Spinal stenosis is caused by a narrowing of the spinal canal that compresses the nerves, either within the spinal cord or as they leave the cord and pass through narrow openings in the spine.

There has been disagreement among doctors about the most effective treatment to relieve this painful and often debilitating condition: medical management with powerful pain medications or more invasive treatment with surgery.

Lumbar spinal stenosis is more frequent with aging and is the most common reason for spinal surgery in the U.S. Its most common symptom is pain that radiates to the legs. Pain in the buttocks or legs is generally made worse by standing or walking but is quickly relieved by sitting or lying down.

Other symptoms include numbness or tingling both in the legs and feet and, less often, weakness in the legs. Most of the time, symptoms affect both legs. It is important to note, however, that people with spinal stenosis often have no symptoms, despite X-ray evidence of the disorder.

Now a large study involving over 650 patients, published in the February 21 issue of the New England Journal of Medicine, indicates that surgery might be your best bet for gaining some relief from these symptoms. Earlier, smaller studies have also demonstrated a benefit from surgery compared with non-surgical management.

After a two-year follow-up, the patients with stenosis of the lumbar spine who underwent decompressive surgery showed significantly greater improvements in their symptoms than did those whose condition was managed without surgery. Surgery yielded significantly greater improvements in pain, function, satisfaction, and the patients' own assessment of their progress.

The symptoms of those who did not have surgery did not worsen during the two-year period of the study; in fact, on average, they improved slightly.