DIAGNOSING LUMBAR SPINAL STENOSIS
Before confirming a diagnosis of stenosis, it is important for your
doctor to rule out other conditions that may produce similar symptoms. In
order to do this, most doctors use a combination of techniques, including:
- History - Your doctor will begin by asking you to describe any
symptoms you have and how the symptoms have changed over time. Your
doctor will also need to know how you have been treating these symptoms,
including medication you have tried.
- Physical Tests - Your doctor will then examine you and check
for any limitations of movement in your spine, problems with balance,
and signs of pain. Your doctor will also look for any loss of reflexes,
muscle weakness, sensory loss, or abnormal reflexes.
- After examining you, your doctor may use a variety of tests to
confirm the diagnosis. Examples of these tests include:
- X-ray - shows the structure of the vertebrae and the outlines of
joints.
- MRI (Magnetic Resonance Imaging) - provides a three-dimensional
view of our back and can show the spinal cord, nerve roots, and
surrounding spaces, as well as signs of degeneration, tumours or
infection.
- CT (Computerized Tomography) scan - depicts the three-dimensional
shape and size of your spinal canal and bony structures surrounding
it.
- Myelogram - highlights the spinal cord and nerves after a dye is
injected into your spinal column, which appears white on an x-ray film
Caution: Radiological evidence of stenosis must be correlated with
your symptoms before the diagnosis can be confirmed.
TREATMENT OPTIONS
Once a diagnosis of spinal stenosis is confirmed, the process of
treating the condition usually begins with a regimen of non-surgical,
"conservative" therapy.
NON-SURGICAL TREATMENT OF STENOSIS
There are a number of ways a doctor can treat stenosis without surgery,
including:
- Medication, such as non-steroidal anti-inflammatory drugs (NSAIDs)
to reduce swelling and pain, and analgesics to relieve pain.
- Corticosteroid injections in the epidural space (so-called "epidural
steroid injections, ESI") to reduce swelling and treat acute pain that
radiates to the hips or down the leg. Pain relief from an epidural
injection may be temporary and patients are usually advised to get no
more than 3 injections per 6-month period.
- Rest or restricted activity.
- Physical therapy and/or exercises to help stabilise the spine, build
endurance and increase flexibility.
While some patients obtain relief from symptoms with these treatments,
others may not or symptoms may come back, as the underlying condition
progresses.
When after a minimum of 6 months conservative treatment does no longer relieve the symptoms, surgery may become an option.
SURGICAL TREATMENT OF STENOSIS
Open Surgical Decompression
The most common surgical procedure for stenosis is a
decompressive laminectomy, sometimes accompanied by fusion. Often referred
to as "unroofing" the spine, this procedure involves the removal of
various parts of the spine, including:
- the lamina, as well as the attached ligaments, that cause
compression of the spinal cord and nerve roots, and/or
- enlarged facets, osteophytes and bulging disc material
The goal of the surgery is to relieve pressure on the spinal cord and
nerves by increasing the area of the spinal canal and neural foramen.
Other types of surgery to treat stenosis include:
- Laminotomy - only a small portion of the lamina is removed
- Foraminotomy - the foramen (the opening through which the
nerve roots exit the spinal canal) is enlarged
- Facetectomy - part of the facet joint is removed
MINIMALLY INVASIVE TREATMENT ALTERNATIVE
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