musculoskeletal and connective tissue disorders
Lumbar Spinal Stenosis
Treatment of Lumbar Spinal Stenosis
Activity as tolerated, analgesics, and sometimes drugs that relieve neuropathic pain Physical therapy Possibly epidural corticosteroid injections Surgery for severe cases In patients with lumbar spinal stenosis, conservative treatments and indications for surgery are similar to those for Sciatica . Epidural corticosteroid injections sometimes provide transient relief. In symptomatic patients who are poor candidates for surgical intervention, the combination of epidural injections and flexion-based physical therapy can result in some symptomatic improvement. For advanced spinal stenosis, surgery involves decompression of nerve root entrapment by vertebral canal and foraminal encroachments, which sometimes requires laminectomy at 2 or 3 levels plus foraminotomies and sometimes fusion surgery. Spinal stability must be preserved. Spinal fusion may be indicated if there is instability or severe, well-localized arthritic changes in 1 or 2 vertebral interspaces; however, some studies highlight the controversial nature of this approach ( Treatment references ). Försth P, Olafsson G, Carlsson T, et al: A randomized, controlled trial of fusion surgery for lumbar spinal stenosis.N Engl J Med374:1413-1423, 2016. doi: 10.1056/NEJMoa1513721 Ghogawala Z, Dziura J, Butler WE, et al: Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis.N Engl J Med374:1424-1434, 2016. doi: 10.1056/NEJMoa1508788 