Spinal stenosis: Should I have surgery?

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Have surgery to relieve your symptoms.
Don't have surgery. Try medicine, exercise, and/or physical therapy instead.

Key points to remember

If your symptoms from spinal stenosis are mild to moderate, then medicine, physical therapy, and exercise may be all you need.
You may want surgery if you have tried other treatment for a while and your pain is still so bad that you can't do your normal activities.
If you have stenosis in the neck (cervical spinal stenosis), you may want to have surgery. If the condition gets worse, it can cause spinal cord damage, nerve damage, and paralysis.
Your symptoms may come back a few years after surgery, and you may need surgery again.
Surgery will probably help leg pain. But it probably won't help back pain.

FAQs

What is spinal stenosis?

Spinal stenosis is the narrowing of the spinal canal. This 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, or it can squeeze the spinal cord itself. 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.

Spinal stenosis occurs most often in the lower back, or lumbar, area. When it does occur in the neck area (cervical spinal stenosis), the spinal cord may become squeezed. If left untreated, this can lead to spinal cord damage, nerve damage, and paralysis.

What tests may help in choosing treatment?

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 also need to consider how severe your symptoms and how they affect your quality of life.

What nonsurgical treatments are used for spinal stenosis?

If your symptoms are mild or moderate, they can most likely be relieved with nonsurgical treatment. This includes:

Medicines. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) 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 can help relieve pain if other nonsurgical treatments haven't worked.

What is the surgery for spinal stenosis?

The purpose of surgery to treat spinal stenosis is to relieve pressure on the spinal cord or 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 cord and 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.

How well does surgery work?

Research shows that:

Out of every 100 people who had this surgery, up to 80 were satisfied with the results. This means that about 20 out of 100 were not satisfied.¹
For people with very bad pain and weakness, surgery usually reduced leg pain and improved walking ability.²
Out of every 100 people who have this surgery, 10 to 20 need to have surgery again after several years because their symptoms come back. This means that 80 to 90 out of 100 don't need a second surgery.¹
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

What are the risks of surgery for spinal stenosis?

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 (more common after more than one laminectomy is done without spinal fusion).
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.

Although surgery for lumbar spinal stenosis usually relieves pain that is mostly in your legs, it does not usually work as well for back pain.¹

What are the risks of not having surgery for spinal stenosis?

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.

Why might your doctor recommend surgery for spinal stenosis?

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.

2. Compare Options

	Have surgery	Don't have surgery
What is usually involved?	You are asleep during the operation. You stay in the hospital for a few days. It can take up to several months before you return to your normal activities.	You can try other treatments to help your symptoms, including medicine, exercise, and physical therapy.
What are the benefits?	Most people who have surgery are satisfied with the results. Surgery usually helps very bad leg pain and improves walking ability.²	Nonsurgical treatments usually work well for people with mild to moderate symptoms. You avoid the risks of surgery.
What are the risks and side effects?	All surgery has some risks, including bleeding, infection, and risks from anesthesia. Risks from surgery for spinal stenosis include nerve injury, tissue tears, chronic pain, trouble passing urine, and an unstable spine. You may not be able to return to all of your normal activities for at least several months. Your symptoms may come back in a few years, and you may need surgery again.	Your symptoms may continue to bother you.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

If you need more information, see the topic Lumbar Spinal Stenosis.

Personal stories about having surgery for spinal stenosis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"The pain and numbness in my legs got to the point where I could hardly walk. After my MRI showed I had spinal stenosis, my doctor said that the final decision for treatment was up to me—I should consider how bad the pain is and whether I can do my normal daily activities. Since I could hardly do my simple everyday routines without pain, I figured that it was time for surgery. "

— Ed, age 62

"I have been working with a physical therapist for several months now to relieve my leg pain that is caused by spinal stenosis. My doctor says surgery may be an option if my leg pain gets worse, but I want to wait and see if other steps help relieve the pain first. The physical therapy seems to be working, so I will stick with it for now. "

— Tom, age 52

"I noticed the numbness and pain in my legs for a while. It came on gradually, and I could manage it with pain relievers. Over time, though, the symptoms got worse and worse. Eventually, the pain got so bad that walking was quite uncomfortable. Since I don't have any other major health problems, I decided to have surgery so I wouldn't have to deal with the leg pain and could start walking again! "

— Clare, age 70

"The pain, numbness, and tingling in my legs started about 5 years ago. Luckily, I did not feel pain all of the time when walking. When I was diagnosed with spinal stenosis, my doctor said that there were several things I could do to keep my pain at a minimum, such as using pain relievers, exercising, and keeping my weight down. That's what I'm doing, and now I hardly ever get leg pain and am relieved that I avoided surgery. "

— Susan, age 64

3. Your Feelings

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for spinal stenosis

Reasons not to have surgery

I want surgery if there is a chance it will help me.

I want to avoid surgery at all costs.

More important

Equally important

More important

My work and home life are flexible enough that I can take the time I need to recover after surgery.

I can't afford to take time off.

More important

Equally important

More important

My other symptoms bother me more than my back pain.

My back pain bothers me more than my other symptoms.

More important

Equally important

More important

Getting relief from my pain and weakness will be worth it, even if I need to have the surgery again in a few years.

I'm not sure it's worth it to have surgery that might need to be repeated in a few years.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts

1. If your symptoms aren't very bad, should surgery be your first choice of treatment?

Yes
No
I'm not sure

That's correct. If your symptoms are mild to moderate, then medicine, physical therapy, and exercise may be all you need.

2. Will surgery help your back pain?

Yes
No
I'm not sure

That's right. Although surgery may help leg pain, it doesn't usually work as well for back pain.

3. Are you more likely to need surgery if your stenosis is in your neck?

Yes
No
I'm not sure

You're right. When spinal stenosis in the neck area goes untreated, it can lead to paralysis.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

References

Citations

Isaac Z, et al. (2005). Lumbar spinal stenosis. In WJ Koopman, ed., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp. 2087–2092. Philadelphia: Lippincott Williams and Wilkins.
Sheehan JM, et al. (2001). Degenerative lumbar stenosis: The neurosurgical perspective. Clinical Orthopaedics and Related Research, 384: 61–74.
Atlas SJ, et al. (2005). Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8- to 10-year results from the Maine Lumbar Spine Study. Spine, 30(8): 936–943.