Spinal Stenosis: Diagnosis & Test | Management & Treatment
How is spinal stenosis diagnosed?
Your provider at Pain Care will review your medical history, ask about your symptoms and conduct a physical exam. During your physical exam, your healthcare provider may feel your spine, pressing on different area to see if this causes pain. Your provider will likely ask you to bend in different directions to see if different spine positions bring on pain or other symptoms. Your provider will check your balance, watch how you move and walk and check your arm and leg strength.
Your provider will order imaging test or review current imaging tests to examine your spine and determine the exact location, type and extent of the problem. Imaging studies may include:
X-rays: X-rays use a small amount of radiation and can show changes in bone structure, such as loss of disk height and development of bone spurs that are narrowing the space in the spine.
MRI: Magnetic resonance imaging (MRI) uses radio waves and a powerful magnet to create cross-sectional images of the spine. MRI images provide detailed images of the nerves, disks, spinal cord and presence of any tumors.
CT or CT myelogram: A computed tomography (CT) scan is a combination of X-rays that creates cross-sectional images of the spine. A CT myelogram adds a contrast dye to more clearly see the spinal cord and nerves.
MANAGEMENT AND TREATMENT
What are the treatments for spinal stenosis?
Choice of stenosis treatments depend on what is causing your symptoms, the location of the problem and the severity of your symptoms. If your symptoms are mild, your healthcare provider may recommend some self-care remedies first. If these don’t work and as symptoms worsen, your provider may recommend physical therapy, medication and finally surgery.
Self-help remedies include:
Apply heat: Heat usually is the better choice for pain due to osteoarthritis. Heat increases blood flow, which relaxes muscles and relieves aching joints. Be careful when using heat – don’t set the settings too high so you don’t get burned.
Apply cold: If heat isn’t easing your symptoms, try ice (an ice pack, frozen gel pack, or frozen bag of peas or corn). Typically ice is applied 20 minutes on and 20 minutes off. Ice reduces swelling, tenderness and inflammation.
Exercise: Check with your healthcare provider first, but exercise is helpful in relieving pain, strengthening muscles to support your spine and improving your flexibility and balance.
Non-surgical treatments include:
Oral medications: Nonsteroidal anti-inflammatory medications (NSAIDs) – such as ibuprofen (Advil®, Motrin®), naproxen (Aleve®), aspirin – or acetaminophen (Tylenol®) can help relieve inflammation and provide pain relief from spinal stenosis. Be sure to talk with your healthcare provider and learn about possible long-term problems of taking these medicines, such as acid reflux and stomach ulcers. Your healthcare provider may also recommend other prescription medications with pain-relieving properties.
Physical therapy: Physical therapists will work with you to develop a back-healthy exercise program to help you gain strength and improve your balance, flexibility and spine stability. Strengthening your back and abdominal muscles — your core — will make your spine more resilient. Physical therapists can teach you how to walk in a way that opens up the spinal canal, which can help ease pressure on your nerves.
Steroid injections: Injecting corticosteroids near the space in the spine where nerve roots are being pinched or where worn areas of bone rub together can help reduce inflammation, pain and irritation. However, only a limited number of injections are usually given (typically three or four injections per year) because corticosteroids can weaken bones and nearby tissue over time.
Decompression procedure: This outpatient procedure, also known as The Vertiflex™ Procedure† Superion™ Indirect Decompression System, specifically treats lumbar spinal stenosis caused by a thickening of a specific ligament (ligamentum flavum) in the back of the spinal column. The Vertiflex™ procedure is a minimally invasive outpatient procedure that is clinically proven to provide long-term relief. The procedure uses a small device placed in the spine targeting the root cause of your pain. The device is designed to provide necessary relief on the nerves when you stand and walk by keeping the space in the spine open, which may reduce or eliminate the pain or discomfort in the back
and legs. People usually go home a couple hours after the procedure and begin walking and/or physical therapy soon thereafter. Compared with before the procedure, you will be able to walk and stand for longer periods of time and experience less numbness, tingling and muscle weakness.
When is spinal stenosis surgery considered?
