Posts tagged spinal stenosis
Do MRI findings help predict symptoms in patients with spinal stenosis?

Lumbar stenosis is a spinal condition where nerves are compressed by the bony canals in our spine.  When symptomatic, this condition can lead to leg pain, numbness, pins and needles, and weakness in one or both legs of older adults.  Physical Therapy has been shown as effective as surgery for this condition and should be utilized in the majority of patient cases as a first line treatment.   

Interestingly, most of as we age accumulate changes in our spine including disc herniations, disc tears, and spinal stenosis yet we remain symptom free.  MRI s in asymptomatic people continue to shown these changes due to the high sensitivity of this testing, but we given the high risk of false positives we must ask if these changes directly correlate with our symptoms.  A recent review article in the journal Spine authors analyzed the available evidence to determine if MRI findings correlated with back or leg symptoms (Burgstaller et al. 2016).  The authors reported that they "were not able to prove any correlation MRI findings and severity of pain".  This highlights the growing evidence behind the limitations of MRI findings to determine a patient's symptoms, function, or prognosis.  

Individuals with spinal stenosis are encouraged to utilize Physical Therapy to help reduce their symptoms and improve their function, and most importantly put their MRI findings into perspective.


Lumbar Injections for Back and Leg Pain
lumbar epidural injections, back and leg pain

The use of lumbar corticosteroid injections is often utilized for patients with back and leg pain (radicular pain) and/or leg numbness, pins and needles, or nerve root weakness (radiculopathy).  In an older adult these symptoms may be due to a narrowing of the canals in which the lumbar nerve roots exit (lumbar stenosis).  These injections are costly and not without risk including a number of cases of infection in 2013-2014.  A recent review of the available literature published this month in the Annals of Internal Medicine found limited effectiveness of these treatments compared to placebo trials for both lumbar radiculopathy and stenosis.  Chou et al. and colleagues reported injections for radiculopathy may offer a small, short-term effect but long term effectiveness is limited.  In patients with lumbar stenosis the evidence reported little to no effectiveness on pain or function.  Physical Therapy is the first line intervention for patients with these conditions. 

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