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Treatment Options and New Techniques for Lumbar Stenosis

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Treatment Options and New Techniques for Lumbar Stenosis

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    1. Treatment Options and New Techniques for Lumbar Stenosis Dr. J. Todd Brown, DO Spine Surgeon Orthopaedic Associates of Michigan, P.C. www.OAMichigan.com (616) 459-7101

    2. What we’ll cover today… Basic Spine Anatomy Spinal Stenosis What is it… What causes it… Symptoms How is it diagnosed Treatment Options Nonsurgical options Surgical options

    3. Your Spine Your spine consists of three primary sections: Cervical- Neck Thoracic- Upper back Lumbar- Lower back

    4. Spinal Anatomy

    5. Spinal Anatomy

    6. Spinal Anatomy

    7. What is Spinal Stenosis? Narrowing of the spinal canal that places pressure on the spinal cord, cauda equina, or nerves that extend to the legs.

    8. Spinal Stenosis Anatomy

    9. What Causes Spinal Stenosis? Canal Narrowing caused by: Disc bulge/herniation Hypertrophied (thickened) Ligamentum flavum Hypertrophied facet joints (thickened joint due to arthritis) Spondylosis (bone spurs)

    10. What Causes Spinal Stenosis? Spondylolisthesis (one bone slipping forward over another)

    11. What Causes Spinal Stenosis?

    12. Symptoms of Spinal Stenosis Low back pain Pain and weakness in the legs that limits prolonged standing or walking Numbness or tingling that radiates down the legs which tends to worsen with standing and walking Symptoms tend to slowly worsen over time

    13. Symptoms of Spinal Stenosis Symptoms can radiate down one leg, sometimes referred to as sciatica

    14. Symptoms of Spinal Stenosis If the stenosis is severe sometimes both legs can have symptoms The location of symptoms can vary depending on which nerves are involved

    15. Symptoms of Spinal Stenosis

    16. How is Spinal Stenosis Diagnosed? X-rays may be recommended to evaluate the bony structure and may identify osteophytes (bone spurs) or spondylolisthesis (slipped vertebrae) Bending x-rays may help identify potential instability

    17. How is Spinal Stenosis Diagnosed? Magnetic Resonance Imaging (MRI) provides exceptional detail of bony and soft tissue anatomy Noninvasive No radiation

    18. How is Spinal Stenosis Diagnosed? Myelography may also be used to give better definition of nerve structures Requires direct injection of contrast into spine around nerves A series of x-rays are then completed E:\Spine pics\csf-fig1.jpg

    19. How is Spinal Stenosis Diagnosed? Computed Tomography scan (CT or CAT scan) utilizes a computer to reconstruct x-rays into different viewing angles Produces detailed pictures of bone and metal Myelography may also be used with CT to give better definition of nerve structures Requires direct injection of contrast into spine around nerves E:\Spine pics\lumbar myelo stenosis.jpg

    20. Nonsurgical Treatment Options After evaluation, a doctor may recommend a variety of nonsurgical options to alleviate your pain This may include Physical therapy Pain medication Anti-inflammatories Chiropractic care Bracing Activity modification Weight loss

    21. Nonsurgical Treatment Options Epidural steroid injections may be recommended and can provide significant relief Amount and time of relief can be unpredictable

    22. Nonsurgical Treatment Options Epidural steroid injection being performed under x-ray guidance

    23. Surgical Treatment Options Surgical Decompression Laminectomy – removal of the lamina Requires hospital stay Typical recovery of 4 to 6 weeks May require fusion with instrumentation (screws) which may lengthen hospital stay and recovery Hemi laminectomy Similar to laminectomy but removes less bone (hemi=half ) Potentially done on outpatient basis Quicker recovery Requires manipulation of nerves E:\Spine pics\hdg7_laminectomy.jpg

    24. Surgical Treatment Options Posterior view of 2 level laminectomy

    25. Surgical Treatment Options X-ray showing evidence of hemilaminectomy

    26. Surgical Treatment Options Laminectomy with instrumented fusion May be required if stability is a concern Hospital stay longer Higher risks Longer recovery with restrictions, such as a brace

    27. Surgical Treatment Options AP (Front/Back view) and Lateral (Side view) of 2 level instrumented spinal fusion

    28. Surgical Treatment Options Minimally invasive techniques X-Stop Implant Implant device placed between spinous processes Mimics bending or sitting Outpatient surgery done in less than one hour Quicker recovery No manipulation of nerves or entrance into spinal canal Less potential risks Used only in select patients Symptoms must be relieved with sitting or bending forward

    29. Surgical Treatment Options Close-up view of X-Stop spinal implant

    30. Treatment Options Which treatment is right for me? A treatment plan can only be developed in close consultation with a spine specialist since no two problems are the same Generally, invasive procedures are avoided unless there is: Persistent severe symptoms Progressive weakness or neurologic deficit Failure of noninvasive treatment

    31. Questions? Thank you for your time and attendance. Dr. J. Todd Brown, DO Spine Surgeon Orthopaedic Associates of Michigan, P.C. www.OAMichigan.com (616) 459-7101

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