FAQ’s on Spinal Stenosis Treatment in Las Vegas

Spinal stenosis is a condition where there is narrowing of the spinal canal. This condition can lead to serious neck and/or back pain, and if spinal nerves are compressed, arm and/or leg symptoms develop.

How common is spinal stenosis?

According to recent statistics, cervical (neck) spinal stenosis affects around 5% of the general population. For people who are over the age of 70 years, the rate goes up to 9%. For lumbar (low back) spinal stenosis, a clinical study found the prevalence rate to be approximately 9%, with men being affected more than women.

Who is at risk for developing spinal stenosis?

The risk factors for spinal stenosis include:

  • Advancing age – Those who are 50 years of age and older.
  • Surgery – Anyone who has spinal surgery.
  • Narrow spinal canal – This is a congenital problem.
  • Certain medical conditions – These include spinal tumors, ankylosing spondylitis, osteoarthritis, and Paget’s disease.

What causes spinal stenosis?

Any thing that makes the spinal canal become narrow will cause spinal stenosis. This occurs due to:

  • Bone spurs – Wear-and-tear on the spinal bones prompts formation of bone spurs, which protrude into the spinal canal.
  • Arthritis – Aging of bones and loss of facet joint cartilage contributes to this condition.
  • Tumors – These abnormal growths form inside the spinal cord and in the membranes between the vertebrae and spinal cord.
  • Thickened ligaments – These are tough cords, which hold the spinal bones together. As they become thick over time, the can bulge into the spinal canal.
  • Spinal injuries – Car accidents and other trauma that affects the spine can damage the spinal canal contents.
  • Herniated discs – These cushions act as shock-absorbers, and they lie between the vertebrae. As these structures dry out from age, cracks develop and the inner material compromises the spinal canal.

What are the symptoms of spinal stenosis?

The patient will almost always have back pain, and possibly, pain that radiates down an arm or a leg, depending where the stenosis occurs. Abnormal spine curvature can occur, as well as lengthening of the hip muscles.

What can the doctor do to diagnose spinal stenosis?

When the pain specialist suspects spinal stenosis, the doctor will ask questions about the pain and associated symptoms, and take a detailed medical history. For confirmation of the diagnosis, the doctor will order x-rays to check bone structures, canal narrowing, and arthritic changes. Magnetic resonance imaging (MRI) is used to assess nerve root compression and disc problems. Electromyogram is used to evaluate nerve-related symptoms.

How is spinal stenosis treated?

The treatment of spinal stenosis often involves a combination of therapies. The options used depend on the extent of nerve involvement, the severity of the disease, and the patient’s willingness to participate in therapy. Options include:

  • Physical therapy – For back muscle-strengthening, and to increase flexibility, the therapist will teach special exercises. For pain relief, the therapist uses massage, electrical stimulation, ultrasound therapy, and heat/cold therapy.
  • Medications – The pain management specialist will prescribe certain medications for nerve pain, such as anticonvulsants (Neurontin and Tegretol) and antidepressants (amitriptyline and nortriptyline). For pain relief, agents used include NSAIDs and narcotic analgesics.
  • Epidural steroid injection (ESI) – A corticosteroid can be injected into the epidural space, which lies between the spinal cord and the sac that surrounds it. Based on one clinical study, ESI has an 85% efficacy rate.
  • Facet joint injection (FJI) – The doctor can inject an anesthetic into the facet joint, with or without a corticosteroid. X-ray guidance (fluoroscopy) is used to guide needles into these tiny joints.
  • Facet joint denervation – The pain specialist may use radiofrequency energy to destroy the nerve root. With this procedure, a special needle probe is inserted through the patient’s back using x-ray guidance. It is then positioned near the affected nerves. This procedure has a 76% success rate, based on clinical studies.

Resources

Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, et al. (2009). Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine Journal, 9(7):545-50.

Lee MJ, Cassinelli EH, & Riew KD (2007). Prevalence of cervical spine stenosis. Anatomic study in cadavers. Journal of Bone and Joint Surgery, 89(2), 376-380.

McLain, RF, Kapural L, & Mekhail NA (2005). Epidural steroid therapy for back and leg pain: mechanism of action and efficacy. Spine Journal, 5:191-201

Streitberger, K, Muller, T, Eichenberger, U, et al. (2011). Factors determining the success of radiofrequency denervation in lumbar facet joint pain: a prospective study. European Spine Journal, 20(12), 2160-2165. Doi:  10.1007/s00586-011-1891-6