SPINAL STENOSIS


Facts:

  1. Usually occurs in elderly population but not always. CT or MRI findings show narrowed spinal canal often at more than one level.
  2. Patients usually have co-existing facet arthopathy.

Symptoms:

  1. Patients may have mechanical low back pain. Pain increases with activity and is worse in evenings than in the mornings. Pain may radiate into the hip and buttock areas. Patients may have isolated nerve root irritation.
  2. Patients may have frank neurogenic claudication.

Diagnosis:

  1. History and physical MRI or CT scans
  2. Diagnostic blocks when the source of pain is uncertain.

Treatment:

  1. Transforaminal epidural blocks for radicular component of the pain. Facet joint injections or medial branch blocks for the axial component of the pain. Radiofrequency medial branch rhizotomy. Using a 22 gauge needle and a radiofrequency probe, the facet nerves can be located and ablated in a short and relatively painless procedure. This lasts between 3 months and a year, with a mean time of 272 days. The procedure may be repeated. Pulsed radiofrequency treatment of the dorsal root ganglion. Spinal cord stimulation.
  2. Pain pump implants.