Primarily a degenerative, age-related narrowing of the lower spinal canal that causes pressure on the nerves, leading to pain and reduced mobility. Lumbar Spinal Stenosis is a common condition, with more than 1.2 million patients diagnosed and treated nationwide each year. Spinal Stenosis means the cavity or pathway that nerves are contained in has gotten real tight. Why did it get real tight? A patient could have a herniated disc or developed growth of the ligaments in the back part of the spine. Once it gets too tight, all the nerves get pinched off and patients have cramping in their legs and weakness. The classic symptom of Lumbar Spinal stenosis is called neurogenic claudication. When walking upright, cramping/weakness gets worse, and improves if the patient walks hunched over (lumbar flexion).
Who Gets LUMBAR SPINAL STENOSIS?
Lumbar Spinal Stenosis is suffered mainly by the middle-aged and elderly. Onset generally occurs after age 50.The prevalence of Lumbar Spinal Stenosis is likely to increase over the next decade. The number of Americans over age 50 will grow by 18 million between 2009 and 2019.
What is the Cause of LUMBAR SPINAL STENOSIS?
Lumbar Spinal Stenosis, or the narrowing of the lower (lumbar) spinal canal, can have several contributing factors such as thickening of the ligaments, formation of excess bone, and bulging of the discs. These issues can reduce space in the lower spinal canal and put pressure on the spinal cord and nerves in the lower back.
Symptoms & Effects of LUMBAR SPINAL STENOSIS
The hallmark symptom of Lumbar Spinal Stenosis is neurogenic claudication, which is characterized by a specific set of symptoms including pain, tingling or numbness in the lower back, legs or buttocks when standing or walking. Discomfort can be relieved by sitting or bending forward. Patients commonly complain of difficulty walking even short distances and might do so with a stooped posture in more advanced cases.Lumbar Spinal Stenosis patients are often limited in their ability to pursue normal daily activities, including work, social, and recreational activities. A lack of activity due to pain and immobility can lead to obesity and associated health problems, as well as depression.
Patients diagnosed with Lumbar Spinal Stenosis historically had to choose between palliative, short-term treatments and more invasive, longer-term procedures. Palliative treatments are low-risk and include:Physical therapyAcupunctureExerciseChiropractic care.
In addition, symptom management can include the use of medications, epidural steroid injections and pain pumps. These options do not treat the underlying cause of the symptoms and typically provide only temporary relief. In the past, when patients’ symptoms could no longer be managed with these treatments, they faced the prospect of more invasive surgical procedures such as laminectomy (partial removal of the lamina, a plate of bone in the vertebrae), laminectomy (removal of the entire lamina and the ligaments that are attached to it) or spinal fusion (the permanent joining of two or more vertebrae to eliminate movement between them). Each of these carries a substantial risk of complications and results in changes to the natural anatomy and structural stability of the spine. The mild® procedure presents an option that treats the underlying cause of LUMBAR SPINAL STENOSIS symptoms in a safe and minimally invasive way and provides lasting relief for many patients.
MILD (minimally invasive lumbar decompression)
MILD (minimally invasive lumbar decompression) is a safe procedure that can help many patients diagnosed with Lumbar Spinal Stenosis stand longer and walk farther with less pain. It is a short, outpatient procedure performed through an incision the size of a baby aspirin that requires no general anesthesia, no implants and no stitches. The procedure has a reported positive-response rate of 81 percent and more than 15,000 patients have undergone the procedure nationwide. After the mild procedure the patient is able to go home the same day. If it works the patient is cured. If mild is not successful, major surgery can be the second option where a surgeon will removed bone to relieve pressure.
Lumbar/Cervical/Thoracic Epidural Steroid Injection
Epidural steroid injections (ESIs) are a common treatment option for many forms of low back pain and leg pain. They have been used for low back problems since 1952 and are still an integral part of the non-surgical management of sciatica and low back pain. The goal of the injection is pain relief; at times the injection alone is sufficient to provide relief, but commonly an epidural steroid injection is used in combination with a comprehensive rehabilitation program to provide additional benefit.
Most physicians will agree that, while the effects of the injection tend to be temporary – providing relief from pain for one week up to one year – an epidural can be very beneficial for a patient during an acute episode of back and/or leg pain. Importantly, an injection can provide sufficient pain relief to allow a patient to progress with a rehabilitative stretching and exercise program. If the initial injection is effective for a patient, he or she may have up to three in a one-year period.
In addition to the low back (the lumbar region), epidural steroid injections are used to ease pain experienced in the neck (cervical) region and in the mid spine (thoracic) region.
Intrathecal Pump Implant
An intrathecal pump or pain pump works to relieve chronic pain by inserting small amounts of medicine directly into the intrathecal space (area surrounding the spinal cord) to prevent pain signals from being perceived by the brain. Because medication is placed directly into the spine, we can give 1/300 of the dose taken by mouth. Medications commonly used are Morphine, Dilaudid, Bupivicaine, Baclofen (for spasticity), and Prialt. Since using smalled dosages of medication, patients usually don’t experience the side effects from these medications by mouth (confusion, sleepiness, constipation, etc). Also, medication is administered 24 hours a day so a patient does not feel the “highs and lows” seen with oral medication. Pain pump are used on patients with chronic debilitating pain that have had relief no other way (cancer; chronic pain from failed surgeries, multiple sclerosis, spasticity, etc). The pain pump is programmed and regulated at our clinic. The pump is refilled every few months. The medicine can be changed and periodic adjustments can be made.