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:

• Medicines. Acetaminophen, such as Tylenol, and nonsteroidal anti-inflammatory drugs like ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve) may help your pain.
• Exercise. Aerobic exercise—especially riding a stationary bike (which allows you to lean forward)—can help your symptoms.
• Healthy body weight. Getting to and staying at a healthy body weight may help your symptoms and keep the stenosis from getting worse.
• Physical therapy. This helps you learn stretching and strength exercises that may reduce pain and other symptoms.
• Steroid injections. These are shots that may help relieve pain if other nonsurgical treatments haven't worked.

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 work better than nonsurgical treatments to relieve pain and help you move better. If nonsurgical treatments have not worked well enough, surgery might be able to help you.¹
• By 3 months, people who had surgery notice more improvement in their symptoms and can be more active than people who did not have surgery.¹ This difference continues for at least 4 years after surgery.²
• The benefits of surgery appear to last for many years. After 8 to 10 years:
  • People treated with surgery were as satisfied as those treated without surgery.
  • People who had surgery were generally able to be more active and had less leg pain than those who had nonsurgical treatment.³
• Surgery appears to be more effective for leg pain than for back pain, but it may help both.⁴

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:

• Problems from anesthesia.
• A deep infection in the surgical wound.
• A skin infection.
• Blood clots.
• An unstable spine.
• Nerve injury, including weakness, numbness, or paralysis.
• Tears in the fibrous tissue that covers the spinal cord and the nerve near the spinal cord, sometimes requiring more surgery.
• Trouble passing urine, or loss of bladder or bowel control.
• Long-term (chronic) pain, which develops after surgery in some cases.
• Death from problems caused by surgery, but this is rare.

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:

• Your pain and weakness are bad enough to get in the way of your normal activities and have become more than you can manage.
• You've tried other treatments—medicine, exercise, physical therapy—for at least a few months and they haven't worked.
• You are less able to control your bladder or bowels than usual.
• You notice sudden changes in your ability to walk in a steady way, or your movement becomes clumsy.