Spinal Stenosis Diagnosis and Treatments
How Is Spinal Stenosis Diagnosed And Treated?
Some patients suffering from spinal stenosis do well with rest and conservative treatment options. When symptoms are severe and last more than 3 months with no relief from conservative treatment, patients may benefit from further diagnostic injections, and least invasive or minimally invasive surgical procedures.
If you are suffering from spinal stenosis and have failed to get adequate care or need a second opinion, contact us at the International Spine Institute for a FREE MRI review or schedule a consultation for 2nd opinion. You don’t need to suffer daily in pain.
How is Spinal Stenosis Diagnosed?
A comprehensive diagnostic workup is essential to properly diagnose spinal stenosis. The following workup provides an accurate and thorough diagnosis.
- Medical History: Inventory of symptoms, previous treatments and medical care.
- Physical Examination: A careful examination by a spine specialist for limitations of movement, problems with balance, and pain. The examination should also cover loss of reflexes in your extremities, muscle weakness, loss of sensation or signs of spinal cord damage.
- Diagnostic Tests: Generally, plain X-ray films are taken which allows the physician to rule out other problems such as infections. CT scans and MRIs are often used to give them a three-dimensional view of the lumbar spine and can help detect herniated discs.
- Pain Mapping Injections: These injections can be used for therapeutic relief, but more importantly, can pinpoint the pain generator – i.e. extruded disc herniation and bone spurs tethering a spinal nerve of spinal cord.
- Pain Medications: anti-inflammatory medication, muscle relaxers and on rare occasions narcotic pain medications.
- Alternating Heat/Cold Therapy: during the first 24-48 hours.
- Physical Therapy exercises to include: stretching, massage and strengthening.
- Chiropractic Care: many patients find relief in seeing a chiropractor for re-aligning and improving motion in “locked” joints.
- Epidural Steroid Injection: are used two-fold, first, to relieve inflammation of the affected spinal nerve and secondly, diagnostically to confirm the correct affected spinal level at which the pain originates from.
Least Invasive Procedures
If pain still persists after conservative treatment and interventional spine injections, and there is evidence by CT Scan, MRI or X-ray or neurological deficit, then surgical intervention is usually recommended.
The following least invasive procedure can treat spinal stenosis with 90% success:
- Endoscopic Spinal Stenosis Decompression: With a ½ inch incision, our surgeon can enter the spinal canal without disturbing or cutting muscle. With an HD camera/scope in an arthroscopy (water) environment, our surgeon directly observes and decompresses boney lamina and bone spurs that compress the spinal nerves. Recovery is superior to laminectomy or laminotomy, with most patients returning to work within 2-3 weeks.
Advantages of Least Invasive Procedures
- Outpatient – Patients Go Home Within 2 Hours
- ½ Inch – Smallest Incision In Spine
- Faster Recovery
- Faster Return To Work And Play
- Less Post-Operative Pain
- Less Narcotic Pain Medication Needed
- Reduced Complications And Scarring
- No General Anesthesia Is Needed
Minimally Invasive Spine Surgery
In some cases spinal stenosis may be so severe that it may not be able to be treated with our least invasive techniques, and therefore we use one of the minimally invasive techniques widely used by spine surgeons across the world.
- MIS Lumbar Discectomy/Laminectomy: A minimally invasive approach involves a small 15-20mm incision and sequential dilating tubes that gently spread the muscles to afford visualization to the spine. The goal of the technique is to decompress the boney lamina and facet that are pressing on the spinal nerves.
- MIS Transforaminal Lumbar Interbody Fusion (TLIF): This MIS fusion provides stability for the spine by stopping movement that used to cause mechanical pain when the patient moved. The surgery also provides complete decompression of spinal stenosis and any pressure on the nerves at this level.
- Anterior Cervical Discectomy and Fusion (ACDF): The goal of an ACDF surgery is to remove pressure on the spinal cord and spinal nerves while stabilizing the affected spinal disc. This surgery has been successfully performed with excellent patient outcomes for over 30 years. The ACDF procedure has been used for decades with a 90% success rate.
- Cervical Artificial Disc Replacement: Artificial disc replacement provides an alternative solution to fusion when treating damaged discs. This procedure has been developed to maintain motion and decrease stress on the surrounding discs.
Least Invasive Procedures
Because we use conscious sedation instead of general anesthesia, most patients can begin getting out of bed one hour after surgery and go home shortly afterwards. Patients can return to administrative work within 2 weeks. Pain after surgery is usually around the incision site and well tolerated with non-narcotic medicine such as Ibuprofen. Always consult your physician or orthopedic surgeon before beginning any physical work.
Minimally Invasive Spine
Most patients can go home once recovered from anesthesia, and their pain controlled with pain medication, within a few hours of surgery. Some patients may elect to stay overnight for observation until post-surgical pain is tolerable. Dr. Rodriguez usually has patients wear a supportive brace when out of bed for 6 weeks. Physical therapy is typically recommended and may be required after 6 weeks. Most patients return to work 6 weeks after the surgery. Patients whose jobs require physical labor may need to wait 3-6 months (after adequately rehabilitating the muscles) before they can return to full duty.
At home, be sure to takes things slowly and get much needed rest. Our doctor and staff will give you instructions on how to gradually increase activity. You may still require some pain medication for first few weeks and as needed thereafter. Most pain will subside after one week of your surgery. You will be given physical therapy instructions to help reduce the pain and increase mobility. Dr. Rodriguez will discuss a timeline for you to resume work, normal activities such as driving, walking and light lifting and more physically demanding manual labor, sports or yard work.