Spinal Stenosis

Stenosis in the neck (cervical spine) can cause the patient to experience weakness, pain, numbness, or tingling in the extremities.  Stenosis in the lumbar region (lower back) can cause pain or cramping in the buttocks, legs and feet. This may be exacerbated with long periods of standing, excessive bending or squatting, and excessive walking. (Excessive is defined differently among patients as some can tolerate more activity than others.)

The pain and discomfort will often subside when the patient lays flat, bends forward or sit down. For some patients sitting for prolong periods also can exacerbate the condition. If you look at a textbook, the typical picture shows a person feeling better while leaning forward on a shopping cart or walking upstairs because it tends to "open" the spinal canal.

Spinal stenosis symptoms are different than that from vascular stenosis. With vascular insufficiency, patients tend to experience calf cramping after walking a particular distance due to the issue. With neurogenic claudication due to spinal stenosis, the symptoms are more positional and tend to start from the buttock and go into the thighs.

The symptoms can point to the likelihood of stenosis, but absolute diagnosis requires the patient to undergo an MRI (Magnetic Resonance Imaging). If a person is unable to obtain an MRI due to a pacemaker or other issue, then a CT scan with dye placement (called a myelogram) can show the areas of nerve pinching.

Medications may be used to help reduce symptoms. Drugs like Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to relieve pain and reduce inflammation. Many of these (like ibuprofen) are over the counter and require no prescription. Even Tylenol can be beneficial.

Muscle relaxers like Flexeril (cyclobenzaprine) can help relax tension in the muscle tissues and lessen stress on the affected area caused by this tension. Usually these are for acute exacerbations.

For some patients, anti-seizure medications such as Neurontin (gabapentin) and Lyrica (pregabalin) are used to reduce pain caused by damaged nerves. Opioid analgesics such as oxycodone and hydrocodone are often used to relieve pain in persons with more severe cases, but usually only for short term flare ups.

Treatments such as PT (physical therapy) and strengthening exercises can often help. This may include ultrasound, electrical stimulation and TENS units. Spinal decompression therapy has been shown to be a revolutionary method of obtaining pain relief for spinal stenosis, which involves intermittent traction. The treatment is FDA cleared and low cost compared to surgery.

A new option available for patients is the Superion procedure from Vertiflex. It is a tiny titanium implant that is delivered through a small incision. It's a short procedure that provides relief from the nerve pinching due to an indirect decompression.

Injections that are designed to relieve pain associated with spinal stenosis include epidural steroid injections. These are the gold standard and are often administered as a series of three over six weeks. Multiple studies have shown epidural injections to work well for over 75% of patients, helping with pain relief and the ability to avoid surgery.

Most patients have a reasonable expectation to experience relief from one or more of the available treatments without having to resort to more drastic measures like surgery.

What percent achieve pain relief? Over 80% of patients will achieve an excellent baseline level of pain that is much lower than where they started!

With medications and PT being fairly self explanatory; the injection treatments are a minimally invasive outpatient procedure. The patient is placed on an examination table; the area to be injected is cleaned and then numbed with a topical anesthetic. Then with the use of a fluoroscope (a type of x-ray machine) for guidance to ensure proper needle placement, a needle is inserted into the area to be treated (epidural space).

There are 3 different types of epidural injections that may be administered. Which one is used by the Chicago pain doctor will depend on how many nerves are being pinched, and exactly where the pinching is occurring.

Contrast dye is then injected into the area to ensure the correct nerves are being treated, and then a mixture of local anesthetic and a corticosteroid is injected. The patient will often experience immediate relief from the local anesthetic, but this wears off after a few hours. It may take a few days for the steroid to take effect, and it may take two or three treatments before maximum benefit is gained.

Persons receiving injections can experience relief for weeks to several months at a time. Every few months, the series of injections may be repeated.

With most medications used for treatment of spinal stenosis there are little to no side effects. However, with opioid analgesics there is a risk of overdose or dependence if the medications are abused.

The injections may pose a few mild side effects, these include slight bruising and swelling at the injection site. Minor bleeding (just a few drops, a band-aid will take care of it), and a slight risk of infection. If the injection site is kept clean for the few days it takes gto heal this risk is lessened to nearly zero.

With repeated injections in the same area there is a risk of tissue deterioration from the steroid, and there is a very slight risk of hitting a nerve with the needle, but when fluoroscope guidance is used this risk is practically non-existent.