I've Been Diagnosed With Spinal Stenosis… What's
The Treatment?
Author: 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:
http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html