Spinal stenosis
Spinal stenosis is a disorder due to narrowing of the spinal canal that causes nerve and spinal cord impingement. Often this results in persistent pain in the lower back and lower extremities. Difficulty walking, decreased sensation in the lower extremities, and decreased physical activity may also be seen. Spinal stenosis most commonly affects people over the age of 65.
Pathology
In spinal stenosis, symptoms are due to complications from the narrowing of the spinal canal where the spinal cord is located. This constriction produces symptoms of impingement on the spinal cord, spinal vasculature, and surrounding peripheral nerves. Disc bulging and herniation as well as arthritic changes of the vertebrae can cause narrowing of the canal.
Diagnosis
Diagnosis of spinal stenosis is most often done clinically by a physician. The physician performs a physical examination demonstrating tenderness over certain areas of the spine as well as assessing the various limitations in movement of the lower extremity. The physician most likely will order radiological imaging, such as a CT scan or MRI, to visualize the level of stenosis. Currently MRIs are the standard of care to visualize chronic back pain and are especially useful before any procedures are undertaken.
Treatment for Spinal Stenosis
Medications: NSAIDs (ibuprofen-like drugs), membrane stabilizing drugs, and other analgesics are often used in the management of pain associated with spinal stenosis. In the past few years, there has been an abundance of research surrounding non-surgical and non-pharmacological procedures and their effectiveness in treating spinal stenosis.- Epidural steroid injections: This procedure involves injecting a medication into the epidural space, where irritated nerve roots are located. This injection includes both a long-lasting steroid and a local anesthetic (lidocaine, bupivacaine). The steroid reduces the inflammation and irritation and the anesthetic works to interrupt the pain-spasm cycle and nociceptor (pain signal) transmission (Boswell 2007). The combination medicine then spreads to other levels and portions of the spine, reducing inflammation and irritation. The entire procedure usually takes less than 15 minutes. The most important and greatest success achieved with the use of epidural steroid injections (ESI) is the rapid relief of symptoms that allows patients to experience enough relief to become active again. With this, they regain the ability to resume their normal daily activities.
- Spinal cord stimulation: SCS involves implanting an electrical device that decreases the perception of pain by confusing the spinal cord and brain pain processing centers. Initially a trial is done to see if this device will help you long-term. In the initial trial, a small electrical lead is placed in the epidural space by your pain physician. Painful signals are replaced by tingling electrical signals. If you have success in your trial, you may decide to have a permanent SCS device implanted.
Alternative treatments
- Surgical treatments: When all conservative measures have been exhausted and the symptoms continue to be severe, a more invasive surgical laminectomy or foraminotomy may be necessary to take pressure off the spinal cord and surrounding nerves. Often surgical decompression is recommended in acute spinal stenosis and especially in patients who rapidly develop loss of bladder/bowel function, weakness, and decreased sensation.
