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Spinal Stenosis

spinal stenosis

Spinal stenosis is a condition that results from the narrowing of the spinal canal, which causes pain due to impingement of the spinal cord and associated nerves. Pain experienced as a result of spinal stenosis usually affects the low back and lower extremities and often results in difficulty walking, a decrease in sensations in the lower extremities, and a reduction in physical activity. Spinal stenosis is interesting in that it is one of the few disorders that advancing in age makes one more likely to be affected without any pre-existing pathology.

Spinal stenosis is often a result of bulging disc or discs becoming herniated, but can also be a result of arthritic deterioration. In any case, spinal stenosis tends to cause disability due to the pain and reduction of mobility seen often in spinal stenosis cases. Central sensitization is a complication that often accompanies spinal stenosis.

In order to diagnose a patient with spinal stenosis, a physician will first perform a physical exam focusing on tenderness over areas of the spine and possible limitations of movement in the lower extremities. Radiological imaging will likely be ordered to check the level of stenosis. An MRI is the most common radiological imaging used to visualize back pain and is especially useful before a procedure, though fluoroscopic imaging often is used during a procedure.

There are several ways to treat spinal stenosis, both pharmacologically and using interventional options. Some of the medications that will likely be used include NSAIDs (such as ibuprofen or naproxen), membrane stabilizing drugs and other over-the-counter or prescription pain relievers. Some of the interventions that can be used to reduce symptoms include:

  • Epidural Steroid Injections-Like the name implies, ESI involves the injection of steroids into the epidural space inside of the spine, which spreads to other levels and portions of the spine. This reduces inflammation and irritation.
  • Spinal Cord Stimulation (SCS)- A spinal cord stimulator is an electrical device that is implanted in the body in order to decrease pain by confusing the spinal cord and brain pain processing centers. A trial SCS will be externally placed in order to test how effective it will be to a particular patient. If pain is relieved during a trial period, a permanent SCS will likely bring great back pain relief.
  • Surgical Treatments- Surgical treatments are usually only done as a last resort when all conservative treatments have failed to bring relief or when a condition becomes severe. A surgical laminectomy or foraminotomy might be needed to take pressure off of the spinal cord and the surrounding nerves.

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