Management for symptomatic spinal canal stenosis

Most, if not all, treatments for symptomatic spinal canal stenosis are of unproven benefit. Nonoperative treatments can include exercise, cognitive behavioural interventions and advice (eg teaching the pelvic tilt to reduce the lumbar lordosis and maximise spinal canal diameter when standing and walking). One trial found that an intensive 6-week structured exercise program plus advice and cognitive behavioural interventions improved walking ability compared with a 6-week program of self-directed exerciseAmmendolia, 2018, 2018. This type of intervention may not be suitable for all patients.

Epidural corticosteroid injection is often considered; however, evidence does not demonstrate a benefitChou, 2015. Oral corticosteroids are not effective for symptomatic spinal canal stenosis.

Surgical consultation is indicated for all patients with severe or progressive neurological deficits, or for any patient if there is concern about a neurological deficit. Surgical consultation should be considered for patients with severe, limiting symptoms of neurogenic claudication. However, relative benefit of surgery compared with nonoperative care is uncertain, and does not seem to be related to the diameter of the widened canal. Fusion added to decompression confers no additional benefit. The risk of harms from surgery increases with advancing age, comorbidity and concurrent fusionMachado, 2015Zaina, 2016.