I'm helping my 82-year-old mother figure out what to do about her spinal stenosis. It has gotten worse over time and now she has stenosis at three levels (L345) instead of just one (it started at L45). What do you suggest?

Stenosis or a narrowing of the spinal canal can cause low back, buttock, and leg pain that is worse when standing up straight, standing for long periods of time, or walking. Spinal extension narrows the spinal canal even more. Patients with this problem tend to avoid that movement and end up in a forward bent posture. That bent forward position may help alleviate some of their symptoms but it puts a lot of pressure on the front part of the vertebral bodies and can result in compression fractures.

All efforts to study this problem have assured us that conservative care (without surgery) can really benefit these patients. Sometimes a simple pain reliever combined with antiinflammatory medications is enough to reduce the pain and allow the patient to resume a more normal upright position.

Bed rest during the worst flare-ups may be advised but in general, too much bed rest has more bad effects than benefits. Getting control of the pain, staying active, and restoring normal movement are the keys to managing this problem. And it is a matter of management because without surgery to open up those pathways, the underlying pathology won't change.

Even if the patient has multiple levels of stenosis, if the vertebrae are in good alignment, they do well with nonoperative care. When surgery is the treatment of choice, results are not better for single level versus multiple level stenosis when stenosis is the only problem present.

There's no reason not to try a six to 12 week course of conservative care. Medications combined with physical therapy can be effective. Surgery can always be considered later if needed. Delaying surgery for a long as possible does not affect results later. In fact, even with multilevel spinal stenosis, patients can get better with conservative management resulting in less intense symptoms and improved daily function.