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I feel like I'm in a train headed for the last station and don't know if I should jump off now or not. I have pretty bad stenosis at L45. Bad enough to go through weeks of acupuncture, take medications I didn't want, do exercises every day, and even let the doc inject my back with steroids. The last stop is surgery. Yes or no? Should I or shouldn't I? Help me decide if it's time to stay on the train to the end or jump off now.
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Lumbar spinal stenosis (stenosis of the low back) is a common cause of back problems in adults over 55 years old. Symptoms of buttock or leg pain occur with or without back pain when the nerves in the spinal canal are compressed or pinched.
The spinal canal is the hollow tube formed by the bones of the spinal column. Anything that causes this bony tube to shrink can squeeze the nerves inside. As a result of many years of wear and tear on the parts of the spine, bone spurs may form and ligaments thicken closing around the spinal canal. Anything that narrows the spinal canal opening for the spinal cord and spinal nerves can put pressure against the nerves.
Many older adults never know they have this condition. They are said to be asymptomatic (without symptoms). But for those who do experience the back, buttock, and/or leg pain (and sometimes tingling/numbness), treatment is important.
When all nonsurgical, noninvasive treatments have been tried without success for lumbar spinal stenosis, surgeons often try epidural steroid injections (ESI). Most people want to avoid surgery, which is why they run the gamut of all conservative approaches ending with steroid injections before surgery.
Those individuals who end up having surgery to remove bone from around the nerve can get relief from symptoms. But one thing to know is that having epidural steroid injections (ESIs) first before surgery can actually affect the benefit of the surgery. The results we will report to you here are based on a recent study comparing outcomes from treatment (injections versus no injections) for patients with lumbar spinal stenosis.
In this study, everyone in both groups (those who had injections, those who didn't) had painful symptoms and had tried at least three months of nonoperative care without success. The type of conservative care they received included home exercise, nonsteroidal antiinflammatory drugs, education and counseling, and active physical therapy. Some of the patients (from either group -- those who had the steroid injection and those who didn't) ended up having surgery .
In the end, they found that patients who had the epidural steroid injections (ESI) had significantly less improvement in symptoms over anyone else. That included patients who had surgery (and those who didn't have surgery). The main conclusion of this study was that patients with lumbar spinal stenosis who have ESI have worse results than those who don't have ESI.
A second observation from the study was related to patient crossover. Crossover refers to patients who start in one group (e.g., injection group) and end up going (crossing over) to the surgical group (or vice versa). In this study, the surgical group had better results than the injection group. So the patients who crossed over from originally being in the surgical group to the injection group may have had worse results than if they had stayed in the surgical group.
Patients in the ESI group who had the injection and then crossed over to have surgery also had worse results than the surgical group who did not have any injections. The surgery took longer for the ESI-crossover-to-surgery group. They were also in the hospital longer without any measurable benefit from the procedure.
From this study it looks like epidural steroid injection for lumbar spinal stenosis may not be the best way to avoid surgery. Future studies may be able to determine who would be a good candidate for ESI before surgery (and who should go from conservative care to surgical care without ESI). Until patient selection for ESI versus surgery is clearly determined, patients should be advised that choosing ESI to avoid surgery isn't always the best option.
Since you have already gone this far, the rest of your journey will require advice from your surgeon. You may want to discuss the information offered from this study and evaluate the pros and cons for your individual situation. It may not hurt to listen to your "gut" on decisions like this one until a clear solution is presented.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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