| Doctor: |
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John Shaird MD Spinal Stenosis |
| Overview: |
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Spinal stenosis is defined as the narrowing of the spinal column around the spinal cord or nerve roots. The spinal column is composed of a number of structures. The most delicate of these is the nerves which make up the spinal cord and branch out into nerve roots. These nerves are protected by a combination of bones, disks and ligaments. The bones have a number of joints, called the facet joints, at every level of the spine. Studies show that spinal stenosis occurs when degenerative arthritis of these face joints leads to calcium deposits on the interior spinal ligaments. When this is coupled with a bulging disk, the result can lead to compressing of a nerve root, which then causes pain and irritating. Patients may also limp as a result of this pain and reduced blood flow to the nerves. Patients may notice that these symptoms occur after they walk a short distance. Resting or flexing the lower spine to help relieve the pain. Research shows that the pain from spinal stenosis can mimic pain brought about by other spinal disorders. For most patients the condition develops slowly over time. It is quite rare for the condition to be brought about by a single incident. |
| Diagnosis: |
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Doctors will often find during a physical examination that a patient with spinal stenosis will have an abnormal gait pattern. There is usually tenderness over the affected portions of the spine, with restrictions in range of motion at the waist. Doctors will often utilize X-rays, such as CT scan, to better study the joints and bony structures in the spine. For patients who may be facing surgery, a MRI or myelogram is sometimes used to better study the nerve structures within the spine. |
| Treatment: |
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Nerve block treatments or injections of anesthetic medication with anti-inflammatory medications can be quite helpful in treating the pain. These injections are called epidural injections and are usually given in a series of three treatments over a two to three week period. If the epidural injections are not helpful, the doctors may use a nerve block designed to reduce irritation from the joints of the back with can be contributing to the symptoms. The use of oral nonsteroidal anti-inflammatory medications in conjunction with pain medications may be useful for patients with spinal stenosis. Doctors may prescribe physical therapy exercises that will at first address flexibility. Patients may then add exercises to promote strength in the surrounding muscles to provide support for the affected parts of the spine. For some patients with spinal stenosis, surgery is utilized as a treatment of last resort to relieve pressure on the effected nerves in the spine. This is usually reserved for patients with neurological weakness in the extremities affected by the nerves involved. Behavioral interventions, including biofeedback and muscle relaxation training, in conjunction with counseling are used for patients with recurring pain when all other methods fail. Helping to develop coping mechanisms to live more productively with the residual pain is the goal of this treatment. |
| Reprinted with permission from Dr. John Shaird |
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