Lumbar
stenosis treatment - What can I
do to relieve the pain and numbness? Once
you know you have lumbar spinal canal stenosis,
you have several choices for treatment.
Your treatment will depend on how bad your
symptoms are. If your pain is mild and you
haven't had it long, you can try an exercise
program or a physical therapy program. This
can strengthen your back muscles and improve
your posture. Your doctor may also prescribe
medicine to help reduce inflammation (soreness
and swelling) in your spine.If you have
more severe symptoms, you may need to see
a spine surgeon. The surgeon may recommend
surgery to take the pressure off the nerves
in your lower spine. This surgery works
well for many people.
An initial course of non-surgical therapy is recommended. Pain reduction with activity modification and relative rest. Strict bed rest no longer advocated. Patients become active as soon possible. Avoid heavy lifting and trunk extension. An elastic lumbar binder for a short period of time. Medications include Nonsteroidal anti inflammatory drugs, Muscle relaxants occasionally, Gabapentin and tricyclic antidepressants for neuropathic pain, Oral corticosteroids for acute flare-ups used briefly. Narcotics prescribed sparingly, cause constipation and habit forming. Therapy modalities and chiropractic treatment have no prospective randomized studies proving their benefit. Chiropractic manipulation is useful when the symptoms are posture dependent. Usually not recommended, but if desired, avoid extension manipulation. Epidural steroid injections reduce the radicular pain with analgesic and anti-inflammatory effects, and may facilitate progression to physical therapy. Acute radicular pain is best treated with a nerve-root block (NRB). Studies show 72% short-term benefit, 28% 2 year success with NRB, and 71% who initially requested surgery decided not to after NRB. Physical therapy is mainly flexion-based exercises, including exercises on a stationary bicycle and inclined treadmill, aquatic therapy, stretching and strengthening, and patient education on posture and daily activities. Non-surgical treatment can minimize the progression of symptoms but is unlikely to affect the underlying pathology. With non-surgical treatment four years later, the pain level is unchanged in the majority of patients and 42% were satisfied with the outcome. Although conservative measures may be of little long-term benefit, nonsurgical is the first line of treatment for lumbar stenosis, reserving surgery for intolerable pain, a progressive neurologic deficit, cauda equina syndrome (which is rare), and patients for whom conservative measures have failed.
Conservative Treatment Cervical Stenosis
An initial course of non-surgical therapy is recommended. Most often, early cervical stenosis can be treated with stretching and strengthening exercises, over the counter medications, and lifestyle modifications. Acute neck pain may be treated with a cervical collar for 6-12 weeks. Physical therapy such as modalities and electrical stimulation followed by isometric exercises may be added . Sometimes, acute flare-ups may be treated with a brief course of medications, including Nonsteroidal antiinflammatory drugs, Muscle relaxants occasionally, and Gabapentin or tricyclic antidepressants for neuropathic pain, Oral corticosteroids for acute flare-ups may be used briefly. Narcotics prescribed sparingly, cause constipation and habit-forming. Epidural steroid injections reduce the radicular pain with analgesic and anti-inflammatory effects, and may facilitate progression to physical therapy. Traction is contra-indicated in myelopathy. Physical therapy is mainly stretching and strengthening, and patient education on posture and daily activities. In patients with myelopathy, non-surgical treatment can minimize the progression of radicular symptoms in the arms but is unlikely to affect the underlying pathology. With non-surgical treatment four years later, the pain level is unchanged in the majority of patients and only 42% were satisfied with the outcome. Although conservative measures may be of little long-term benefit, conservative options are the first line of treatment for cervical stenosis, reserving surgery for intolerable pain, a progressive neurologic deficit and patients for whom conservative measures have failed.
As a 61 year old real estate agent Mrs. T. is always on the go. She began experiencing myelopathic symptoms. She has a long-term complaint of neck pain usually controlled with ibuprofen (Motrin™) and some home exercises. Occasionally, she wears a soft cervical collar to calm her neck spasms. In the past two months, however, she finds that her fingers are becoming clumsy, and she has to take frequent breaks. In addition, Mrs. T. is finding that she is not as agile buttoning her shirts in the morning. She is not complaining of any pain in the arms or legs. Interestingly, her legs are a bit wobbly, but she attributes that to some arthritis that has set in over the years. Mrs. T. has had no problems urinating on her own, and no change in her bowel habits or control. Examination showed diminished reflexes in the arms and hyper-active reflexes in the legs. The MRI scan clearly showed that she suffered from multifocal cervical stenosis. Treatment may include physical therapy, medication, pain-blocking injections, or surgery. She elected surgery that thankfully was without problem. After three months, she felt that her fingers were working better and she no longer felt wobbly in the legs. She returned to knitting, producing a blue baby bonnet for her newborn grandson.
Risk Factors for Spinal Stenosis
Spinal Stenosis Risk Factors
Is lumbar spinal canal stenosis the same as a ruptured disk? Lumbar spinal canal stenosis is not the same as a ruptured disk. A ruptured (also called "herniated") disk usually pinches 1 or 2 nerves at a time. The pain caused by a ruptured disk in the lumbar spine is usually easy to diagnose. This pain has a special name: "sciatica." Sciatica usually causes back pain that shoots down one leg. This pain can happen any time, not just when you stand up or start walking.