Information extracted from www.spinalstenosis.org
There are many forms of lumbar spinal stenosis. The most common
is degenerative stenosis, occurring in virtually the entire adult
population as a result of the natural process of aging.
The posture of patients with lumbar spinal stenosis while walking
is typically bent forward, or, kyphotic. Patients will sometimes
describe how they can walk for longer periods in a store only by
leaning forward supported by a shopping cart. Extension of the spine
will often provoke symptoms while flexion will relieve them. Thus,
many patients will stop walking, and bend over or squat to relieve
their pain. The patients may only be able to walk a few hundred
meters but may be able to ride a bicycle for several kilometers.
The first diagnosis of lumbar spinal stenosis may have been made
as early as 1900 but it was not until the availability of axial
imaging, as provided by computed tomography and magnetic resonance
imaging, that there was a rapid increase in reported cases. The
effect of this dramatic improvement in medical technology can be
seen in the rapid increase in clinical literature concerning this
condition after 1976.
While some patients experience a rapid decline in physical function
and a rapid increase in symptom severity, for many more, the process
of becoming disabled from lumbar spinal stenosis is a slow one.
Once the diagnosis has been made positively, the process of treating
the disease begins with a regimen of non-invasive conservative therapy.
Conservative treatment typically consists of bedrest and controlled
physical activity, physiotherapy, anti-inflammatory drugs, epidural
steroid injections and the use of a lumbar corset. While some patients
are able to obtain some relief from symptoms with these measures,
many others do not. The most common surgical procedure for stenosis
is a decompressive laminectomy sometimes accompanied by fusion.
The indications for the surgical treatment of lumbar spinal stenosis
are not absolute. It is generally agreed that surgery is elective,
performed to improve the quality of life for individuals who have
disabling back and leg pain and significant limitations in walking
tolerance. This leaves many patients under-served by currently available
treatments as their symptoms and pain do not warrant massive spinal
surgery and yet they are tired of limiting their daily activities
to manage pain. There may be hope for these patients.
Led by Dr. James Zucherman and Ken Hsu, both of the St. Mary's
Spine Center, San Francisco, California, investigational centers
around the country are currently enrolling patients in a randomized
clinical study to evaluate a new, minimally invasive surgical therapy
aimed at treating mild to moderate symptoms of lumbar spinal stenosis.
The out-patient procedure is perfomed under local anesthsia and
does not involve the removal of any soft tissue or bone.
The technique involves placing a small titanium spacer posteriorly
in the lumbar spine. For inclusion, a patient must have completed
at least six months of conservative therapy, which may include physical
therapy, bracing, and/or systemic or injected medications. In addition,
the patient must be willing to receive the investigational device
or continue non-operative therapy. If a patient finds this unreasonable,
he or she would be excluded from participation. The duration of
the study is two years. If a patient is unable to complete two additional
years of non-operative therapy, he or she will be offered surgery
as an option.
- 1.1 Definition and Classification
- 1.2 The
Normal Aging of the Spine; The Degenerative Cascade
- 1.2.1 Clinical Presentation
of Lumbar Spinal Stenosis - A Puzzle
- 220.127.116.11 Neurogenic
- 18.104.22.168 Radicular
- 22.214.171.124 Atypical Leg
- 126.96.36.199 Cauda Equina
- 1.2.2 Diagnosis of Lumbar
- 2. Current
- 2.1 Conservative Treatment
- 2.1.1 Bed
Rest, Orthosis and Controlled Physical Activity
- 2.1.2 Physical Therapy
- 2.1.3 NSAIDs
- 2.1.4 Epidural Injections
- 2.2 Decompressive Laminectomy
- 2.2.1 Success Rates
- 2.2.2 Indications
- 2.2.3 Complications
- 3. Footnotes
- 4. Links
Further information can be found at:
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Spinal Stenosis - Information About Spinal Stenosis
The horrible pain caused by stenosis, treatments, doctors, and medications.