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There are many forms of lumbar spinal stenosis. The most common is degenerative stenosis, occurring in virtually the entire adult population as a result of the natural process of aging.
The posture of patients with lumbar spinal stenosis while walking is typically bent forward, or, kyphotic. Patients will sometimes describe how they can walk for longer periods in a store only by leaning forward supported by a shopping cart. Extension of the spine will often provoke symptoms while flexion will relieve them. Thus, many patients will stop walking, and bend over or squat to relieve their pain. The patients may only be able to walk a few hundred meters but may be able to ride a bicycle for several kilometers.
The first diagnosis of lumbar spinal stenosis may have been made as early as 1900 but it was not until the availability of axial imaging, as provided by computed tomography and magnetic resonance imaging, that there was a rapid increase in reported cases. The effect of this dramatic improvement in medical technology can be seen in the rapid increase in clinical literature concerning this condition after 1976.
While some patients experience a rapid decline in physical function and a rapid increase in symptom severity, for many more, the process of becoming disabled from lumbar spinal stenosis is a slow one. Once the diagnosis has been made positively, the process of treating the disease begins with a regimen of non-invasive conservative therapy.
Conservative treatment typically consists of bedrest and controlled physical activity, physiotherapy, anti-inflammatory drugs, epidural steroid injections and the use of a lumbar corset. While some patients are able to obtain some relief from symptoms with these measures, many others do not. The most common surgical procedure for stenosis is a decompressive laminectomy sometimes accompanied by fusion.
The indications for the surgical treatment of lumbar spinal stenosis are not absolute. It is generally agreed that surgery is elective, performed to improve the quality of life for individuals who have disabling back and leg pain and significant limitations in walking tolerance. This leaves many patients under-served by currently available treatments as their symptoms and pain do not warrant massive spinal surgery and yet they are tired of limiting their daily activities to manage pain. There may be hope for these patients.
Led by Dr. James Zucherman and Ken Hsu, both of the St. Mary's Spine Center, San Francisco, California, investigational centers around the country are currently enrolling patients in a randomized clinical study to evaluate a new, minimally invasive surgical therapy aimed at treating mild to moderate symptoms of lumbar spinal stenosis. The out-patient procedure is perfomed under local anesthsia and does not involve the removal of any soft tissue or bone.
The technique involves placing a small titanium spacer posteriorly in the lumbar spine. For inclusion, a patient must have completed at least six months of conservative therapy, which may include physical therapy, bracing, and/or systemic or injected medications. In addition, the patient must be willing to receive the investigational device or continue non-operative therapy. If a patient finds this unreasonable, he or she would be excluded from participation. The duration of the study is two years. If a patient is unable to complete two additional years of non-operative therapy, he or she will be offered surgery as an option.
For more information, please send an email, call toll free 888-MY X STOP (888-699-7867). For additional information on lumbar spinal stenosis, please go to spinalstenosis.org. |
