Spinal stenosis is a narrowing of the spinal canal that puts pressure on the cord and nerves, most often in the lower back or neck and most often after age 50. Non-surgical care starts with physical therapy, activity changes and medication, then moves to epidural steroid injections when symptoms persist. Between conservative care and open decompression sit several outpatient options: endoscopic laminotomy, the Vertiflex interspinous spacer and minimally invasive lumbar decompression. Which one fits depends on where the narrowing sits and how symptoms behave with standing and walking. Spine Institute of North America (Spine INA) in East Brunswick, New Jersey evaluates stenosis patients for these options before recommending laminectomy or fusion.

Spinal stenosis is a painful condition of the spine that many people experience, either due to age, injury or spinal malformations. Fortunately, treatment options are available to help with spinal stenosis pain management in NJ.

What Is Spinal Stenosis?

Spinal stenosis is a condition where the spinal canal, the bone around the spinal cord, narrows, putting pressure on the spinal cord and nerves and causing back pain. In most cases, the condition affects the lower back or neck. Some symptoms associated with spinal stenosis include:

Numbness in the extremities
Issues with coordination of the limbs
Weakness of the limbs
Difficulty with bowel or bladder control
Pain in the neck and shoulders or in the low back and glutes

How Does Spinal Stenosis Happen?

Spinal stenosis is attributed to a variety of causes. While it most often occurs in people over the age of 50 as an age-related condition, younger populations suffering from spinal degeneration, spinal injuries, disc bulges, disc herniation or synovial cysts may also experience spinal stenosis.

Osteoarthritis and rheumatoid arthritis are also common causes of spinal stenosis, as both conditions result in the inflammation of the joints in the spine. Some cases are also the result of heredity, as some individuals are born with narrowing spinal canals and structural malformations.

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Spinal Stenosis

What Are The Symptoms Of Spinal Stenosis?

Spinal stenosis can present with many different symptoms. The symptoms are mainly determined by severity and location in the spine. Here are the most common symptoms:

Sciatica – Pain that shoots down one or both legs that may start as an ache in the lower back or buttocks
Foot Drop – A term that refers to a weakening of the muscles that allow for flexing of the ankle and toes. The result of foot drop may cause a person to “drag” their foot on the ground.
Trouble With Standing Or Walking – Spinal stenosis can compress the spinal nerves and cause pain while you stand for long periods of time.
Loss Of Bowel And Bladder Control – Cauda equina syndrome is a severe condition that comes with extreme pressure and swelling of the spinal nerves. It can cause loss of control of the bladder and bowel, and immediate medical attention is needed.
Tingling Sensation – Spinal stenosis can compress the spinal nerves in the back and neck causing tingling symptoms in the legs or arms and hands.

How Is Spinal Stenosis Diagnosed?

Spinal stenosis diagnosis requires a complete review of a patient’s medical history and a physical examination, during which time the specialist will review the patient’s symptoms to determine if and where the spinal cord is compressed. Following the initial diagnosis, they may order imaging tests to confirm, including X-Ray, MRI, CT or Myelogram imaging tests. Once the location and cause of the compression are identified, the specialist can then move on to spinal stenosis treatment.

What Are the Treatment Options for Spinal Stenosis?

Spinal stenosis treatment in NJ often starts with nonoperative pain management, such as anti-inflammatory medications, physical therapy, weight reduction or epidural injections. If these treatment options prove unsuccessful, the specialist may then consider spinal stenosis surgery. In our NJ office, several surgical options are available to help make more room for the spine by removing bone or ligaments.

Non-Operative Treatment

Pain Medications – Anti-inflammatory medication, muscle relaxers and on rare occasions narcotic pain medications
Alternating Heat/Cold Therapy – During the first 24-48 hours.
Physical Therapy – Exercises to include: stretching, massage, and strengthening.
Chiropractic Care – Patients may find relief in seeing a chiropractor for re-aligning and improving motion in “locked” joints.
Epidural Steroid Injection – Used to relieve inflammation of the spinal nerve and to confirm the correct spinal level at which the pain originates from.

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Least Invasive Procedures

If pain persists after conservative treatment and interventional spine injections, and there is evidence by CT Scan, MRI or X-ray or neurological deficit, then surgical intervention is usually recommended. The following least invasive procedures treat spinal stenosis with a high success rate through the removal of compressed tissue:

Endoscopic Laminotomy

After making a 1-2 centimeter incision, our doctor can observe and open the small area of the lamina above and below the spinal disc using an HD camera/scope. The specialist can then also remove any thickened ligaments to relieve painful nerve compression and remove any herniated disc or bone spur causing additional pain. Patients are free to leave the clinic on the same day as the procedure, and most return to work within three months.

Vertiflex

Vertiflex’s Superion is another least invasive alternative that requires no bone work or tissue removal. As an indirect decompression device, the Superion implant is planted between the vertebrae and holds them open to relieve pressure. Our specialist inserts the device through a small tube the size of a dime, which reduces blood loss and damage to the surrounding tissue and allows for fast recovery.

This solution is ideal for patients who have undergone six months of non-operative treatments without relief or for those who find traditional spinal surgery options too demanding.

Minimally Invasive Lumbar Decompression

Minimally invasive lumbar decompression or MILD® is a least-invasive procedure which can help spinal stenosis patients stand up longer and walk further distances with reduced pain. As opposed to traditional open surgery, MILD® spine surgery utilizes a very small incision, allowing for a faster recovery and quick pain relief.

During the procedure, your doctor will remove overgrown ligament and bone located at the lower part of your spine. After a short recovery, many patients quickly return to

their normal, everyday activities. These technique prevents the spinal instability associated with open surgery and avoids the invasive fusion surgical approach.

Minimally Invasive Spine Surgery

In some cases, spinal stenosis may be so severe that it may not be able to be treated with our least invasive techniques, and therefore we use some of the minimally invasive techniques widely used by spine surgeons across the world.

MIS Lumbar Discectomy/Laminectomy – The goal of the minimally invasive technique is to decompress the bony lamina and facets that are pressing on the spinal nerves.
MIS Transforaminal Lumbar Interbody Fusion (TLIF) – This minimally invasive spine fusion provides stability for the spine and complete decompression of spinal stenosis and any pressure on the nerves at this level.
Anterior Cervical Discectomy and Fusion (ACDF) – The goal of an ACDF surgery is to remove pressure on the spinal cord and spinal nerves while stabilizing the affected spinal disc. The ACDF procedure has a 90% success rate.