Spinal Stenosis treatment

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SPINAL STENOSIS TREATMENT
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WHAT IS SPINAL STENOSIS?
Sometimes we go through lifes little aches and
pains without so much as a Hello! to our family
doctor. The most famous words we use as we set
these small discomforts aside are Heck! Im
getting old. Not until the situation has grown
extremely critical and the pain has become
piercing, coupled with a certain numbness, do we
sit up and take notice. Spinal Stenosis creates
circumstances almost exactly like these. Within
your spine are open spaces through which your
body nerves travel. When these spaces start to
narrow and become smaller, it can put pressure on
your spinal cord and nerves. When this happens,
you are said to be suffering from Spinal
Stenosis. It usually develops in the neck and the
lower back. While some persons develop no
tell-tale signs or symptoms, Spinal Stenosis can
bring about pain, weakness in the muscles,
numbness and sometimes problems with bowel and
bladder function. Spinal Stenosis generally
occurs as a consequence of wear and tear changes
in the spine as you grow older.
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NON-SURGICAL TREATMENT FOR SPINAL
STENOSISMEDICATIONS
Less than 5 of patients with a spinal disorder
ever require spine surgery. There are several
non-surgical options your doctor may recommend to
treat your spinal stenosis. Often, treatment
combines more than one type of therapy. For
example, medication may be combined with physical
therapy. Let's review a few of the non-surgical
therapies one by one.
OVER-THE-COUNTER MEDICATIONS FOR SPINAL
STENOSIS Unless your symptoms are very serious,
your physician will probably choose to start out
your treatment with medication. You can probably
agree with this The main goal is to relieve your
pain and inflammation. Pain relievers such as
acetaminophen (Tylenol) can control pain, but
don't have any effect on inflammation. If you
want to fight both your pain and inflammation,
you may consider non-steroidal anti-inflammatory
drugs (NSAIDs). These products relieve pain and
also reduce inflammation and swelling. NSAIDs
include aspirin, ibuprofen (Advil or Motrin),
indomethacin, and naproxen. PRESCRIPTION
MEDICATIONS THAT MAY RELIEVE YOUR PAIN If you've
taken over-the-counter medications but are still
experiencing spinal stenosis pain, your doctor
may recommend prescrip- tion medications to
combat your pain. Prescription-strength NSAIDs
are a common prescription medication used to
control spinal stenosis pain.
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NON-SURGICAL TREATMENT FOR SPINAL
STENOSISSPINAL INJECTION

• SPINAL INJECTIONS A PAIN MANAGEMENT OPTION FOR
  SPINAL STENOSIS
• If you have a severe case of spinal stenosis, a
  pain management specialist may inject a
  corticosteroid medication into the spinal fluid
  around your spinal cord and nerve roots. This may
  be referred to as an epidural steroid injection.
  This injection targets the epidural space, which
  is the space surrounding the membrane that covers
  the spinal cord and nerve roots. Nerves travel
  through the epidural space to the neck,
  shoulders, arms, and legs. If a nerve root is
  inflamed in the epidural space, you can have
  pain.
• The epidural injection may provide total and
  permanent reliefor it may reduce your pain for
  several weeks to several months.
• Corticosteroids can be especially helpful in
  treating pain that radiates down the back of your
  leg. Many people report almost imme- diate relief
  from the injections. But corticosteroids can have
  significant side effects. These are rare, but you
  should know and discuss the risks with your
  doctor.

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NON-SURGICAL TREATMENT FOR SPINAL STENOSIS
SPINAL INJECTION

• Potential side effects of corticosteroids
  include
• increased pain where you had the injection
• fever after you get the injection (if it's above
  101ºF for more than 24 hours, you should let
  your doctor know)
• anxiety
• weight gain
• trouble sleeping
• high blood sugar (more so for people with
  diabetes)
• high blood pressure
• decreased ability to fight infection (more so for
  people who already have an infection)
• stomach ulcers
• damage to the bones in your large joints, like
  your hips (that's called avascular necrosis)
• cataracts
• After an epidural injection, call your doctor
  immediately if you
• have trouble controlling your bladder and/or
  bowels
• lose feeling and/or function in your arms or legs
• have a terribly painful headache when you sit up
  or stand, and the only way to make it feel better
  is to lay down
• have extreme pain that doesn't go away when you
  try typical pain-fighting measures (eg,
  over-the-counter medications)
• Because of these potential serious side effects,
  most doctors limit the number of injections a
  patient receives. The actual number of injections
  a patient receives is determined by many factors.
  Be sure to talk through this issue with your
  doctor.

