problems increase the risks from surgery.