Lumbar spinal stenosis epidural steroid injection

The main goal of surgery is to remove the structures that are compressing the nerves in the spinal canal or vertebral foramen. This is referred to as lumbar decompression surgery (laminectomy, laminotomy, foraminotomy). In some patients, this can be performed alone, but in other patients, it must be combined with lumbar fusion. If too much of the compressive structures need to be removed to free the nerve, the vertebrae may become unstable (spinal instability). This leaves the vertebrae with abnormal motion. If this occurs, a spinal fusion can be performed to attach the vertebrae together and eliminate the motion at that level. Sometimes this requires metallic hardware to be installed in the vertebrae to adequately support and fix the involved bone.

Alternatively, the caudal vertebral body superior articulating process (SAP) contributes to lateral recess and foraminal stenosis (see the image below). Indeed, facet hypertrophy between L4 and L5 vertebrae may impinge the L4 nerve root in the foramen and the L5 proximal nerve root sheath in the lateral recess. The 2 lower motion segments (L3-L4, L4-L5) are most commonly affected by degenerative stenosis. These segments are in a transition zone from the rigid sacrum to the mobile lumbar spine. In addition, the posterior joints in this area have less of a sagittal orientation, which affords more rotation and are therefore more vulnerable to rotatory strains.

The diagnosis of spinal stenosis begins with a complete medical history and physical examination. Your doctor will determine what symptoms are present, what makes them better or worse, and how long they have been present for. A physical examination is essential for determining how severe the condition is, and whether or not it is causing weakness or numbness in certain parts of the body. Abnormalities in the strength and sensation of particular parts of the body that are found with a neurological examination provide the most objective evidence of chronic nerve root compression caused by spinal stenosis. The examination is also used to rule out other conditions such as those associated with hip and knee arthritis or diabetes.

Initial treatments include anti-inflammatory medications such as ibuprofen ( Motrin , Advil , etc.) or naproxen ( Anaprox , Naprelan, Naprosyn , Aleve ). These medications help reduce the inflammation and swelling around the nerves being compression. Oral cortisone medications may be tried. Epidural steroid (cortisone) injections can provide a larger dose of medications to reduce inflammation directly to the site of nerve compression . Physical therapy can help strengthen the muscles surrounding the spinal column and take some of the pressure off the spine.

Lumbar spinal stenosis epidural steroid injection

lumbar spinal stenosis epidural steroid injection

Initial treatments include anti-inflammatory medications such as ibuprofen ( Motrin , Advil , etc.) or naproxen ( Anaprox , Naprelan, Naprosyn , Aleve ). These medications help reduce the inflammation and swelling around the nerves being compression. Oral cortisone medications may be tried. Epidural steroid (cortisone) injections can provide a larger dose of medications to reduce inflammation directly to the site of nerve compression . Physical therapy can help strengthen the muscles surrounding the spinal column and take some of the pressure off the spine.

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