Which of the following is a conservative treatment for lumbar spinal stenosis?

• A. Laminectomy
• B. NSAIDs and physiotherapy
• C. Steroid injections have robust data supporting benefit
• D. Opioid analgesics as sole therapy

Answer: (B)

Lumbar spinal stenosis is often managed first with nonoperative approaches aimed at reducing pain and improving function without surgery. The best conservative strategy combines NSAIDs with a structured physical therapy program. NSAIDs help reduce inflammation and pain, which can make it easier to participate in exercises, while physical therapy focuses on improving flexibility, core and leg strength, and gait mechanics. This combination can alleviate neurogenic claudication symptoms and improve walking distance without exposing the patient to surgical risks.

Steroid injections may offer short-term symptom relief, but the data do not show a durable, long-term benefit for most patients, so they’re not a substitute for ongoing conservative management. Opioids used as the sole therapy are not appropriate due to safety concerns and limited efficacy for chronic spinal stenosis. If conservative measures fail to control symptoms after an adequate trial, surgical decompression (such as laminectomy) becomes a consideration.