Spinal Stenosis

THE CLINICAL SYNDROME

Spinal stenosis is the result of a congenital or an acquired narrowing of the spinal canal. Clinically, the pain of spinal stenosis usually presents in a characteristic manner as pain and weakness in the legs and claves when walking. This neurogenic pain is called pseudoclaudication or neurogenic claudication. These symptoms are usually accompanied by lower extremity pain emanating from the lumbar nerve roots. In addition to the pain, the patient with spinal stenosis include bulging or herniated disc, facet arthropathy, and thickening and buckling of the interlaminar ligaments. All of these inciting factors tend to worsen with age.

SIGNS AND SYMPTOMS

The patient suffering form spinal stenosis will complain of calf and leg pain and fatigue with walking, standing, or lying supine. This fatigue and pain will disappear if the patient flexes the lumbar spine or assumes the sitting position. Extension of the spine may also cause an increase in symptoms. Patients will also complain of pain, numbness, tingling, and paresthesias in the distribution of the affected nerve root or roots. Patients may also note weakness and lack of coordination in the affected extremity. Muscle spasms and back pain as well as pain referred into the trapezius and intrascapular region are common. Decreased sensation, weakness, and reflex changes are demonstrated on physical examination.

Pseudoclaudication is the sine qua non of spinal stenosis.

Occasionally, a patient suffering from spinal stenosis will experience compression of the lumbar spinal nerve roots and cauda equina resulting in myelopathy or cauda equina syndrome. Patients suffering from lumbar myelopathy or cauda equina syndrome will experience varying degrees or lower extremity weakness and bowel and bladder symptomatology. This represents a neurosurgical emergency and should be treated as such, although the onset of symptoms is often insidious.

TREATMENT

Spinal stenosis is best treated with a multimodality approach. Physical therapy, including heat modalities and deep sedative massage, combined with nonsteroidal anti-inflammatory drugs and skeletal muscle relaxants represents a reasonable starting point. The addition of caudal or lumbar steroid epidural nerve blocks is a reasonable next step. Caudal epidural blocks with local anesthetic and steroid have been shown to be extremely effective in the treatment of spinal stenosis. Underlying sleep disturbance and depression are best treated with a tricylic antidepressant compound such as nortriptyline, which can be started at a single bedtime does of 25 mg.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age –related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.