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NON-SURGICAL TREATMENT FOR SPINAL
STENOSIS EXERCISES

• If you are in pain from spinal stenosis, you
  probably don't even want to think about
  exercising. However, as counterintuitive or
  impossible as it sounds, exercise, stretching,
  and movement can help relieve your spinal
  stenosis pain.
• A few notes first
• Please, before starting any exercise regimen or
  activity, talk to your doctor. He or she may have
  recommendations for what types of exercise would
  be best for you, and he or she will be able to
  caution you against certain exercises. Since
  your doctor knows your pain history and symptoms
  well, he or she is your best resource for
  information and recommendations.
• You should, in general, avoid any activities that
  put too much stress on your spine (contact
  sports, for example).
• The old adage "no pain, no gain" doesn't apply
  here. What you're trying to do is take good care
  of your spine, strengthen the muscles that
  support the spine, and maintain your
  range-of-motion you aren't trying to become a
  power lifter or Olympic swimmer. Pay attention
  to your body's signals, and if your pain
  increases or if you notice new pain, stop and
  call your doctor.

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NON-SURGICAL TREATMENT FOR SPINAL STENOSIS
EXERCISES
TYPES OF EXERCISE FOR PEOPLE WITH SPINAL
STENOSIS Walking is a suitable exercise for you
if you have spinal stenosis. It is low-impact,
and you can easily vary the pace as needed.
Consider a daily walk (perhaps on your lunch
break or as soon as you get home). As a bonus, a
daily walk is an excellent time to de-stress (if
you need that), and, if you can swing it, a walk
outdoors can be beautiful. Swimming is also an
ideal exercise because it exercises all your back
muscles in a safe, supportive environment. The
water supports your weight well, which means that
there's less weight on your back. You could also
do water walking. In the active part of physical
therapy, your physical therapist may show you
exercises and stretches to help you build and
maintain strength, endurance, and flexibility for
spinal stability. Some of these exercises will
help strengthen your abdominal muscles since they
help support your backand yes, it will be more
than doing sit-ups. Your physical therapist will
create an indi- vidualized program, taking into
consideration your health and history. Your
exercises may not be suitable for another person
with spinal stenosis.
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NON-SURGICAL TREATMENT FOR SPINAL
STENOSIS PHYSICAL THERAPY
Your doctor may refer you to a physical therapist
to help relieve your pain from spinal stenosis
and restore movement. Whether you have surgery or
not, physical therapy may be a key to your
healthy recovery. Physical therapy includes both
passive and active treatments. Passive treatments
help to relax you and your body. They also
prepare your body for therapeutic exercise, which
is the active part of physical therapy.
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NON-SURGICAL TREATMENT FOR SPINAL STENOSIS
PHYSICAL THERAPY

• Your physical therapist may give you passive
  treatments such as
• deep tissue massage This technique targets
  chronic muscle tensiontension in your low back
  (lumbar spine) that perhaps builds up through
  daily life stress. The therapist uses direct
  pressure and friction to try to release the
  tension in your soft tissues (ligaments, tendons,
  muscles).
• hot and cold therapies By using heat, the
  physical therapist seeks to get more blood to
  target the area because an increased blood flow
  brings more oxygen and nutrients to that area.
  That helps your body heal. Cold therapy slows
  circulation, helping to reduce inflammation,
  muscle spasms, and pain. Your physical therapist
  will alternate between hot and cold therapies.
• Transcutaneous electrical nerve stimulation
  (TENS) You could even use this at home, if your
  therapist thinks it's necessary. A machine
  stimulates your muscles through variable (but
  safe) intensities of electrical current. TENS may
  increase your body's production of endorphins,
  your natural painkillers. The TENS equipment your
  physical therapist uses is larger than the
  "at-home" use machine. However, whether large or
  small, a TENS unit can be a helpful therapy. But
  keep in mind that TENS is not recom- mended for
  chronic pain. In fact, a 2009 study from the
  American Academy of Neurology found that TENS
  units are not effective at treating chronic low
  back pain.
• ultrasound By increasing blood circulation, an
  ultrasound helps reduce muscle cramping,
  swelling, stiffness, and pain. It does this by
  sending sound waves deep into your muscle
  tissues, creating a gentle heat that enhances
  circulation and healing.

