Spinal stenosis is a narrowing of the spinal canal, and results in increased pressure on the spinal cord in the segment affected. It is classified based on the anatomical area affected (cervical, lumbar or thoracic), and most commonly is caused by arthritis of the spine. Symptoms include back pain, sciatica (pain radiating down the hamstrings), sensory disturbances in the leg, motor weakness, claudication (increasing pain with activity), and occasionally urinary problems. Conservative measures such as rest, nonsteroidal anti-inflammatory medication such as ibuprofen and Tylenol, and aerobic exercise are tried before other treatments.
Epidural Steroid Injection
Inflammation has been thought to play a role in the development of spinal stenosis, which is the rationale for treatment with steroid injections in the epidural region of the spinal cord. Steroid injections decrease inflammation and swelling that may be making symptoms worse. Complications include bruising at injection site, infection, meningitis and air in the epidural space.
Laminectomy
When conservative measures fail, surgical laminectomy is the treatment of choice for lumbar spinal stenosis. The surgeon removes bone, bone spurs, and ligaments that can be responsible for nerve compression and resulting symptoms. It can be done in the traditional open method where a large incision is used to access the spine, or via minimally invasive technique, where several smaller incisions are used; the physician will decide which works best for individual cases. Complications can include wound infection, nerve damage and continuing pain and/or instability in the region.
Fusion
When spinal stenosis progresses past the initial symptoms, it cause instability of the spine. In this case, surgical fusion of the spine is undertaken. The surgeon takes a bone from another part of the body, usually from the hip or pelvis, and uses it turn two or three vertebrae into one continuous bone. This eliminates motion between the vertebrae, and rods and screws may be left in the body to accelerate the fusion process. Complications can include continued motion between vertebrae (known as pseudarthrosis), decreased range of motion, infection, spinal cord damage or nerve injury.
Interspinous Process Devices
A device known as "spacer" is fit between vertebrae in the spine and holds them apart to give space for the nerves. The advantages to this procedure is that it can be done under local anesthesia and that limited bone is removed from the body. However, not every patient is eligible and the surgeon must decide who can benefit from this novel approach. Eligibility criteria include minimum age of 50, leg/buttock/groin pain that is relieved with hip flexion, have ability to walk 50 feet and sit for 50 minutes. Complications of the procedure include migration of the device after surgery (which can necessitate reoperation), infection, bruising, spinal cord or nerve damage, and blood clot formation in the lungs.
References
- Neurologic Clinics. "Lumbar Spinal Stenosis." Chad D. Volume 25, Issue 2 (May 2007)
- "Campbells Operative Orthopaedics, 11th Edition;" Canale & Beaty; 2007
- "DeLee and Drez's Orthopaedic Sports Medicine, 3rd Edition;" DeLee; 2009
