Spinal Stenosis

Description


Spinal stenosis can be defined as degeneration of one or more spinal segments, producing a narrowing of the spinal canal. This problem is much more common in people over the age of sixty, and invariably worsens with time and age. Stenosis is the culprit for back discomfort, leg pain and weakness brought on by activity, nerve root irritation, and lower extremity dysfunction. Pain is typically relieved when sitting or lying down. After years of wear and tear, many structural changes occur in the spinal canal such as: bone spur formation around the facet joint and disc space, herniation of the discs themselves, and thickening of the ligamentous structures connecting the vertebra together. These changes produce a narrowing of the spinal canal. This narrowing of the spinal canal (stenosis) minimizes the space in which the nerve lies. The nerve eventually becomes compressed, and blood flow to the nerve becomes restricted producing leg pain.

Symptoms

In many cases there is slow progression of pain in the lower back, buttock, thigh, and calf. Patients will present to the office with complaints of fatigue, weakness, cramping, and difficulty walking or standing for any prolonged period of time. Patients feel markedly better with rest, lying, sitting, or adopting a position of flexion at the waist when walking (leaning forward on a shopping cart). The pain comes on and increases with activity.

Treatment

The treatment for spinal stenosis can be conservative or surgical, depending upon the severity of pain and progression of neurological symptoms. Physical therapy, rest, anti-inflammatory medication, and epidural steroid injections should be tried. Pain typically waxes and wanes; in many instances the passage of time, with or without other modalities, lessens the patients symptoms. If conservative measures do not provide adequate relief of symptomology, surgical intervention may be a consideration. Surgery is an alternative for those patients who have progressive difficulty with ambulatory activities, neurological dysfunction, incontinence due to stenotic changes, or restriction of lifestyle that is unacceptable.

Procedures

Spinal Injections

Spinal injections are used to diagnose and treat spinal conditions. With most spinal injections, a local anesthetic (numbing medication) is injected into a specific area of the spine. The anesthetic is fast-acting, but the effects wear off within about two hours. A strong anti-inflammatory steroid medication, such as cortisone, is usually injected with the anesthetic to reduce inflammation in the affected area. Cortisone is long lasting and can be slow releasing in order to give the best possible benefit of pain relief. Cortisone may take several days to start working, but the effects may last for months.

Several of the injections given at our office under fluoroscopic guidance include:

Epidural Steroid Injections - Good for reducing radicular pain caused by nerve root irritation from herniated discs and spinal stenosis. The patient may require a series of several epidural injections over a period of a few weeks.

Transforaminal Injections - Selective injection around a specific nerve root and into the spinal canal. This is more effective for nerve compression with sciatica.

Facet Joint Injections - Used to localize and relieve low back and neck pain caused by arthritic facet joints.

Sacroiliac Joint Injections - Used for pain from an inflamed sacroiliac joint.