Doctors sat down and in preparing their research on determining a clear cut preferred method of treating lumbar spinal stenosis, they found that there was no clear cut standard of treatment.1
This asks the question then, in 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 by some doctors. 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
Recent articles in the lay press and literature have raised concerns about the ability to report honest adverse events from industry-sponsored spine surgery studies. To address this, clinical trials may utilize an independent Clinical Events Committee (CEC) to review adverse events and readjudicate the severity and relatedness accordingly. . . Thirty-seven percent of adverse events were reclassified by the CEC; the large majority of the reclassifications were an upgrade in the level of severity or a designation of greater relatedness to the surgery or device.3 Surgical treatment of adult lumbar spinal disorders is associated with a substantial risk of intraoperative and perioperative complications.4
Spinal Stenosis Surgery
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.
As a chronic pain specialist, many patients come into our office with a date for surgery or, and more unfortunate, a diagnosis of failed back surgery. For the patients who had put off surgery, they have explored their options and have discovered that surgery is not the answer for them. For the patients who had the surgery, they need more options than before. 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 spainal 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
Many “conservative” or 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. Osteoarthritis occurs because the bone is trying to stabilize a joint. Fusion surgery is recommended as a means to accelerate that type of stabilization – the use of bone for stabilization. Prolotherapy works a completely different way. It stabilizes by strengthening the often forgotten and under appreciated spinal ligaments and tendons. It has been estimated that 70 % of lower back pain can be traced to problems of the ligaments. Why then aren’t most therapies geared to treating the ligaments? Because many physicians do not believe that the ligaments can be successfully treated. Why? Because ligaments have very poor circulation and therefore do not have the ability to heal. This is taught in basic anatomy. Muscles are big, red, and powerful because they are filled with blood. Ligaments and tendons are small and white because there is no blood in them.
Treating spinal stenosis with Prolotherapy,Platelet Rich Plasma Therapy, and Stem Cell Therapy is explained in the video below.
1. 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]
2. Omidi-Kashani F, Hasankhani EG, Ashjazadeh A. Lumbar spinal stenosis: who should be fused? An updated review. Asian Spine J. 2014 Aug;8(4):521-30. doi: 10.4184/asj.2014.8.4.521. Epub 2014 Aug 19.
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. Auerbach JD, McGowan KB, Halevi M, Gerling MC, Sharan AD, Whang PG, Maislin G. Mitigating adverse event reporting bias in spine surgery. J Bone Joint Surg Am. 2013 Aug 21;95(16):1450-6. doi:10.2106/JBJS.L.0251.
5. Further resources on spinal stenosis treatments and information
6. NY Times article on Prolotherapy