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NON-SURGICAL TREATMENT FOR SPINAL
STENOSIS ALTERNATIVE TREATMENTS
Alternative treatments for spinal stenosis are
just that alternatives to medication, physical
therapy, or surgery (the traditional Western
approach to medicine).You may consider going to a
complementary and alternative medicine (CAM)
practitioner CAM is a somewhat sweeping grouping
of practices and therapies that aren't considered
part of conventional medicine right now. It
includes acupuncture, homeopathy, and
massage. Although these alternative treatments
are not considered part of traditional Western
medicine, many patients have reported that these
treatments have helped.
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NON-SURGICAL TREATMENT FOR SPINAL STENOSIS
EXERCISES

• To treat your spinal stenosis pain, you may
  consider
• Acupuncture Acupuncture practitioners believe
  that your body has an energy force called your Qi
  or Chi (pronounced "chee"). They think that when
  your Chi is blocked, you can develop physical
  illness. Acupuncture works to restore a healthy,
  energetic flow of Chi. (This Eastern approach to
  healing is different from Western scientific
  concepts. That doesn't make it better or worse
  it just makes it different.) In acupuncture, the
  practitioner inserts fine needles into your body
  at specific pointsand it doesn't hurt, honestly!
  There is some evidence that acupuncture may
  stimulate the release of endorphins, which are
  the body's own anti-pain chemicals.
• Homeotherapy This field includes a number of
  herbal medications and remedies that are helpful
  in reducing pain, including chondroitin sulfate,
  glucosamine, and hyaluronic acid.
• Massage You may find that a good massage eases
  your pain because it relaxes very tense muscles
  (and tension can add to your pain).
• As with any treatment for back pain or neck pain,
  please talk to your doctor before you try
  something new. For example, an herbal medication
  you take may actually interfere with another
  prescription or over-the-counter medication
  you're taking. You don't want to unwittingly
  harm yourself, so talk to your doctor and make
  sure that you're clear to try a treatment.

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TREATMENT FOR SPINAL STENOSIS SURGERY

• Most patients with spinal stenosis respond well
  to non-surgical treatments (such as medication),
  so you may not have to have surgery. However,
  there are situations when you may want to go
  ahead with spine surgery.
• You've tried non-surgical treatments and they
  haven't been successful.
• You've been in severe pain for a lengthy period
  of time.
• You're experiencing radiculopathy, which is a
  medical term used to describe pain, numbness, and
  tingling in the arms or legs.
• You've lost sensation in your arms or legs.
• You have decreased motor strength in your arms or
  legs.
• You've lost bowel or bladder control.
• One main goal of spinal stenosis surgery is to
  free up area for your spinal cord and/or the
  nerve roots. That's called decompres- sion. By
  giving your spinal cord and nerve roots more
  space to pass through, your spine surgeon hopes
  to decrease your pain from nerve inflammation.

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TREATMENT FOR SPINAL STENOSIS SURGERY

• Another goal of spinal stenosis surgery is to
  increase your motor strength in your arms or
  legs. If you've lost sensation in your arms or
  legs, your surgeon also hopes to restore that.
• Typically, surgeons use 2 surgical techniques for
  spinal stenosis surgery.
• Decompression The surgeon will remove tissue
  pressing against a nerve structure, which makes
  more room in the spinal canal (for the spinal
  cord) or in the foramen (for the nerve roots).
• Stabilization The surgeon works to limit motion
  between vertebrae.
• DECOMPRESSION SURGERY FOR SPINAL STENOSIS
• To remove the tissue that's pressing on a nerve,
  your spine surgeon may perform one of the
  following types of surgery.
• Foraminotomy If part of the disc or a bone spur
  (osteophyte) is pressing on a nerve as it leaves
  the vertebra (through an exit called the
  foramen), a foraminotomy may be done. -tomy
  means "to make an opening." So a foraminotomy is
  making the opening of the foramen larger, so the
  nerve can exit without being compressed.
• Laminotomy Similar to the foraminotomy, a
  laminotomy makes a larger opening, this time in
  your bony plate protecting your spinal canal and
  spinal cord (the lamina). The lamina may be
  pressing on your nerve, so the surgeon may make
  more room for the nerves using a laminotomy.
• Laminectomy Sometimes, a laminotomy is not
  sufficient. The surgeon may need to remove all or
  part of the lamina, and this procedure is called
  a laminectomy. This can often be done at many
  levels without any harmful effects.
• Indirect decompression is a variation of
  decompression surgery where pressure is relieved
  by spreading the bones apart instead of removing
  bone. This can be done with instrumentation
  (hardware), such as interspinous process devices
  or interbody cages. Even artificial discs can
  accomplish some indirect decompression by
  restoring the height between adjacent vertebrae.

