The Latest Treatment Options for Spinal Stenosis
Have you ever suffered unexplained pain, numbness or a tingling sensation in your lower back and neck region, or perhaps your legs and arms? Or maybe you’re getting a feeling of weakness in the muscles in these parts of the body? If yes, the reason for it may well lie in your spine.
This is exactly what happened to my mother. About 20 years ago, she was diagnosed with spinal stenosis and has had to deal with the chronic pain of spinal stenosis. Essentially, the open spaces in her spine became narrow. This leads to pressure on the spinal cord and also in the nerves leading down to your legs and arms. Unfortunately, it is a degenerative disease and leads to mobility issues.
In terms of causes, The most common is osteoarthritis where the cartilage that is meant to cushion the joints begins to degenerate due to age. Osteoarthritis is considered hereditary and individuals may be prone if it runs in their family. Other causes of spinal stenosis are bulging discs, herniated discs, or injury to the spine.
Some people show no symptoms of this problem, at least, to begin with. And by the time they do start showing some signs, the condition will have worsened, necessitating surgery. Early diagnosis is thus critical to the treatment of spinal stenosis. Given my mother’s age, the family decided that surgery would be too risky.
Any delay could cause the pain to become severe and chronic, and chronic pain of spinal stenosis can be really hard to manage. Testing for spinal stenosis may include a variety of diagnostic tools, including X-rays, MRI and/or CT scans and EMG (electro-diagnosis).
Timely diagnosis can help keep the problem under check by preventing its further deterioration and can also help in alleviating the pain. Pain management in spinal stenosis traditionally follows a typical route, comprising of medication, physiotherapy, steroid injections and, in acute cases, surgery.
Among the traditional treatments for spinal stenosis is medication. The medication used to treat spinal stenosis primarily relates to controlling the pain resulting from the disease. The commonly-prescribed medicines include non-steroidal anti-inflammatory drugs (NSAIDs).
These work by reducing the inflammation and alleviating the pain. Muscle relaxants may also be prescribed to control the muscle spasms that sometimes result from spinal stenosis. Anti-depressant and anti-seizure drugs may also be needed to treat some of the symptoms of the problem.
Another aspect of the traditional treatment of the spinal stenosis linked chronic pain and muscle weakness relates to physiotherapy. Physical therapy helps by building up the body’s strength and also by bringing some stability, balance and flexibility to the affected spinal region. Physical therapy and pain management have helped my mother the most.
In extreme cases, steroid injections may be needed to reduce the pressure and inflammation at the nerve roots. This can, however, lead to some serious side-effects, since repeated injections can cause the adjacent bones and connective tissue to become weak.
Surgery is considered the last of the traditional treatments for spinal stenosis. A risky option, it is resorted to only in extreme cases such as disability arising from the spinal stenosis symptoms. There are various kinds of surgeries that can help in such cases which include laminectomy, laminotomy and laminoplasty. A surgery may involve the risk of infection, formation of blood clots, tears in the spinal cord membrane and even neurological problems.
Advancements in Treatment
Since the existing and conservative methods of treating the chronic pain of spinal stenosis are limited, and in fact come with several risks, scientists are constantly striving to develop new treatments for the disease. That’s very good news!
Interspinous process spacers
One new treatment for spinal stenosis involves the use of interspinous process spacers that work as an alternative to laminectomy. This device is mainly used for treatment of lumbar spinal stenosis, wherein a patient complains of severe pain in the back which suddenly shoots up when standing or walking.
In a laminectomy, doctors remove the bone from the spinal canal to protect the nerves. This, however, may have some adverse consequences on the spine, as it may lead to more pain and even disabilities later in case of recurrence.
The new interspinous process spacers constitute a less invasive treatment for chronic spinal stenosis. This treatment involves holding the spinous processes (points in the spine that one can feel on touch) open, thus indirectly helping to open up the spinal canal.
The interspinous process spacers go within and between the spinous processes to open them up. At the moment, there’s only one such device approved for use in the US, although more are being developed and tested. (http://www.spineuniverse.com/treatments/surgery/minimally-invasive/interspinous-process-decompression)
This is another new, minimally-invasive procedure that’s believed to be quite effective in the treatment of lumbar spinal stenosis and the chronic pain caused by it. Developed by interventional radiologists, it’s said to alleviate the chronic pain of spinal stenosis to an extent where the patients can stand longer and even walk farther with reduced pain.
It involves just a small incision as part of a procedure that requires no hospitalization. The patient doesn’t need general anesthesia in this procedure, which excludes implants and stitches. Mild has been validated as safe and effective by as many as 11 clinical studies in the US. (http://www.news-medical.net/news/20130930/Minimally-invasive-treatments-for-lumbar-spinal-stenosis-an-interview-with-James-Corbett-President-Chief-Executive-Officer-of-Vertos-Medical.aspx)
These trials have not thrown up any complications as a result of the procedure, which doesn’t take more than a few days of recovery by the patient. (www.mildprocedure.com).
Researchers are working on other possible treatments of spinal stenosis. The SPORT (Spine Patient Outcomes Research Trial) is one such research in progress at Dartmouth (http://www.dartmouth.edu/sport-trial/). Funded by the National Institutes of Health (NIH), it’s aimed at giving patients and their physicians solid information to help guide them as they make decisions about how to treat their spinal stenosis condition.
While clinical research continues to come up with new treatments for chronic spinal stenosis pain, health experts also suggest some alternative therapies for the problem. Not considered a part of conventional treatments, these alternative therapies include acupuncture (stimulation of certain skin regions with needles) and chiropractic treatment (adjustment of the spine through traction and other means to restore its normal movement).
Exercise and activity modification are also recommended as effective conservative treatments for controlling chronic pain in spinal stenosis.