Category Archives: Spinal stenosis

Patients over 70 do well after minimally invasive spinal stenosis surgery

Rosemary Frei writing in Pain Management News reported on a study led by Raja Rampersand, MD at the Spinal Program of the Toronto Western Hospital and the University of Toronto. Analysis of data from 2008 to 2011 compared patients aged 40 to 69 with patients past the age of 70 who underwent surgical decompression for lumbar spinal stenosis.  There were no differences in adverse events between the two groups, although patients in both groups took longer to recover if a fusion accompanied the decompression. lumbar-spinal-stenosis-old-man

Comment: Spinal stenosis is one of the most common low back syndromes seen in rheumatology practice.  Although epidural steroid injections and physical therapy can be effective for many patients, many people with this malady go on to have surgery. This study provides encouraging news for patients with spinal stenosis.

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No “July” Effect With Spine Surgery

Kathleen Struck writing for MedPage Today reported that, according to a recent study, “The  ‘July effect’ that new residents and fellows have on patient outcomes in teaching hospitals is negligible in spinal surgery patients.”

spine-surgeryThe study, published in the Journal of Neurosurgery: Spine, “looked at July because it is the month when new residents and fellows begin working at teaching hospitals,” and “researchers searched the U.S. Nationwide Inpatient Sample (NIS) database from 2001 to 2008 to note the complication rate post surgery and whether admission month in teaching hospitals impacted these rates.”

The complication rate as far as death was not increased; however, the incidence of infection was.

Still… if you have a choice don’t go into the hospital in July.

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Epidural steroid injections for arthritis… another risk

One of the most common problems seen in clinical rheumatology practice is low back pain related to osteoarthritis.  Many of us rheumatologists do epidural injections for patients with spinal arthritis, particularly when patients have spinal stenosis.

As you can imagine there has been a furor over recent reported of fungal, meningitis related to tainted steroid preparations.  The New York Times reported “that more people may be at risk from contaminated drugs” produced by the “company linked to a growing meningitis outbreak.” The FDA also said that products from the New England Compounding Center in Framingham, Massachusetts, “may have also caused other types of infections in patients who have had eye operations or open-heart surgery.”

Fortunately, our practice does not use a compounding pharmacy as a source for injectable steroids.

This is a terrible occurrence, and is one that should remind us all about the risks of medical therapies.

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Lumbar spinal stenosis: the masquerader

One of the most common problems encountered by rheumatologists is lumbar spinal-stenosisspinal stenosis.  This is a condition where arthritis and disc disease in the low back narrows the central canal that the spinal cord occupies.  As a result there is pressure placed on the spinal cord leading to many confusing symptoms.

Typically occurring in people past the age of 65, most will have back pain that radiates into the buttocks and upper thighs. The pain is worse with standing and walking and relieved by sitting.  Patients will often exhibit a waddling gait and have an abnormal sensory exam during the physical.

MRI scanning can help confirm the diagnosis.  Typically, the exam will show mri-spinal-stenosisarthritis in the facet joints, bulging of the intervertebral discs, and enlargement of the ligamentum flavum, the thick ligament that runs lengthwise down the spinal canal.

Other conditions can make the diagnosis difficult.  These include osteoarthritis of the hip, mechanical back pain, hip bursitis, and vascular narrowing.  The latter also causes aching in the legs with walking. The difference can be made by having the patient ride a bike.  With vascular claudication, the pain will return.  With spinal stenosis, the pain will not.

Treatment is highly dependent on the individual patient. While exercise and non-steroidal anti-inflammatory drugs may relieve some symptoms, they are difficult for many older patients with spinal stenosis to tolerate.  Epidural injections of steroids sometimes are helpful.  Many patients will require decompression surgery.

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