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Spinal stenosis

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Many people with spinal stenosis can be effectively treated with conservative measures. But if you have disabling pain or your ability to walk is severely impaired, you may want to consider spinal surgery. Acute loss of bowel or bladder function is usually considered a medical emergency and requires immediate surgical intervention.

Nonsurgical treatments
Before considering surgery, your doctor is likely to recommend trying one or more of the following for at least three months:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These include over-the-counter and prescription medications such as aspirin, ibuprofen (Advil, Motrin, others) or indomethacin (Indocin) to reduce inflammation and pain. Although they can provide real relief, NSAIDs have a "ceiling effect" — that is, there's a limit to how much pain they can control. If you have moderate to severe pain, exceeding the recommended dosage won't provide additional benefits. What's more, NSAIDS can cause serious side effects, including nausea and stomach ulcers that may bleed. If you take these medications, talk to your doctor so that you can be monitored for problems.

  • Analgesics. This group of pain relievers includes acetaminophen (Tylenol, others). Analgesics don't reduce inflammation, but they can effectively treat pain. Yet chronic overuse of acetaminophen can cause kidney and liver damage. Drinking alcohol increases your risk of serious side effects.

  • Nonproprietary drugs. Nonprescription supplements such as chondroitin sulfate and glucosamine, either alone or in combination, have shown positive effects on osteoarthritis. But it's not yet known whether they're effective at treating or preventing osteoarthritis of the spine. Talk to your doctor if you're interested in these supplements — they may interfere with other medications you're taking, especially warfarin (Coumadin).

  • Rest or restricted activity. Moderate rest followed by a gradual return to activity may improve symptoms. Walking is usually the best exercise, especially for people with neurogenic claudication. But biking is also recommended because it keeps your back in a flexed position rather than in an extended one.

  • Physical therapy. Working with a physical therapist can build up your strength and endurance and help maintain the flexibility and stability of your spine.

  • A back brace or corset. This helps provide support and may especially benefit people who have weak abdominal muscles or degeneration in more than one area of the spine.

  • Epidural steroid injections. In some cases, your doctor may inject a corticosteroid medication into the spinal fluid around your spinal cord and nerve roots. Corticosteroids suppress inflammation and can be especially helpful in treating pain that radiates down the back of your leg — in fact, a single dose may provide significant relief. But because corticosteroids can cause a number of serious side effects, the number of injections you can receive is limited, usually to no more than three in one year.

The goal of surgery is two-fold: to relieve pressure on the spinal cord or nerves, and to maintain the integrity and strength of your spine. This can be accomplished in several ways, depending on the cause of the problem. The most common surgical procedures include:

  • Decompressive laminectomy. In this procedure, your surgeon removes all of the lamina — the back part of the bone over the spinal canal — to create more space for the nerves and to allow access to bone spurs or ruptured disks that may also be removed. A laminectomy is often performed through a single incision in your back (open surgery), although in some cases, your surgeon may use a laparoscopic technique. In that case, a tiny camera and surgical instruments are inserted through several small incisions, and your surgeon views the operation on a video monitor. Laparoscopic back surgery is complex and requires great skill. It's also not appropriate for many people with spinal stenosis. When done appropriately, however, you're likely to have less pain and to recover from surgery more quickly with this technique.

  • Risks of laminectomy include infection, a tear in the membrane that covers the spinal cord at the site of the surgery, bleeding, a blood clot in a leg vein, decreased intestinal function (paralytic ileus) and neurologic deterioration.

  • Laminotomy. In this procedure, just a portion of the lamina is removed to relieve pressure or to allow access to a disk or bone spur that's pressing on a nerve. The risks are the same as for laminectomy.

  • Fusion. This procedure may be performed on its own or at the same time as laminectomy. It's used to permanently connect (fuse) two or more vertebral bones in your spine and may be especially indicated when one vertebra slips over another. To fuse the spine, small pieces of extra bone are needed to fill the space between two vertebrae. This may come from a bone bank or from your own body, usually your pelvic bone. Wires, rods, screws, metal cages or plates also may be used, especially if your spine is unstable or the operation takes place to correct a deformity.

  • Back surgery can relieve pressure in your spine, but it's not a cure-all. You may have considerable pain immediately after the operation, and you might continue to have pain for a period of time. For some people, recovery can take weeks or months and may require long-term physical therapy. What's more, surgery won't stop the degenerative process and symptoms may return — sometimes within just a few years.

Spinal stenosis > 1 > 2 > 3 > 4

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
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