Lumbar Spinal Stenosis and Neurogenic Claudication

2017 ◽  
Author(s):  
Laxmaiah Manchikanti ◽  
Sheri L Albers ◽  
Richard Latchaw
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Cord Stimulation ◽  
Neurogenic Claudication ◽  
Spinal Decompression ◽  
Epidural Injections ◽  
Interspinous Spacers ◽  
Lumbar Spinal

Lumbar spinal stenosis is a degenerative condition that develops and progresses slowly over time. Lumbar spinal stenosis may be local, segmental, or generalized. The majority of lumbar spinal stenosis cases are acquired, degenerative stenosis, resulting from aging of the spine or following surgery or infection. Management of lumbar spinal stenosis is challenging and requires the integration of the history, clinical findings, and results of diagnostic imaging. Magnetic resonance imaging is the most commonly used imaging modality in diagnosing lumbar spinal stenosis. Typical features of spinal stenosis with neurogenic claudication include an increase in symptoms with extension and a decrease with flexion. With lateral recess stenosis or foraminal stenosis, isolated radiculopathy can occur. Spinal stenosis is classified as mild, moderate, and severe, ranging from one third to two thirds of the canal, and grade I to grade III classification of neurogenic intermittent claudication. Management of lumbar spinal stenosis is largely conservative except in cases of severe spinal stenosis and neurogenic claudication with or without paresis and other symptoms. Nonsurgical management of lumbar spinal stenosis includes drugs, physiotherapy, epidural injections, multidisciplinary rehabilitation, and spinal cord stimulation. Minimally invasive techniques include minimally invasive lumbar spinal decompression, interspinous spacers, and endoscopic surgical decompression. The final treatments include open surgery with decompression with or without fusion and spinal cord stimulation. Key words: acquired stenosis, central spinal stenosis, congenital stenosis, decompression with fusion, decompression without fusion, endoscopic spinal decompression, epidural injections, foraminal spinal stenosis, interspinous spacers, lateral spinal stenosis, lumbar spinal stenosis, minimally invasive lumbar decompression, neurogenic claudication, percutaneous adhesiolysis, shopping cart syndrome, spondylolisthesis, vascular claudication

Spinal Cord Stimulation for Treatment of Leg Pain Associated With Lumbar Spinal Stenosis

2013 ◽  
Vol 17 (4) ◽  
pp. 340-345 ◽  
Author(s):  
Masahito Kamihara ◽  
Susumu Nakano ◽  
Tomoe Fukunaga ◽  
Kazuyo Ikeda ◽  
Takashi Tsunetoh ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Cord Stimulation ◽  
Leg Pain ◽  
Lumbar Spinal

scholarly journals Retrospective Review of Patient Self-Reported Improvement and Post-Procedure Findings for mild® (Minimally Invasive Lumbar Decompression)

2010 ◽  
Vol 6;13 (6;12) ◽  
pp. 555-560
Author(s):  
Jay S Grider
Keyword(s):  
Adverse Events ◽  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Ligamentum Flavum ◽  
Neurogenic Claudication ◽  
Lumbar Decompression ◽  
Post Procedure ◽  
Lumbar Spinal ◽  
Major Adverse Events

Background: Lumbar spinal stenosis and neurogenic claudication functionally impact thousands of patients per year. Those who fail conservative therapies and are not surgical candidates due to co-morbid conditions have few interventional options available. The recently described mild® procedure (Minimally Invasive Lumbar Decompression) is a candidate to fill this void. While 2 studies have reported no major adverse events with this procedure, the typical post-procedure patient course has not been previously described. Objective: To examine the minor adverse events and periprocedural course associated with mild. Additionally, to evaluate the efficacy of the procedure with regard to pain relief and functional status. Design: Retrospective evaluation. Methods: Forty-two consecutive patients meeting magnetic resonance imaging (MRI) criteria for mild underwent the procedure performed by 2 interventional pain management physicians working at the same center. The pre and post procedure visual analog scale (VAS) as well as markers of global function were recorded. Major and minor adverse events were tracked and patient outcomes reported. Results: There were no major adverse events reported. Of the minor adverse events, soreness lasting 3.8 days was most frequently reported. No patients required overnight observation and only 5 required postoperative opioid analgesics. Patients self-reported improvement in function as assessed by ability to stand and ambulate for greater than 15 minutes, whereas prior to the procedure 98% reported significant limitations in these markers of global functioning. Visual analog pain scores were significantly decreased by 40% from baseline. Eighty-six percent of the patients reported that they would recommend the mild procedure to others. Conclusions: The mild procedure appears to be a safe and likely effective option for treatment of neruogenic claudication in patients who have failed conservative therapy and have ligamentum flavum hypertrophy as the primary distinguishing component of the stenosis. Key words: Minimally invasive lumbar decompression, lumbar spinal stenosis, neurogenic claudication, fluoroscopy, ligamentum flavum

Facetoplasty Using Radiofrequency Thermocoagulation for Facet Joint Hypertrophy

2016 ◽  
Vol 4;19 (4;5) ◽  
pp. E649-E652
Author(s):  
Daehyun Jo
Keyword(s):  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Facet Joint ◽  
Definitive Treatment ◽  
Neurogenic Claudication ◽  
Interventional Treatment ◽  
Low Back ◽  
Radiofrequency Thermocoagulation ◽  
Lumbar Spinal

