Spinal Stenosis

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Spinal Stenosis: aka Spondylothistheses: Metabolic Bone Diseases, Spondyloarthropathis, Disc Disease




What is it?


Spinal stenosis is a disease that causes narrowing of the lumbar spine especially of the lumbar canal and neural foramina or space where the nerve and nerve sheath pass in the spine. This can cause compression of the lumbar nerve roots which can produce pain in the leg, lower back and buttock.


Pain, numbness and weakness are also common symptoms in the lower extremities among patients that are 50 years and older, the most common age group in which spinal stenosis affects. Many patients experience symptoms on one side of the body however it can affect both sides of the body and can occur with or without back pain.


People usually find standing and walking on an incline can increase pain, and sitting and lying on the side with the hips and knees in a flexed position can dramatically reduce pain. Still others find that walking and standing in the upright position are the worst positions for exacerbating or worsening pain.


Spondylolisthesis is a condition that typically affects the young and old alike, but is more common among the young than the old. It occurs often as a defect, where the body of the spinal vertebra is displaced to the anterior side of the spine, called spondylolisthesis. Typically scoliosis, a curvature of the spine occurs with this condition or with a condition known as spondylolysis, where a defect occurs involving the lumbar 5 disc.


This condition can cause slippage of the spine to 50% and may require a spinal fusion to prevent further slippage and deterioration of the spine. The slip angle can occur at 10 degrees or more. The risk of progression depends on many factors including the age of presentation, whether the individual is female (girls are more at risk) and whether the slip is a high grade or low grade.




The Operation


Typically spinal fusion surgery helps prevent spondyloptosis, where the slip is complete in the spine causing very severe problems and possible paralysis. Usually a fusion of the L5 or lumbar 5 to the SI or sacro-iliac joint will help solve the problem of spondylolisthesis.


Most patients that have a Grade I to II spondylolisthesis and a L5 that is not tilted can undergo an uncomplicated fusion surgery.


Both anterior and posterior fusions are available for patients with severe lumbosacral problems.




Alternatives to Surgery


Usually may patients with spondylolisthesis respond well without surgery and to conservative treatment especially if they present with Grade I spondylolisthesis. Many patients with this can progress with a watch and wait treatment approach that will not require spinal fusion. Often the risk of progression of the disease is minimal and with proper care and checking little risk of symptoms or progression will occur.


Some patients will fare far better using an orthotic instrument than proceeding with surgery. Some patients however will require surgery. These include patients where spine fusion is necessary to prevent further progression and where patients do not respond to more conservative measure to prevent slippage.


In cases where spinal slippage is greater than 50% spinal fusion surgery is almost always warranted.




Before the Operation


There will be specific requirements given to the patient from the surgeon that need to be adhered to regarding laboratory work to be completed, weight and overall health standards and when to stop eating and drinking the day or night prior to the surgery.




After the Operation- In the Hospital


Most patients will spend some time in the hospital recovering for several days following their surgery. You can reduce the amount of time necessary in the hospital by taking active measures to recover quickly. These will include getting up as soon as you are able following surgery to move around. This will reduce your risk of blood clots and stimulate our body’s natural healing processes.


Your doctor will come in to check your overall progress and health following surgery. Once you get the green light from your physician or nurse, ask for someone to escort you from one side of the room to another. Remember that your recent surgery and anesthesia will leave you feeling weak and tired. Some patients will find their stamina is reduced. Deep breathing exercises to expel unwated fluids from the lungs can help with this. These exercises will also help improve your lung capacity for when you decide to go hiking.




After the Operation- At Home


You will need someone to drive you home following your surgery. This person should not take any medications following your surgery. You will need someone that is alert and capable of monitoring your vitals if necessary. This person should also keep your home free and clear of intoxicants following surgery.




Possible Complications


Make sure you steer clear of any medications you may be allergic to following surgery. If redness, itching or purulent puss forms at the incision site or in any limb or part of the body contact your doctor immediately for accurate health advice and a recommendation about who to see, as this can turn into a life-threatening condition with time.




General Advice


Summer is a time to get outside and enjoy the season. Rather than moping about inside you should spend more time outside and encourage your children to do the same. Being outside is great for calming the muscles and reducing stress. Sometimes just sitting out of doors for a few minutes is all your body needs to relax. Many people find it hardy to just sit outside under the sunshine for  a few minutes each day.




Estimated Costs for Spinal Stenosis Surgery


Costs associated with treating spinal stenosis and surgery or spinal fusion surgery to correct spondilolisthesis can be costly depending on where you go. If you opt for this surgery make sure you take time to properly check the references of the trained medical staff and personnel. This is not a job you want to save money with.


Country Cost
USA $15,000 - 62,000
Singapore $10,000-18,000
Malaysia $9,000-15,000
India $7,500-12,500
Thailand $7,000 - $15,000

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