Spinal stenosis is a condition that involves the narrowing of the spinal canal and/or its lateral openings. This condition leads to compression of the nerve passing through such channels which, in turn, can cause neurogenic symptoms.

The two most common types of stenosis are lumbar stenosis and cervical stenosis. The former can lead to neurogenic claudication, while the latter can lead to myelopathy and/or radiculopathy.

Treatment pathways for either condition depend on the severity of the stenosis and the degree to which it has progressed. The following guide will help provide some direction to individuals suffering from spinal stenosis.

I. Conservative Management & Manual Therapies

A. Physical Therapy + Manual Therapy

The first type of conservative treatment for stenosis is a combination of physical therapy and manual therapy. It is best for mild-moderate lumbar stenosis with claudication and/or cervical stenosis with mild radiculopathy.

The approach here usually entails flexion-based exercises, manual mobilization, and an effort to educate the patient (of things to do and exercises to avoid) and modify certain cognitive-behavioral elements.

A study on Springer found that ”supervised physical therapy yielded similar effects to lumbar surgery.”¹ Hence, patients are usually encouraged to seek out the less invasive physical therapy first.

These therapies can be accessed at hospitals, private physical therapy clinics, or spine rehab centers. In Anchorage, AK the locations that provide such include:  

• Better Health Alaska
• Advanced Physical Therapy
• Progressive Physical Therapy
• Alaska Physical Therapy Specialists

B. Chiropractic Care (Flexion-Distraction & Mobilization)

Chiropractic care is another type of conservative care effective against stenosis. It is best used in situations involving patients with lumbar stenosis who are seeking non-surgical symptom relief.

The techniques used are usually flexion-distraction techniques combined with gentle mobilization. However, HVLA  (high velocity, low amplitude) techniques are discouraged and should not be used.

A case report on PubMed involving a 78-year-old man with multilevel stenosis showed that he improved after flexion-distraction sessions and experienced sustained benefit at five months.²

This type of care can be found at a healthcare office with chiropractors specializing in stenosis or sports/integrative medicine. An excellent choice for chiropractic care in Anchorage, AK is:

• Better Health Alaska

II. Medical Management & Injections

A. Epidural Steroid Injections (ESI)

Epidural steroid injections (ESI) are another avenue of treatment for spinal stenosis. These are usually best in situations involving lumbar or cervical stenosis with radicular symptoms (pain, numbness, or other sensations affecting other parts body serviced by the nerve affected).

The best places to go for ESI treatment are interventional pain clinics, PM&R clinics, and/or spine specialist practices. In the Anchorage area, these include:

• Alaska Center for Pain Relief, Inc.
• Algone Anchorage Interventional Pain Clinic
• Advanced Pain Centers of Alaska

III. Surgical and Minimally Invasive Options

A. Decompressive Surgery (Laminectomy, Laminotomy)

Another option available is decompressive surgery (e.g. laminectomy, laminotomy). This is best in situations involving moderate to severe stenosis that remains after conservative care has been attempted unsuccessfully for a sufficient length of time.

In fact, a study on PubMed found that decompressive surgery was “more effective than continued conservative treatment after the latter has failed for 3 to 6 months.”³ However, the study on Springer cited earlierstill indicates that supervised physical therapy can delay or match recovery in some cases.⁴ 

Decompressive surgery can be performed at neurosurgery or orthopedic spine centers. The following locations in Anchorage provide this type of care:

• Denali Injury and Spine Center
• Alpine Surgery Center
• Anchorage Neurosurgical Associates

B. Spinal Fusion (with Decompression)

In some cases, in addition to decompression, spinal fusion may be needed. This is generally for situations where the stenosis occurs in conjunction with instability or deformity. The fusion allows for stabilizing the spine and providing a greater degree of movement going forward.

This type of surgery can be accessed at specialty spin surgery centers – who, very often, have fusion capabilities. Locations in Anchorage who have this capability include:

• Anchorage Neurosurgical Associates
• Alaska Regional Hospital
• Alaska Spine Center

IV. Emerging & Adjunct Therapies

A. Spinal Implant Devices (e.g., X-STOP)

Another option, but one that comes from the realm of emerging and adjunct therapies, is a spinal implant device like, for example, the X-Stop device. This is a device implanted in the back to create more space in the spine and keep pressure off the spinal cord.

These are usually best for selected cases of moderate lumbar stenosis. Access to such treatments is usually limited to spine surgeons specifically trained in interspinous device implantation.

V. Where to Seek Care

Here is a small table summarizing where you can find the various types of care and treatment discussed above.

Conclusion

There are several takeaways from the discussion above. First, it is clear that the science and evidence supports conservative care as a first-line defense against spinal stenosis – especially when such care incorporates manual therapy and exercise. Additionally, chiropractic with flexion-distraction offers a non-invasive option with growing, albeit limited, evidence.

Although effective, surgery is, generally, only recommended for cases that are unresponsive to conservative treatment, and spinal fusion, in particular, is only added when instability is present. Lastly, always remember that early referral to the appropriate specialists maximizes the chances of experiencing symptom relief and function restoration.

Here, at Better Health Alaska, we offer multiple treatment modalities to treat spinal stenosis: chiropractic care and physical therapy – to name just two. We also have a wealth of knowledge on the condition and can provide the necessary referral in cases that require surgery or other more heavy-hitting techniques. So, reach out and make an appointment today. We’ll get you back to your healthier self.

Studies and Sources:

1. Minetama, M, et al., “Supervised physical therapy versus surgery for patients with lumbar spinal stenosis: a propensity score-matched analysis,” Springer Nature Link, Volume 23, article # 658, (2022), link.springer.com 
2. Snow, G. J., “Chiropractic management of a patient with lumbar spinal stenosis,” PubMed, 2001 May;24(4):300-4, https://pubmed.ncbi.nlm.nih.gov/11353943/
3. Kovacs, F. M., “Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials.” 2011 Sep 15;36(20):E1335-51. https://pubmed.ncbi.nlm.nih.gov/21311394/ 
4. Minetama, “Supervised physical therapy,” link.springer.com