Because of the complexity of spinal stenosis and the delicate nature of the spine, surgery is usually considered when all other treatment options have failed. Fortunately, most people who have spinal stenosis don’t need surgery. However, talk with your healthcare provider about surgical options when:
Your symptoms are intolerable, you no longer have the quality of life you desire and you can’t do or enjoy everyday life activities.
Your pain is caused by pressure on the spinal cord.
Walking and maintaining your balance has become difficult.
You have lost bowel or bladder control or have sexual function problems.
What are the surgical treatments for spinal stenosis?
Surgery options involve removing portions of bone, bony growths on facet joints or disks that are crowding the spinal canal and pinching spinal nerves.
Types of spine surgery include:
Laminectomy (decompression surgery): The most common type of surgery for this condition, laminectomy involves removing the lamina, which is a portion of the vertebra. Some ligaments and bone spurs may also be removed. The procedure makes room for the spinal cord and nerves, relieving your symptoms.
In a laminectomy, the lamina portion of the vertebral bone is removed.
Laminotomy: This is a partial laminectomy. In this procedure, only a small part of the lamina is removed – the area causing the most pressure on the nerve.
Laminoplasty: In this procedure, performed in the neck (cervical) area only, part of the lamina is removed to provide more canal space and metal plates and screws create a hinged bridge across the area where bone was removed.
Foraminotomy: The foramen is the area in the vertebrae where the nerve roots exit. The procedure involves removing bone or tissue this area to provide more space for the nerve roots.
Interspinous process spaces: This is a minimally invasive surgery for some people with lumbar spinal stenosis. Spacers are inserted between the bones that extends off the back of each vertebrae called the spinous processes. The spacers help keep the vertebrae apart creating more space for nerves. The procedure is performed under local anesthesia and involves removing part of the lamina.
Spinal fusion: This procedure is considered if you have radiating nerve pain from spinal stenosis, your spine is not stable and you have not been helped with other methods. Spinal fusion surgery permanently joins (fuses) two vertebrae together. A laminectomy is usually performed first and bone removed during this procedure is used to create a bridge between two vertebrae, which stimulates new bone growth. The vertebrae are held together with screws, rods, hooks or wires until the vertebrae heal and grow together. The healing process takes six months to one year.
Is spinal surgery safe? What are the risks of surgery for spinal stenosis?
All surgeries have the risks of infection, bleeding, blood clots and reaction to anesthesia. Additional risks from surgery for spinal stenosis include:
Tear in the membrane that covers the nerve or spinal cord.
Failure of the bone to heal after surgery.
Failure of the metal plates, screws and other fasteners.
Need for additional surgery.
No relief of symptoms/return of symptoms.
How do I prepare for spinal stenosis surgery?
To prepare for spine surgery, quit smoking if you smoke and exercise on a regular basis (after checking with your healthcare provider first) to speed your recovery time. Ask your provider if you need to stop taking any non-essential medications, supplements or herbal remedies that you may be taking that could react with anesthesia. Also, never hesitate to ask your healthcare team any questions you may have or discuss any concerns.
What happens after spinal surgery?
If you’ve had a laminectomy, you may be in the hospital for a day or two. If you’ve had spinal fusion, you may have a three- to five-day hospital stay. If you’re older, you may be transferred to a rehabilitation facility to receive additional care before going home.
You will be given pain medications and/or NSAIDs to reduce pain and swelling. You may be given a brace or corset to wear for comfort. You will likely be encouraged to get up and walk as soon as possible. Your healthcare provider or physical therapist will recommend a light form of exercise right after spinal surgery to insure that your back does not stiffen and to reduce swelling. Your physical therapist will develop an individualized exercise plan to stretch and strengthen muscles to support your back and stabilize your spine.
Taking hot showers and using hot compresses may help alleviate pain. Additionally, using an ice pack may ease pain before and after exercise.
How long is the recovery period after spinal stenosis surgery?
Full recovery after surgery for spinal stenosis and return to normal activities typically takes three months and possibly longer for spinal fusion, depending partially on the complexity of your surgery and your progress in rehabilitation.
When can I return to work after spinal surgery?
If you’ve had a laminectomy, you will likely be able to go back to work at a desk job within a few days of returning home. If you’ve had spinal fusion, you’ll likely be able to return to work a few weeks after your surgery.