Spinal Stenosis
The evaluation and diagnosis of spinal stenosis requires a team approach if necessary, to accurately determine the exact cause of the condition. This is critical in outlining the most appropriate treatment program including the use of certain medications, physical therapy, intervention pain procedures, and/or surgery.
Most cases of spinal stenosis can be managed without surgery. Further, a comprehensive and multidisciplinary treatment plan that looks at the patient as a whole will produce the best and most lasting results. This is especially true in an aging population where maintaining an active lifestyle is important for ongoing general health and well-being. Spinal stenosis is a very crippling problem, but a very treatable problem.
If surgery is required, what is the best approach? The traditional operation includes a laminectomy (removing the entire backside of the spinal canal) with or without a spinal fusion (including the use of rods, plates, screws, and fusion cages). These are large and complex surgical procedures especially in an older patient population. By removing a great deal of bone from the spine to free up or decompress the spinal nerves, surgeons are concerned that the spine will become unstable and further problems develop. A spinal fusion helps address those concerns.
A minimally surgical approach for the treatment of symptomatic spinal stenosis is available avoiding the need to perform larger and more aggressive operations. The surgery is performed using micro or endoscopic techniques through very small incisions incorporating the use of microscopic instruments, drills, and lasers. The surgery can be performed under local or spinal anesthesia and requires only an overnight stay in the hospital. The success rate is 85-90% and patients can return to most normal activities within a month after surgery including golf and other recreational sports.
The traditional larger operation can always be performed later if necessary. Only a limited number of spine surgeons perform this type of surgery.
A selective nerve block, or more specifically a selective nerve root block is performed as both a treatment and a diagnostic tool for a pinched nerve.
A caudal epidural injection is similar to a regular epidural except that the injection is performed very low in the spine at a location called the sacral hiatus.
An epidural block is one of the most common pain management procedures and has been around for quite some time.
A transforaminal epidural injection is similar to the standard epidural but differs in that access to the epidural space is gained through the foraminal canal.
Radio frequency nerve ablation can be performed to destroy, or ablate, the nerve endings around a certain structure when other attempts at pain management have failed.
OTC meds for back pain (over the counter medicine) may be used to combat some of the inflammation and pain felt in the early stages of back injury.
Massage therapy including back massages, medical massages and trigger point massages help by passively stretching an injured muscle.
Back traction can come in many forms. Cervical traction and lumbar traction are believed to work by stretching the back muscles to relieve chronic spasm as well as reversing the effects of gravity.
Participating in water exercises in a low or zero gravity environment allows individuals to work muscles or joints without having to support them at the same time.
"Core" Exercises help with lower back pain by building up your lower back muscles that provide support for the spine structure.
Aerobic exercise conditioning goes hand in hand muscle stretching, joint mobilization and muscle strengthening.
Ranging from anti-inflammatory to anti-spasm medication, prescription medication for back pain can help alleviate this pain.
A laminotomy is an open surgical procedure allowing the surgeon to remove offending abnormal tissue, bone spurs, or a herniated disc.
Laminectomy surgery may either be performed as a lumbar laminectomy or a cervical laminectomy. This is an aggressive operation where the entire lamina or back side of the spine is removed.
A laminaplasty procedure can have the same benefits as the laminotomy or laminectomy but works by enlarging the bony spinal canal without removing the lamina.
A foraminotomy is used to treat a condition called foraminal stenosis. The goal of the surgery is to create a larger bony foraminal canal to take the pressure off of the exiting nerve.
A micro decompression laminaplasty is an operation performed for the treatment of symptomatic central spinal stenosis and is typically performed in patients 55 and older.
A MED (micro endoscopic decompression) procedure is performed for the treatment of symptomatic spinal stenosis.
The back surgery x-stop technique works by spreading apart the two spinous process bones in the back side of the spine and placing a spacer between them to keep them apart.
If a spinal fusion needs to be performed, we know that screw instrumentation increases fusion success rates. This is the procedure performed by the majority of spinal surgeons today, especially if a laminectomy is also performed.
Laser Ablation uses very high heat and energy of a laser to ablate the nerve endings and the adjacent affected soft tissue.
