Illustration: ADAM

A recent study completed at 13 spine clinics around the US, and published in the Feb. 21 issue of the New England Journal of Medicine shows that surgery yields more dramatic pain relief than non-operative care of spinal stenosis. The study also revealed that 2 years after surgery, the positive effect - in terms of pain relief and return to function - is less, and the benefits gap between invasive treatment and conservative care for this condition is narrowed.

The goal of surgery is to relieve pressure on nerve roots and the spinal cord. A laminectomy is the type of surgery usually done for stenosis.

Spinal stenosis can be a real bear, and surgery, as the study indicates, will likely relieve a lot of pain, fast. But the New England Journal of Medicine also points out that there have been no high quality research studies addressing pain relief when non-operative, aka, conservative care is tried. In other words, we still don’t have all the information.

But there are some things we do know. As far as pain medication goes, Tylenol is usually tried first. If that doesn’t work, NSAIDs are next. Sometimes doctors will recommend an injection for scar tissue they believe to be in the epidural space. But there is only sparse and conflicting data on the value of this injection for patients. If your doctor wants to try the epidural, ask her or him to explain how it will relieve your back pain.

Also, extension movements (bending backwards) of the spine bring on symptoms of spinal stenosis. Therefore, a slight bit of spinal flexion (forward bending) tends to relieve symptoms. The NEJM recommends that a physical therapist show you how to incorporate flexion into your daily life. It also says that strengthening core abdominals can help you to live with a little spinal flexion all the time, thus relieving some of the pain.