Spinal Stenosis Pain Clinic

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Spinal stenosis is a condition that results from the narrowing of the spinal canal, which causes pain due to impingement of the spinal cord and associated nerves. Pain experienced as a result of spinal stenosis usually affects the lower back and lower extremities and often results in difficulty walking, a decrease in sensation in the lower extremities, and a reduction in physical activity. People affected by spinal stenosis are usually over 65. Scoliosis and hypertension are both considered risk factors. Interestingly, advancing in age makes a person more likely to be affected without any pre-existing pathology.

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Spinal stenosis is often a result of bulging discs or discs becoming herniated, but can also be a result of arthritic deterioration. In any case, spinal stenosis tends to cause disability due to the pain and reduction of mobility seen often in spinal stenosis cases. Central sensitization is a complication that often accompanies spinal stenosis. Central sensitization is the development of both the central nervous system (CNS) and the peripheral nervous system (PNS). Injury and inflammation activate the PNS, which sends signals to the brain through the spinal cord. When central sensitization occurs, there is increased excitability of the CNS’s neurons, causing normal inputs from the peripheral nervous system to produce abnormal, often painful, responses. Allodynia is characterized by minor stimuli (such as the wind blowing against the skin) causing pain symptoms. Hyperalgesia is characterized by a normally painful stimulus (bumping against something) that causes much higher levels of pain than would normally be felt.

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Spinal Stenosis Pain Clinic

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In order to diagnose a patient with spinal stenosis, a physician will first perform a physical exam focusing on tenderness over areas of the spine and possible limitations of movement in the lower extremities. Radiological imaging will likely be ordered to check the level of stenosis. An MRI is the most common radiological imaging used to visualize back pain and is especially useful before a procedure. Fluoroscopic imaging often is used during a procedure.

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Spinal Stenosis Treatment

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There are several ways to treat spinal stenosis using interventional and pharmacological options. Some of the medications that will likely be used include NSAIDs (such as ibuprofen or naproxen), membrane stabilizing drugs, and other over-the-counter or prescription pain relievers. Some of the interventions that can be used to reduce symptoms include:

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• As the name implies, ESI involves the injection of steroids into the epidural space inside of the spine, which spreads to other levels and portions of the spine. This reduces inflammation and irritation.
• (SCS)- A spinal cord stimulator is an electrical device that is implanted in the body in order to decrease pain by confusing the spinal cord and brain pain processing centers. A trial SCS will be externally placed in order to test how effective it will be to a particular patient. If pain is relieved during a trial period, a permanent SCS will likely bring pain relief.
• Acupuncture- When small needles are inserted into the skin during acupuncture, the body naturally releases endorphins. Acupuncture can also help people relax, decreasing tension, stress and muscle spasms.
• Lysis of Adhesions- Also known as “Racz procedure,” has proven effective in the removal of scar tissue in the epidural space of the spine where more conservative options have failed. The procedure is used in vertebral body compression fractures, radiculopathy, post-laminectomy syndrome and disc disease.

• Surgical Treatments- Surgical treatments are usually only performed as a last resort, when all conservative treatments have failed to bring relief or when a condition becomes severe. A surgical laminectomy or foraminotomy might be needed to take pressure off of the spinal cord and the surrounding nerves.
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For more information on how we can help treat your spinal stenosis pain, please contact us at 470-424-8888.