Lumbar spinal stenosis is one of most common pathologic conditions affecting the lumbar spine. Pain and/or disability in the low back and lower extremities with or without neurogenic claudication may occur as a result of compression of dural sac contents or nerve roots in the narrowed space. Bulging and protrusion, facet joint hypertrophy, and disc herniation combined with osteophytes and arthritic changes of facet joints can be the cause of lumbar spinal stenosis. Medical/interventional treatment may be considered as an initial treatment for patients with mild symptoms of lumbar spinal stenosis. Surgery is usually considered when medical/interventional treatment has failed. Even though surgery has been considered to be the definitive treatment for spinal stenosis conventionally, it has potential problems including general anesthesia related complications and failed back surgery syndrome. For that reason, minimally invasive techniques such as percutaneous endoscopic lumbar discectomy (PELD), epiduroscopic laser neural decompression (ELND), and nucleoplasty with radiofrequency have been developed as alternatives to surgery. The authors present a case of treating lumbar spinal stenosis by using radiofrequency thermocoagulation. Radiofrequency therapy is used for spinal pain, usually in forms of neurotomy or nucleoplasty. The patient in this case had leg pain with neurogenic claudication caused by lumbar spinal stenosis from facet joint hypertrophy. His pain did not respond to conservative treatment including epidural steroid injection, but he didn’t want to get surgery. As an alternative to surgery, we applied radiofrequency thermocoagulation with high temperatures of electrode to the hypertrophied facet joint for the decompressing of the spinal nerve and the patient’s pain was improved without any complications after the treatment. Key words: Low back pain, neurogenic claudication, lumbar spinal stenosis, facet joint hypertrophy, radiofrequency thermocoagulation, minimally invasive technique

Spinal Cord Stimulation for the Treatment of Chronic Pain in Patients with Lumbar Spinal Stenosis

2010 ◽  
Vol 13 (4) ◽  
pp. 275-280 ◽  
Author(s):  
Amedeo Costantini ◽  
Eric Buchser ◽  
Jean Pierre Van Buyten
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Cord Stimulation ◽  
Lumbar Spinal

scholarly journals Improvement in Neurogenic Pain with Epidural Injections Following Interspinous Spacer Implantation in Patients with Lumbar Stenosis: A Case Series

2020 ◽  
pp. 211-215
Author(s):  
Steve M. Aydin
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Case Series ◽  
Invasive Procedure ◽  
Neurogenic Claudication ◽  
Lumbar Region ◽  
Neurogenic Pain ◽  
Interspinous Spacer ◽  
Epidural Injections ◽  
Lumbar Spinal

Background: Lumbar spinal stenosis with neurogenic claudication can be a debilitating condition, affecting quality of life. Interspinous spacer implantation is a minimally invasive procedure for treatment of lumbar spinal stenosis with neurogenic claudication and associated symptoms by minimizing spinal extension and therefore neural compression. Case Presentation: This case series presents 4 cases of patients with multilevel stenosis, most radiographically severe in the lumbar region, all who received interspinous spacers at L3-4 and L4-5 after minimal improvement in symptoms with conservative management including epidural injections. In all 4 cases, patients reported improved standing and gait but limited improvement in pain and overall function after interspinous spacer implantation. Each patient underwent repeat epidural injections at or below the level of the interspinous spacer with significant improvement in pain for up to 6 months. Conclusion: Our conclusion is that either postspacer epidural injections helped reduce inflammation associated with the implantation procedure, or the spacer maintained an open space to allow the injectate to permeate areas with the most stenosis and help reduce inflammation and therefore pain. Key words: Epidural injection, interspinous process decompression, interspinous spacer, interspinous spacer implant, low back pain, lumbar spinal stenosis, neurogenic claudication, spinal stenosis

scholarly journals Minimally invasive lumbar decompression: a review of indications, techniques, efficacy and safety

2020 ◽  
Vol 10 (5) ◽  
pp. 331-348 ◽  
Author(s):  
Sameer Jain ◽  
Timothy Deer ◽  
Dawood Sayed ◽  
Pooja Chopra ◽  
Sayed Wahezi ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Treatment Guidelines ◽  
Treatment Algorithm ◽  
Neurogenic Claudication ◽  
Efficacy And Safety ◽  
Safety And Efficacy ◽  
Lumbar Decompression ◽  
Lumbar Spinal

Lumbar spinal stenosis is a common degenerative spine condition. In properly selected patients, minimally invasive lumbar decompression ( mild®) may be an option to improve outcomes. This review provides an in-depth description of the mild procedure and a comprehensive examination of safety and efficacy. Two randomized controlled trials, together with 11 other controlled clinical studies, have established the efficacy of mild, which is a minimally invasive procedure that does not involve implants and has demonstrated excellent efficacy and safety. With an established safety profile equivalent to epidural steroid injections, and efficacy that has been shown to be superior to such injections, mild can reasonably be positioned early in the treatment algorithm for these patients. Based on extensive review of the literature, robust safety and efficacy through 2 years, and in accordance with minimally invasive spine treatment guidelines, mild is recommended as the first intervention after failure of conservative measures for lumbar spinal stenosis patients with neurogenic claudication and ligamentum flavum hypertrophy.

scholarly journals Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical practice guideline.

2021 ◽  
Author(s):  
André Bussières ◽  
Carolina Cancelliere ◽  
Carlo Ammendolia ◽  
Christine M. Comer ◽  
Fadi Al Zoubi ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Neurogenic Claudication ◽  
Surgical Interventions ◽  
Lumbar Spinal
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