Nonoperative treatment for lumbar spinal stenosis.

The natural history of degenerative lumbar spinal stenosis is documented poorly. Little is known about the efficacy of nonoperative treatments. An aggressive nonoperative treatment consisting of therapeutic exercise, analgesics, and epidural steroid injections is proposed. The clinical evaluation of the patients is reviewed and the relevance to the selection of the nonoperative treatment plans is emphasized. Efficacy of nonoperative treatment may depend greatly on the nature and severity of the patient's symptomatic and radiographic presentation. Several studies on nonoperative treatment of patients with between 1 and 5 years of followup suggest that variably 15% to 43% of patients will have continued improvement after nonoperative treatment.