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postheadericon I've Been Diagnosed With Spinal Stenosis… What's The Treatment?

Article by Nathan Wei

The spine consists of a number of vertebrae which are stacked, one on top of another, and separated from each other by discs. Down the center of this stack of vertebrae runs the spinal canal, an opening that accommodates the spinal cord. Between each set of vertebrae, the spinal cord sends out a pair of nerve roots.

Spinal stenosis is a condition where there is not enough room in the spinal canal for the spinal cord and nerve roots. The most common cause of spinal stenosis is disc degeneration and arthritis affecting the bony structures of the spine. Pain is often located in the low back as well as the legs.

The chief complaint is that prolonged walking or standing causes intolerable pain. If the patient is able to sit for a bit, they can resume their walking but the leg pain then returns. This type of leg pain with exertion is termed claudication. Claudication is usually due to insufficient blood flow to the legs as occurs with atherosclerosis. Claudication-like pain may also occur as a result of pressure on the spinal cord from stenosis. This pain is called “pseudoclaudication.”

Once the diagnosis of spinal stenosis is made by careful history and physical examination and confirmed by either magnetic resonance imaging (MRI) or computerized tomography (CT scanning), it is time to initiate treatment.

Treatment involves more than just medication.

If the patient is overweight, weight loss is essential. This would consist of a program of dieting plus non impact aerobic exercise. A stationary bicycle is probably the best form of exercise since it does not stress the spine like walking on a treadmill might. (In fact, one tip-off as to the cause of claudication pain, i.e. whether it is due to blood flow insufficiency to the legs versus spinal stenosis is that a patient can tolerate a stationary bike well with spinal stenosis but will develop claudication pain with arterial blood flow in sufficiency).

Water exercises using a flotation vest is another good non impact alternative.

Exercises to strengthen the core muscles are critical to a good outcome. These muscles help to support the spine and enable the patient to achieve what is called a “pelvic tilt” posture that enlarges the volume of the spinal canal.

If the patient is a smoker, they need to stop. Ingredients in tobacco reduce blood flow to the spine and impede blood flow and healing.

As far as medical therapies are concerned, non-steroidal-anti-inflammatory drugs (NSAIDS) are sometimes helpful. Adding an analgesic, either non-narcotic or a narcotic is sometimes needed for more severe pain.

Epidural steroid injection (ESI) is another helpful modality. Guidance using either fluoroscopy or ultrasound can help ensure proper location of the injection.

A relatively need method is internal disc decompression, also known as IDD. This is a computerized form of traction and can be used as an adjunctive therapy with the other treatments described above.

In patients who fail conservative measures, surgery is recommended. While there are different surgical procedures that are done they all have one thing in common… they open up the spinal canal and allow more room for the spinal cord and nerve roots to pass. In patients who have an unstable spine, they may also undergo a fusion procedure to give the spine more stability.

Outcome measures for surgical success are difficult to interpret because of the wide variation in surgical approaches, techniques, experience of the surgeon, etc

About the Author

Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment

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