We asked David Wong, MD, an orthopaedic surgeon who specializes in spine care, to respond to questions about spinal stenosis, a condition of the spine that results from narrowing ( stenosis) of the spinal canal. For more information on Dr. Wong, please see the Author Information link at the end of this section.

Answer: Yes, here are several things to consider. First, it is not a matter of "giving in." Rather, it is a matter of appropriate "pacing." Walking is one of the activities associated with additional irritation of the nerves to the legs in patients with spinal stenosis. Leaning forward, such as when using a grocery cart while shopping or finding a place to sit down for a few minutes, will usually allow the sensation of weakness and poor balance to subside. Take note, however, that if you are performing any activity to the point of weakness and poor balance, you may be overdoing it and should consider taking rest stops more frequently. Persistent weakness, numbness, and balance problems are definitely concerns that require additional evaluation by a physician.

Answer: The more modern minimally invasive microsurgical procedures for spinal stenosis require much less anesthesia time, minimal blood loss, and less tissue cutting. Age is thus not as major a consideration in surgical decision making as previously. If your mother's stenosis symptoms are the major limiting factor in her activities of daily living and she has no significant medical conditions that would negatively affect her anesthesia risk, then she may well be a reasonable candidate for surgery.

Answer: Although injecting steroids into a closed space (as is done with epidural injections) limits the amount of steroids reaching the systemic circulation, there still may be some side effects. The most common side effects include water retention, weight gain, and high blood pressure. Epidural steroids are used cautiously in diabetic patients because the blood sugar levels of these patients may be more difficult to control.

Fortunately, major complications associated with epidural steroids, such as paralysis or nerve damage, are extremely rare. There is a small risk of infection and spinal fluid leakage. Blood thinners such as coumadin should be stopped before steroid injections to reduce the risk of epidural hematoma.

Answer: People who ask this question are generally concerned about the risk that their neurological situation might proceed progressively downhill, perhaps even to the point of becoming wheelchair-bound. Fortunately, this situation almost never occurs. Similarly, the risk of major bowel and bladder problems is very low. The natural history of spinal stenosis is generally one of stabilization or very slow deterioration over time. If you decided not to consider surgery, you would primarily have to look forward to ongoing persistent symptoms of leg pain, numbness, tingling, and weakness. Some patients also have back pain. If surgery is an option for you at this stage, then symptoms are likely already at a point that your daily activities are being hampered. In the end, it primarily comes down to a quality of life decision as to whether you would be content to live with the functional limitations imposed by your symptoms.

Answer: As the underlying pathology leading to spinal stenosis is wear and tear caused by degenerative arthritis of the spine, a self-help exercise program including range of motion, strengthening, endurance, and stability is a cornerstone of treatment with or without surgery. Chiropractic treatments and homeopathic remedies may give temporary symptomatic relief, but they are generally not believed to be "curative" of the underlying arthritis.

Answer: With the minimally invasive microsurgical decompressions being performed for stenosis these days, you will absolutely not be bed-ridden. Generally, patients are up to the bathroom and walking soon after arriving from the post-anesthesia care unit. The days of incapacitating, writhing pain after stenosis surgery are gone as well. Pain is in the mild to moderate range and is usually kept under good control with oral medication. The majority of my patients are able to go home with just an overnight hospital stay for a single level decompression.

Therapy (physical therapy and occupational therapy) is very helpful. There are usually two phases to physical therapy. The first begins in the hospital with exercises and activities to get patients up and steady on their feet, climbing stairs, and invested in a basic back exercise program. The second phase typically starts 1 month or so after surgery when the incision has healed and endurance has improved to the point of being able to participate in more vigorous exercises. The therapists will start a full program of range-of-motion, strengthening, endurance, and stability exercises. The ultimate goal is to transition patients to a maintenance home program that they can continue to do on their own as part of a regular exercise plan. During the initial hospital stay, the occupational therapists generally review activities of daily living such as dressing, showering, and cooking to evaluate whether the patient would benefit from adaptive aides such as an elevated toilet seat, reacher, or sock puller.

Answer: Spinal stenosis is not a condition open to pushing through the pain. Discomfort generally worsens the more one pushes. Walking and standing are the activities that typically aggravate spinal stenosis symptoms. You can help yourself avoid significant symptoms by planning regular changes in position when standing and trying to break longer walks into shorter segments with a periodic rests. As you suggest, take it easier. Arthritis medication, anti-inflammatory medications, a spine exercise program, and mild analgesics are often prescribed for the early symptoms of spinal stenosis. If these treatments are insufficient to control symptoms, then the next stage is commonly a trial of cortisone injections around the nerves and sometimes the joints in the spine to try to reduce local inflammation directly.

Patients with spinal stenosis should still endeavor to stay as active as possible. When degenerative changes reach the point that they are causing spinal stenosis symptoms, patients are generally encouraged to participate in activities toward the "smooth repetitive" end of the exercise spectrum (such as swimming, biking, elliptical trainer, and walking) rather than "repetitive impact" activities (such as jogging). Activities such as stationary bike riding where the body is in a slightly flexed forward posture are ideal because this position tends to open up the tunnels around the nerves and thus allows for longer activity endurance (just like using a shopping cart in the store will allow longer walking).