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Thursday, November 7, 2013

Patient Information: Lumbar (low-back) Spinal Stenosis explained with Color X-Ray and MRI Images: Part II

The following Information is Copyright Medical Media Images:

 
 
 
How is Lumbar Spinal Stenosis diagnosed?

This condition is diagnosed by combining information from the patient history, physical examination, and special tests:

 

1.     History

The diagnosis revolves around asking the patient questions about some of the common symptoms of spinal stenosis. Here are some:

a.     Do you have a difficult time walking a certain distance?
b.     Do your legs feel weak and cramping after walking a certain distance?
c.      Do you feel better walking when bending forward?
d.     Do you feel like you are having problems with your balance?
e.     Do you have weakness in the legs?
f.       Do you have numbness or tingling in your legs?
g.     Do you have trouble emptying your bladder?
h.     Do you ever lose control over your bowels?

 

2.     Physical Examination:

The spine specialist often examines the following:

a. Gait for stability
b.Reflexes testing of the legs
c. Ankle clonus
d. Strength testing (motor) of the legs
d. Sensation testing (sensory) of the legs
f. Babinski test




 
3.     Imaging
                 a.     X-Ray
 
X-Rays can be helpful to establish the anatomy of the low-back. However, they cannot offer information about the spinal canal or spinal cord. They cannot show spinal stenosis clearly.
 
 
This image is an X-Ray of the low-back (lumbar spine) which shows the spine from the side. The front of the spine is to the left. The vertebrae are shown in orange, separated by the discs in green. The nerve channels where the spinal nerves leave the spine are seen in yellow.
   b. MRI
MRI information is critical and the best study when evaluating severe spinal stenosis. It can show the spinal cord and spinal nerves in detail and can accurately assess how much compression of each exists. It can also determine if there is swelling present in the nerve or spinal cord (gliosis). The latter can be a sign of impending damage or existing damage to the spinal cord.
This image is an MRI scan of the low-back (lumbar spine) showing the spine from the side. The front of the spine is the left, the back to the right. The vertebrae can be seen in orange, separated by the discs in green. The spinal cord and cauda equina are shown in yellow. An area of spinal stenosis is pointed out by the arrow. At this point, a disc has pushed material backwards into the spinal canal, and a bone spur has pushed forward. A ligament (ligamentum flavum) shown in dark red has also thickened. All these factors contribute to the development of the spinal stenosis.
           c. CAT scan
Regular CT scans can show the spinal canal and foramen accurately. However they have the disadvantage of not being able to show the spinal nerve and spinal cord in detail.
A myelogram can show spinal stenosis in detail.
              How is Lumbar (low-back) Spinal Stenosis treated?


The treatment of lumbar spinal stenosis is dependent on the severity of the case. Surgery is reserved for severe conditions not responding to non-surgical care.
 

1. Non-Surgical Care

a.     Alternative Health Care
Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition. Massage therapy techniques can help with the muscle components of this condition. 

b.     Nutrition and Weight Loss
Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms (Spine and Obesity).

c.      Chiropractic Care
Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

d.     Spine Exercises
Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility. 

e.     Physical Therapy (PT)
PT has many modalities to offer for this condition. They can range from Manual Therapy and Exercises to Traction and Ultrasound Treatments. Traction can help with compressed spinal nerves, but not the compression of a spinal cord per se. Ultrasound and Electrical stimulation can help with muscle spasms. Certain PT exercises such as conditioning exercises can help maintain the muscle tone and function in the legs. 

f.       Self Help Tools
Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories. Braces can provide some comfort and prevent patients from bending backwards too far. Bending backwards can worsen the symptoms of spinal stenosis in severe cases. 

g.     Spine Medications
Here are some of the common groups of medications which are available for this condition: 

1.Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)2.Steroids                                                                     3.Muscle Relaxants                                               4.Pain Killers                                                                          5. Antidepressants                                         `    6.Nerve Pain Medications
                                     h.     Injections

Lumbar Epidural steroid injections can help with cases of lumbar spinal stenosis without cauda equine syndrome. It may not be recommended to perform injections in a patient with extremely severe spinal stenosis due to the pressure the injected fluid can place on the cauda equina.

Here are types of epidural injections for Lumbar Spinal Stenosis:
Lumbar Interlaminar Epidural Steroid Injections
Lumbar Transforaminal Epidural Steroid Injections
Caudal Epidural Steroid Injections

 

 

2.     Surgical Care

Here are some of the surgical procedures offered for cases of severe Lumbar Spinal Stenosis:
a.     Lumbar Laminectomy Decompression

b.     Lumbar Laminotomy and Foraminotomy

c.      Lumbar Interspinous Process Spacers.

d.     Lumbar Fusion

 

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