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SPINAL
STENOSIS
Definition
Spinal stenosis is
defined as narrowing of the bony spinal canal which pinches the nerves
traveling through the lumbar spine into the legs. This usually occurs in
elderly patients, and always worsens with time and age.
What kind of pain and other symptoms will I
experience?
Spinal stenosis
typically produces an aching, sometimes sharp pain into both buttocks,
thigh regions and sometimes into the calves and feet. The pain is
usually in both legs, but may involve only one leg; it is worsened by
walking even short distances, and is relieved by rest.
Spinal stenosis causes the patient to lean forward while standing or
walking, and prevents them from standing up in a fully straightened
posture. This is due to the arthritis in the facet joints of the spine,
which are enlarged. This enlargement of the facet joints of the spine is
what produces the narrowed spinal canal and the pinching of nerves in
the spinal canal, which is partially relieved by a flexed forward
posture.
Findings on examination typically show no weakness of the legs, only
pain. Reflexes may be absent. Low back pain is not a characteristic
finding of spinal stenosis; however, when it is present in association
with spinal stenosis, it is a result of arthritis.
What diagnostic tests are used for
evaluation?
MRI is an excellent
initial evaluation, as this will demonstrate spinal stenosis. More
importantly, this will reveal any tumor or herniated disc which must be
differentiated from spinal stenosis. Plain x-rays of the lumbar spine
will demonstrate arthritis, which is the precursor to spinal stenosis
with disc space narrowing and straightening of the spine, However,
x-rays will not show pinching of the nerve roots, as demonstrated on MRI
tests.
Non-invasive Doppler studies are used to diagnose lower extremity
vascular problems often confused with spinal stenosis. Nerve testing (EMG)
is beneficial to confirm nerve involvement and degree of damage.
A lumbar myelogram with subsequent computerized axial tomography or MRI
Magnetic Resonant Imaging) are the best tests to diagnose lumbar spinal
stenosis. These tests are significantly better than a CT scan without
intrathecal contrast, as they can detail nerves, soft tissue such as
disc, as well as bony detail.
Treatment
Treatment frequently
includes non-steroidal anti-inflammatory medications such as Motrin,
Voltaren, Naprosyn, Lodine, FeIdene, Indocin, Clinoril, Tolectin,
Dolobid, Advil or Nuprin. Initially, treatment commonly involves
postural training with physical therapy to flex the spine forward. This
creates a postural decompression of the nerve roots. Also, swimming pool
exercises may be beneficial. Lumbar epidural steroid injections may be
helpful in relieving the inflammation of the pinched nerves, which can
relieve the pain in the legs and buttocks region. Spinal stenosis
patients may require surgical decompression in the form of lumbar
laminectomy at the involved narrowed spinal levels where the nerve roots
are being pinched.
This surgery is indicated if:
The patient's pain is
severe enough to warrant it or if there is increasing muscle weakness,
despite the use of anti-inflammatory medications, physical therapy, and
epidural steroid injections. Notably, patients with spinal stenosis are
generally in the older age group and, therefore, their general medical
condition must also be considered. The operation is usually very
successful in relieving spinal pain. The procedure takes one to two
hours and involves minimal blood loss.
Prognosis
The prognosis without
surgery is for recurrent episodes of spinal stenosis type pain, with
achiness as described. This sometimes includes weakness in both legs
which can be treated with repeated epidural steroid injections,
anti-inflammatory medications, and short courses of physical therapy.
However, if these treatment methods do not offer relief, then surgery
becomes necessary.
The overall prognosis of spinal stenosis, without surgery, is to
progressively increase, consistent with the rate of progression of
spinal arthritis as it further narrows down the spinal column, pinching
the nerves traveling down the spinal canal down into the legs.
Recommendations
The recommendations for
spinal stenosis are the same for any arthritis. Dr. Columbus recommends
the following: Lose weight, if overweight, down to your ideal body
weight, so as to put less force on the joints of the spine and
consequently lessen spinal stenosis symptoms. Since the patient already
has the condition of spinal stenosis by the time these recommendations
are made, the patient should remain as active as possible with
low-impact exercises, primarily walking and swimming; short courses of
anti-inflammatory medications as listed above may be helpful. A back
support brace, such as a lumbar corset, may be beneficial; however, a
lumbar support seat is not usually helpful. If you smoke, QUIT! This may
be beneficial in allowing the pinched, compromised nerves in the spinal
canal to obtain improved blood flow and oxygen, to heal. Circulation of
blood carrying oxygen is restricted with smoking.
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