discussion-8 - lascrusesdoc

[ArchivalUser]

lumbar spinal stenosis-symptoms and tx

[ArchivalUser]

uphill- pain...(extends back----
downhill- relieves pain(bending)

positional claudicatgion... not releived with standing.. must seat


surgery is tretment

[ArchivalUser]

The most common cause of lumbar spinal stenosis is degenerative arthritis, others like infection, tumor...etc

symptoms:

1.low back pain,
2. weakness, numbness, pain, and loss of sensation in the legs.

3. In most cases the symptoms improve when the patient is sitting or leaning forward.

Typically, painful sensations shoot down the legs with continued walking, and diminish with resting. Standing and bending backwards can make the symptoms worse. This is because bending forward increases the space in the spinal canal and vertebral foramen, while bending backward decrease the space. It more comfortable for patients to sit or lean forward and are unable to walk for long distances. Patients often state their symptoms are improved when bending forward while walking with the support of a walker or shopping cart.

If left untreated the compression on the nerves from lumbar spinal stenosis can lead to increasing weakness and loss of function of the legs. It can also lead to loss of bowel and bladder control and loss of sexual function.

In most cases the treatment for lumbar spinal stenosis begins with conservative (non-operative) treatment. This can include medications to reduce inflammation, even short courses of oral cortisone medication, and pain medications. There are also several medications directed specifically at nerve pain that are helpful in lumbar spinal stenosis, including gabapentin (Neurontin) and pregabalin (Lyrica). Physical therapy can help in some cases. Cortisone (steroid) injections in the lumbar spine can also reduce the symptoms by decreasing inflammation and swelling around the nerve tissue.

Surgery may be indicated for patients that do not improve with the above treatments, or if there is severe or progressive weakness or loss of bowel or bladder function (cauda equina syndrome).

The main goal of surgery is to remove the structures that are compressing the nerves in the spinal canal or vertebral foramen. This is a lumbar decompression surgery (laminectomy, laminotomy, foraminotomy).