Lumbar Spinal Stenosis Treatment Options

The symptoms of lumbar spinal stenosis (LSS) are pretty clear: severe pain when walking more than 50 feet, and relief when bending over or sitting. And the cause is usually clear-cut, too; it’s another sign of aging.

The good news is there are effective outpatient surgical procedures available when physical therapy, chiropractic and other conservative measures have failed to ease the pain of spinal stenosis.

What is Lumbar Spinal Stenosis?

LSS is a degenerative condition that typically comes from a lifetime of the lower spine supporting the supper body. As people age, the discs between the vertebrae, or spinal bones, become worn down. This causes the spinal canal to slowly narrow, effectively squeezingthe nerves that exit the spine. This pressure often leads to tingling, numbness, or sciatic nerve pain that radiates to the buttock, leg and groin. It can be excruciating.

Lumbar Spinal Stenosis Back Pain Treatment

People with LSS typically cannot walk father than 50 feet without feeling this pain and find relief when sitting down or leaning forward. A typical scenario is the older person at the grocery store hunching over a shopping cart to relieve the pain.Left untreated, muscle weakness, loss of reflexes, and sometimes a condition called foot drop can develop.

The goal in treating LSS with surgery is to gently widen the narrowed opening in the spinal canal, giving the spinal cord and nerves more room to function normally. While injections of numbing medication can keep the pain away for a certain period of time, sometimes surgery is the best option.

Minimally Invasive Spine Surgery (MISS)

Skilled surgeons no longer need to treat low-back stenosis with traditional open back surgery, which involves a 5- to 6-inch incision and the cutting of muscles to reach the spine. Instead, specialists can use narrow dilation tubes that spread muscles like a curtain, and tiny endoscopic instruments outfitted with cameras. This approach avoids damage to muscle and tissue.

“A cut or torn muscle is essentially damaged forever. It becomes weak and never functions the same way again,” says Dr. James St. Louis, an orthopedic spine surgeon with Physician Partners of American Minimally Invasive Spine Group. “In minimally invasive spine procedures, the muscle fibers are left intact. There’s less bleeding and pain, and the recovery is days or weeks, not months.”

A laser maybe used in these procedures to ablate pain-causing nerves and shrink bulging discs that cause spinal stenosis.

Foraminotomy – This procedure increases the width of the intervertebral foramen, or opening between a pair of vertebrae in the treatment area. A small tool called a Rongeur is used to remove small slivers of spinal bone.It allows more room for the exiting nerve and alleviates the painful compression.Thisis a minimally invasive outpatient procedure that requires only two or three stitches and allows the patient to go home the same day.

Laminotomy – This procedure targets the lamina, the bony cover of the spinal canal. The surgeon removes a small part of the lamina to relieve pressure on the nerve exiting the spinal cord. In experienced hands, this procedure will not harm the structure of the spine.

Interspinous Process Spacers for Lumbar Spinal Stenosis

Another alternative to traditional surgery is a spacer, which helps keep spinal bones separated while the patient is standing. This small device, implanted by an experienced surgeon, relieves pressure on the spinal nerves. Its effectiveness has been validated by years of clinical research and is FDA approved.

While the idea of “back surgery” may seem scary, minimally invasive procedures are nothing like traditional open back surgery. They are highly effective and safe, allowing the patient to walk out of the surgery center the same day and heal quickly. Most people report a steep reduction in pain and some are immediately pain free.

Spinal Cord Stimulation Can Relieve Arachnoiditis

Arachnoiditis is not related to spiders, but one of its symptoms is a creepy-crawly sensation. It is a rare condition of a web-like spinal membrane that is difficult to treat; however, spinal cord stimulation is proving to be a highly effective to relieve arachnoiditis symptoms.

With only about 11,000 cases diagnosed each year, this condition causes scarring of the layers surrounding the spinal nerves. Inflammation causes the nerves to stick together and create scar tissue, which presses against the nerve roots that exit the spine.

What Does Arachnoiditis Feel Like?

The condition presents differently in everyone. It can be as mild as a creeping skin sensation or as severe as muscle cramps and spams or sharp electric shock-like pain. In some people, it can cause bladder, bowel or sexual problems.“Sometimes the same patient can have all these symptoms at once or at different times,” says Dr. Abraham Rivera, Chief Medical Officer of Physician Partners of America in Tampa. “It’s the kind of condition that few doctors ever encounter.”

Arachnoiditis treatment

Arachnoiditis is commonly linked to impurities that enter the fluid surrounding the spinal column. This can happen accidentally during medical procedures like spinal taps, myelograms and epidurals. It can also be a unique reaction to preservatives used in certain injectable medicine.

New Ways to Treat Arachnoiditis

Prescription opioid medication has been a go-to treatment for arachnoiditis pain relief, but the side effects of a systemic treatment can outweigh the temporary relief. Interventional pain management specialists, who treat the root of pain conditions, have found greater success with spinal cord stimulation (SCS). Also known as neurostimulation, this treatment delivers a mild electrical current to the affected area. This current serves to counter the pain signals to the brain with a light tingling.

Spinal cord stimulators are implanted in a minimally invasive procedure performed outpatient, meaning the patient can go home the same day. The devicecombines a thin, flexible lead attached to a small generator placed under the skin. The patient controls the intensity of the stimulation using a handheld Bluetooth device. Some generators are changed out every few years, but the newest models are externally rechargeable.

How Does Spinal Cord Stimulation Work?

Spinal cord stimulation therapy begins with a trial period:temporary electrodes are put in place using careful x-ray guidance, and the patient controls the current using an external device.

If both patient and physician agree that the trial offers adequate pain relief, the permanent device is implanted in the nerve fibers of the spinal cord. The generator is placed under the skin in the abdomen or lower back, and the two are connected with an extension wire.

Spinal cord stimulators are one of the few fully reversible chronic pain treatments. A skilled physician can remove the lead and generator in a short outpatient procedure. The lead is threaded down the spine in the epidural space, and the generator is placed under the skin in the lower back. The two are connected by a thin, flexible extension wire. The patient may be awakened briefly during the procedure to make sure the right nerves are being targeted.

Spinal cord stimulation is successfully used to treat many other severe, chronic pain conditions, such as lasting pain after back surgery (failed back syndrome), peripheral neuropathy and complex regional pain syndrome. Results also show promise for arachnoiditis,

“For the right patient, spinal cord stimulation can successfully treat the symptoms associated with arachnoiditis,” says Dr. Rivera.