Focus on the Right Treatment for the Right Patient at the Right Time

Lumbar Spinal Stenosis (LSS) is the progressive and gradual narrowing of the spinal canal as a result of degenerative changes involving bone and soft tissue surrounding the spinal column. The narrowing of the the spinal canal compresses the spinal nerves thus causing local pain in the back and potentially numbness, burnining sensations, or weakness in the lower regions of the body. The symptoms and signs of LSS depend upon the region of stenosis in the spinal canal. Often symptoms lead physcians to the L4-L5 vetebral region, but any of the lumbar regions (1-5) may develop stenosis.

Symptoms, Signs, and Diagnosis

Symptoms for each patient are different based on a patients activity level, current health status, and pain tolerance. Pain may be sharp and acute or dull and chronic. Typically stenosis occuring in the lumbar region, from the source down toward the buttocks. Somtimes it can even involve pain in the legs. If left untreated, irreversible neurological damage can occur. Patient's history, MRI scans, CT scans, and plain X-ray are used to properly diagnose the condition.

Conservative Management

Conservative Management is generally any form of treatment that does not involve operative procedures. There are several forms of conservative treatment that are exercised before surgery is considered, though this  is not always the case. When lumbar stenosis is the issue, depending upon the person's age, health, stage of condition, surgery may be the only option. The key to proper treatment is considering all physical and social (.i.e. family, work, etc.) benefits  and potential complications. Conservative treatment includes over-the-counter drugs, perscription medication, activity modification, exercise, physcial therapy, and epiural steroid injections.

Surgical Options

LSS surgery involves physically decompressing the affected nerves, and can be curative if performed properly.  There are a variety of surgeries that can be performed depending upon the severity of the stenosis.

Laminotomy: the partial removal of the lamina, the posterior covering of the spinal cord and and nerves

Laminectomy: the full removal of the lamina

Non-instumented Lumbar Fusion: - typically performed when there is severe instability in the spine as a result of trauma, synovial cyst removals, unstable laminectomies, etc. In posterolateral intertraverse process fusions, surgeons use bone from the patient, also known as autograft bone, (laminectomy bone, iliac crest bone, etc.) and cadaveric bone to fuse together transverse processes of two vertebral bodies. No outside instrumentation is used to further stabilize the spine.

Instrumented Lumbar Fusion: performed when additional support is needed to allow proper fusion of vertebral bodies. In addition to the posterolateral intertraverse process fusion procedure, surgeons implant pedicle srews and rods to provide additional spinal support during the healing process. Often used when patients have multiple levels of spinal instability.

Posterior Lumbar Interbody Fusion: also used when patients have multiple levels of instability. This procedure involves placing a bony graft in the disc space between the vetebral bodies and then further supporting the spine with rods and screws.

Interspinous Process Device: a titanium implants that are place in between the lumbar spinous process that are designed to open up the spinal canal by placing the lumbar spine into slight flexion.

Post-Operative Care

Post-operative care plays a large role in the overall success of the LSS surgery. Success rates vary based on the overall medical condition of the patient. However, when the proper LSS treament option is chosen, there is a greater opportunity for positive results.