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• TREATMENT FOR SPINAL STENOSIS SURGERY
• STABILIZATION SURGERY FOR SPINAL STENOSIS
• Not everyone who has surgery for spinal stenosis
  will need stabilization, which is also known as
  spinal fusion. It's especially helpful in cases
  where one or more vertebrae has slipped out of
  the correct position, which makes your spine
  unstable (and painful). In these cases, the bones
  slipping can pinch nerves. The need for
  stabilization also depends on how many vertebrae
  your surgeon needs to work on. For example, if he
  or she needs to remove the lamina (using a
  laminectomy) in multiple vertebrae, your spine
  may be unstable without those structures. You'll
  need to have spinal fusion to help stabilize your
  spine.
• Spine stabilization surgery has been common for
  many years. It can be done alone or at the same
  time as a decompression surgery. In spine
  stabilization, the surgeon creates an environment
  where the bones in your spine will fuse together
  over time (usually over several months or
  longer). The surgeon uses a bone graft (usually
  using bone from your own body) or a biological
  substance (which will stimulate bone growth).
  Your surgeon may use spinal instrumentationwires,
  cables, screws, rods, and platesto increase
  stability and help fuse the bones. The fusion
  will stop movement between the vertebrae,
  providing long-term stability.
• OPEN SPINE SURGERY OR MINIMALLY INVASIVE SPINE
  SURGERY?
• If your surgery is performed through a relatively
  large incision in your back, that's called open
  surgery. Another option is minimally invasive
  surgery, which is done through several small
  incisions. The surgeon may use a microscope,
  endoscope, or tiny camera and very small surgical
  instruments.
• However, minimally invasive surgery is not for
  everyone. If your surgeon needs to work on many
  vertebrae, you'll probably need to have open
  surgery.
• BE AWARE OF THESE SURGICAL RISKS
• As with any operation, there are risks involved
  with surgery for spinal stenosis. Your doctor
  will discuss potential risks with you before
  asking you to sign a surgical consent form.
  Possible complications include, but are not
  limited to
• general risks of anesthesia
• injury to your spinal cord or nerves
• non-healing of the bony fusion (pseudoarthrosis)
• failure to improve
• instrumentation breakage/failure
• infection and/or bone graft site painAnd take
  heart The results with surgery to correct spinal
  stenosis are usually good. Gener- ally, 80 to
  90 of patients have relief from their pain after
  surgery.

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TREATMENT FOR SPINAL STENOSIS SURGERY
RECOVERY FROM SPINAL STENOSIS SURGERY After your
surgery, you aren't going to be instantly better.
You will most likely be out of bed within 24
hours, and you'll be on pain medications for 2 to
4 weeks. After the surgery, you'll receive
instructions on how to carefully sit, rise, and
stand. It's important to give your body time to
heal, so your doctor will probably recommend that
you restrict your activities In general, don't
do anything that moves your spine too much. You
should avoid contact sports, twisting, or heavy
lifting while you recover. After surgery, be
vigilant. Report any problems such as fever,
increased pain, or infection to your doctor
right away.
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TREATMENT FOR SPINAL STENOSIS SURGERY

• You should always take good care of your body and
  practice healthy habits, but you should be
  especially healthy following surgery. You should
• follow your doctor's treatment plan
• sit and stand properly
• learn to lift correctly
• exercise regularly (low-impact aerobic exercise
  is especially good, but check with your doctor
  first)
• use proper sports equipment
• attain and maintain a healthy body weight
• eat healthy foods (a well-balanced, low-fat diet
  rich in fruits and vegetables) and get enough
  calcium
• stop smoking
• avoid excessive use of alcohol
• And take heart The results with surgery to
  correct spinal stenosis are usually good.
  Generally, 80 to 90 of patients have relief
  from their pain after surgery.