1. Neurosurgical Updates 2016 Brain & Spine Symposium:
Presented by:
Mary L. Dombovy, MD, MHSA
Paul K. Maurer, MD
Anthony L. Petraglia, MD
Patrick J. Reid, MD
Matthew L. Dashnaw, MD, Pharm D
M. Gordon Whitbeck, Jr., MD

2. Lumbar Spinal Stenosis
Presented by
Matthew L. Dashnaw, MD, PharmD
Neurosurgeon
Rochester Regional Health

3. Goals Define Spinal Stenosis Explain Clinical Features
Determine Optimal Imaging
Review Treatment Options
Review Surgical Options
Review Surgical Outcomes

4. What is Spinal Stenosis?
Lumbar spinal stenosis (LSS) is a medical condition in which the spinal canal narrows and compresses the spinal nerves at the level of the lumbar vertebra.

5. Some “Bad” Causes
Huge Disk Herniation Trauma Tumor Infection

6. What is Spinal Stenosis?
Typically 2/2 degeneration Sometimes 2/2 instability Central canal vs. Later Recess

7. Clinical Features

8. Clinical Features – Chief Complaint

9. Clinical Features Cauda Equina Syndrome Flaccid paralysis in distal LE
Areflexia
Urinary and fecal retention
Saddle anesthesia
Loss of sensation
Neuropathic pain

10. Clinical Features Neurogenic Claudication
Buttock, hip, thigh or leg discomfort
Precipitated by walking
Relieved by sitting or being “stooped” forward
Gradual
Exam usually normal
Must be differentiated from vascular claudication
Relief by standing still
Diminished pulses and decreased LE skin temp
Trochanteric bursitis – pain on first step, can’t lie on affected side, fail patrick’s test, tender to palp.
Also need to r/o degenerative hip disease

11. Imaging: When and What to Order?
Ask the Insurance company
Early
If warning signs of a serious cause:
Deficit, nocturnal pain, fever, weight loss, acute onset, CA Hx
After 4-6 weeks of conservative tx
What to get
MRI is the study of choice
Myelogram may also be helpful in some patients

12. Imaging in Lumbar Stenosis

13. Treatment Options Do nothing Physical Therapy Medication
Natural history over 4 years
70% stable
15% progress, 15% have some improvement
Physical Therapy
Stretch, strengthen core, and aerobic exercise (water,bike)
Reduce lordosis
Medication
Analgesics
Anti-inflammatories
Epidural steroid injections
Surgery
PT – weight loss for overweight folks – aquatic therapy, bicycling

14. Surgical Options for Spinal Stenosis
Lumbar Decompression Surgery
Laminectomy +/- foraminotomy
4 year data (SPORT) shows benefit
Pain, Function, Disability
Intraspinous Spacer Implantation
Designed to keep spine in “flexion”
Advantages and Disadvantages
Lumbar Fusion Surgery
Reserved for spondylolisthesis*
Several options for instrumentation