The pain is often relieved by sitting or leaning on a supermarket trolley. The narrowing can occur in the central spinal canal or in the tunnels where the nerves exit the spine.
Conservative management often involves physical therapy, medication, postural re-education and exercises.
Other conservative options include: Epidural spinal injections, nerve block injections, facet joint injections, medial branch diagnostic nerve blocks, radio frequency ablation ( also known as radiofrequency denervation) of arthritic facet joints or prolotherapy.
The pain of lumbar spinal stenosis can often originate from the facet joints as opposed to coming from the narrowed canal. This is when diagnostic injections are used to ascertain the origin of the pain. The facet joints can then be injected with cortisone to reduce inflammation, they can be ‘denervated’ with a radiofrequency needle to interrupt the pain sensation, or the whole segment can be stabilised by using prolotherapy injections since instability is often the cause of the narrowing in the first place.
Surgical management in severe cases can include using inter-spinous spacers, decompression or even fusion.
Conservative therapies and injections should be considered before considering surgical intervention.
An article published in the Journal of Pain Medicine in 2019 reviewed these options and emphasises the importance of exhausting conservative measures before considering surgical intervention. At our Blackberry Clinics we can offer all of the non-surgical, evidence-based interventions mentioned here and are happy to refer for surgical opinion should it be necessary. See what our patients say about us on our testimonials page.
Reference: Diwan, S., Sayed, D., Deer, T.R., Salomons, A. and Liang, K., 2019. An Algorithmic Approach to Treating Lumbar Spinal Stenosis: An Evidenced-Based Approach. Pain Medicine, 20(Supplement_2), pp.S23-S31.
