Spinal stenosis treatment is highly dependent on the severity of symptoms and the degree of stenosis. Spinal stenosis can be treated conservatively or surgically.
Conservative measures for spinal stenosis treatment
Indicated for mild symptoms, conservative measures are non-surgical interventions, which aim to relieve pressure off the spinal cord or the compressed nerve roots. These measures may be the only ones needed for the treatment of spinal stenosis symptoms that are mild.
These conservative measures includes :
- Medications – These drugs are used, primarily to reduce pain and swelling. They may include general painkillers such as ibuprofen and analgesics, but if pain is not relieved with these painkillers, the following may be prescribed as alternative spinal stenosis treatments:
- Antidepressants – Taking these drugs may help in reducing the symptoms of low back and muscle pain. An example is amitryptyline.
- Anti-seizure drugs – Drugs used to resolve seizures, such as Gabapentin, may also help to ease pain caused by nerve irritation.
- Opiates – Due to their codeine content, these drugs may also help. However, its adverse effects discourage prolonged use. Oxycodone is one example.
- Steroids – These are given, through an injection, to decompress irritated tissues. These pharmacologic agents give temporary relief only. They are only injected for a limited number of times in a year as they may cause tissues to weaken and get brittle easily over time.
- Changes in activity – As another spinal stenosis treatment, patients should avoid positions or activities that aggravate their symptoms, exemplified by walking with an extended spine.
- Physical therapy – It aids in preventing symptoms to worsen through exercises taught to recondition the spine and structures related to it. A spinal stenosis exercise program aims to improve stability, flexibility, strength and endurance of the muscles affected. Heating agents, like heating modalities, may also be used, to alleviate pain.
- Assistive devices – Such as forearm crutches may be used to aid in mobility.
- Supportive Devices – In the form of braces are used to prevent an aggravation of the symptoms of spinal stenosis.
- Alternative therapies – Other spinal stenosis treatments, such as acupuncture and massage therapy may be sought for pain relief.
Relief of symptoms may be experienced with these conservative treatments. However, symptoms persist in some patients.
Surgery for spinal stenosis treatment
Over time, symptoms may persist or become chronic in some patients; pain and weakness may worsen. More advanced spinal stenosis treatments are employed in such cases, one of which is surgery. Other grounds to consider surgery include the following:
- Bowel and bladder control is lost.
- Neurologic/radicular symptoms may develop as well – This leads to radiating pain to the upper and lower limbs, which may lead to losing one’s sensation.
- Disability – Patients find difficulty in performing daily activities and even weight-bearing activities can no longer be tolerated.
A decompressive surgery may be considered when these symptoms could no longer be managed using conservative spinal stenosis treatments and when all the other treatment options above have been exhausted and failed. This option is more effective than medical intervention and is done to relieve pressure off the spinal cord and nerves by removing the tissues that cause the irritation or compression completely.
Spinal stenosis treatment through surgery may include the following operations:
- Laminotomy – It involves partial curettage of the lamina affected in spinal stenosis.
- Laminectomy – It involves the complete removal of a part of an affected vertebra called lamina, done to decompress the spinal canal; indicated for the treatment for spinal stenosis caused by arthritic/degenerative changes to the spine. This surgical resection is done when Laminotomy is not enough to achieve decompression.
- Facetectomy – With the abnormal growth of tissues or of bones in the vertebral column, facet disorders result and spinal stenosis may occur. Facets are located on either side of the spinal column. In this operation, a facet is excised partially or completely to enlarge the space in the spinal column for spinal stenosis to be eliminated. Foraminotomy – It is a less invasive surgical procedure which aims to widen the opening or foramen where nerve roots emerge or exits the spinal canal. It involves removal of the tissues causing the obstruction. Nerve root irritation and/or compression are avoided, and these alleviate symptoms.
Another surgical procedure, known as Spinal Fusion surgery may also be performed in some cases. It is a surgical procedure, which aims for a total spinal stenosis treatment. It may be done alone or along with decompressive surgeries listed above. Union of spine vertebrae aims to stop movement of a painful segment. This procedure is considered for the treatment of spinal stenosis that is brought about by vertebral fractures and instability (such as vertebral slippage), which ultimately leads to spinal stabilization.
In addition, a newer surgical method has been developed. As a spinal stenosis treatment, it still achieves decompression but in a different way. It is called IPD or interspinous decompression, which can be performed under local anesthesia. It is a minimally invasive procedure, which utilizes an implant placed between the spinous processes and no excision of any soft tissues is required.
Spinal stenosis treatment through surgery is successful in most patients. Resumption of normal activities results after a few weeks of rehabilitation and less pain and inflammation are noted. Some patients may still present with symptoms after surgery; others may even get aggravated. All pros and cons need to be considered before opting for a surgical procedure. In patients with other chronic medical conditions such as diabetes etc. surgery may not be advisable.
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