This unclear understanding has lead to more questions. Who should get cortisone and epidural injections and who should not? Who should get a spinal fusion and who should not? What does the research say?
A new paper published ahead of its February 2016 release date says: Targeted interventional delivery of corticosteroids remains a mainstay of treatment for spinal pain syndromes because this approach has a wider therapeutic index than other approaches.
The best evidence for analgesic efficacy is in subacute radicular syndromes (radiating pain down the back of the legs) associated with new-onset or recurrent lumbar radiculopathy. HOWEVER – Complications often relate to drug delivery technique as much as actions of the steroid itself and require careful consideration and vigilance by the administering physician. Considerable uncertainty persists concerning which patients with chronic pain are most likely to benefit from corticosteroid injections. Matching this treatment option with specific spinal pain syndromes remains a major challenge.1 I covered this in detail in my article: More questions about Epidural steroid injections
Lumbar spinal stenosis who should get a fusion and who should not?
This question was recently addressed by researchers. Doctors know that lumbar spinal stenosis is mostly caused by osteoarthritis (spondylosis). The symptoms of patients can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication).
Both of these symptoms usually improve with appropriate conservative treatment, but in difficult cases, surgical intervention is occasionally indicated.
In the patients who primarily complain of radiculopathy with an stable spine, a decompression surgery may be recommended. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc disease, and adjacent segment disease, lumbar fusion may also be recommended.2
Surgical treatment of adult lumbar spinal disorders is associated with a substantial risk of intraoperative and perioperative complications.
The above statement comes from the research.3
Lumbar Spinal Stenosis is a narrowing of the space between vertebrae where the spinal cord and the spinal nerves travel. It is a diagnostic term to describe lower back pain with or without weakness and loss of sensation in the legs. It is a very common condition brought on mostly by aging and the accompanying degeneration of the spine. As we age, our spine loses a lot of its youthful vitality. Discs compress, muscles, ligaments, and tendons weaken. With the spine weakened, the boney structures of the vertebrae begin to overgrow (osteoarthritis) as a means to stabilize the structure. The new boney mass begins to encroach on the openings in the spine that the nerves and spinal canal pass through. As the openings begin to narrow, the spinal canal and nerves rub against the bone causing irritation, inflammation and the symptoms of stenosis mentioned above.
In the recommended surgical procedures for spinal stenosis, two choices are the most favored. A Decompression procedure where the surgeon will shave and cut away the bone narrowing the spinal canals. The second, a fusion procedure to limit the movement between two vertebrae and hopefully stop the compression of nerves. Surgery for spinal stenosis should always be considered only after other conservative therapies have been exhausted because it is usually not as successful as hoped and leads to a new diagnosis “failed back surgery syndrome,” where symptoms continue to deterioriate. It is important to note that in instances where stenosis is so severe that the patient has lost circulation to the legs or bladder control – a surgical consult should be made immediately.
Lumbar spinal stenosis treatment
As mentioned above the standard of care in non-surgical treatment options include the use of anti-inflammatories or epidural cortisone injections.
We avoid the use of these treatments as they are temporary “quick-fixes.” The medical literature is now long in studies that have shown that these treatments are contributors to accelerated deterioration of spinal and joint degeneration.
Bone growth occurs in the spine because the bone is trying to stabilize the spine from excessive movement or laxity. Fusion surgery is recommended as a means to accelerate that type of stabilization.
Regenerative medicine including PRP, Stem Cell Therapy, and Prolotherapy works in a completely different way. It stabilizes by strengthening the often forgotten and under appreciated spinal ligaments and tendons. These techniques help stabilize the spine, which is imperative as unstable joints can lead to – or further exacerbate – the arthritis that causes spinal stenosis.
New research is now calling for doctors to provide more accurate diagnosis to determine the cause of lumbar back pain – with a focus on the spinal ligaments.4,5
Treating spinal stenosis with Prolotherapy,Platelet Rich Plasma Therapy, and Stem Cell Therapy is explained in the video below.
1. Krych AJ, Griffith TB, Hudgens JL, Kuzma SA, Sierra RJ, Levy BA. Limited therapeutic benefits of intra-articular cortisone injection for patients with femoro-acetabular impingement and labral tear. Knee Surg Sports Traumatol Arthrosc. 2014 Apr;22(4):750-5. doi: 10.1007/s00167-014-2862-3. Epub 2014 Feb 1.
2. Overdevest GM, Moojen WA, Arts MP, Vleggeert-Lankamp CL, Jacobs WC, Peul WC. Management of lumbar spinal stenosis: a survey among Dutch spine surgeons. Acta Neurochir (Wien). 2014 Aug 7. [Epub ahead of print]
3. Proietti L, Scaramuzzo L, Schiro’ GR, Sessa S, Logroscino CA. Complications in lumbar spine surgery: A retrospective analysis. Indian J Orthop. 2013 Jul;47(4):340-5. doi: 10.4103/0019-5413.114909.
4. Romero-Vargas S, Obil-Chavarria C, Zárate-Kalfopolus B, Rosales-Olivares LM, Alpizar-Aguirre A, Reyes-Sánchez AA. [Profile of the patient with lumbar failed surgery syndrome at National Institute of Rehabilitation. Comparative analysis]. Cir Cir. 2015 May 15. pii: S0009-7411(15)00007-9. doi: 10.1016/j.circir.2015.04.006. [Epub ahead of print]
5. Ishimoto† Y, Noriko Y, Shigeyuki M, Hiroshi Y, et al. Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: The Wakayama Spine Study. Osteoarthritis Cartilage. 2013 Mar 5. pii: S1063-4584(13)00706-1. doi: 10.1016/j.joca.2013.02.656. [Epub ahead of print]