Spinal stenosis medical therapy: Difference between revisions

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{{Spinal stenosis}}
{{Spinal stenosis}}
{{CMG}} {{AE}}{{MMJ}}
{{CMG}} {{AE}}{{MMJ}}


==Overview==
==Overview==
Conservative management, including medications, physical therapy, and lifestyle changes, is encouraged for the treatment of spinal stenosis. If cervical spinal stenosis is mild, treatment may be as simple as [[physical therapy]] and the use of a [[cervical collar]].  If severe, treatment options include [[laminectomy]], [[hemilaminectomy]], or decompression. Treatment for lumbar spinal stenosis includes [[weight loss]], and activity modification, such as using a walker to promote a certain posture.  [[Epidural]] steroid injections may also help relieve the leg pain. If the symptoms are more severe, a [[laminectomy]] or [[foraminotomy]] may be indicated to take pressure off the spinal nerve.  Various other medications may help with chronic pain, including [[phenytoin]], [[carbamazepine]], or [[tricyclic antidepressant]]s such as [[amitriptyline]].
 
 


==Medical Therapy==
==Medical Therapy==
===Epidural Corticosteroid Injections===
*Pharmacologic medical therapy is recommended among patients with spinal stenosis.<ref name="pmid20227646">{{cite journal| author=Genevay S, Atlas SJ| title=Lumbar spinal stenosis. | journal=Best Pract Res Clin Rheumatol | year= 2010 | volume= 24 | issue= 2 | pages= 253-65 | pmid=20227646 | doi=10.1016/j.berh.2009.11.001 | pmc=2841052 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20227646  }} </ref><ref name="pmid28461958">{{cite journal| author=Covaro A, Vilà-Canet G, de Frutos AG, Ubierna MT, Ciccolo F, Caceres E| title=Management of degenerative lumbar spinal stenosis: an evidence-based review. | journal=EFORT Open Rev | year= 2016 | volume= 1 | issue= 7 | pages= 267-274 | pmid=28461958 | doi=10.1302/2058-5241.1.000030 | pmc=5367584 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28461958  }} </ref>
[[Epidural]] [[corticosteroid]] injections may offer benefit for one to two weeks among patients with spinal stenosis. However, the benefit may be entirely due to the accompanying local anesthetic and the benefit is minimal to none by four to six weeks (see [http://www.wikidoc.org/index.php/File:Epidural_steroids_for_spinal_stenosis_-_Forest_plot_for_improvement.png Forest plot]).<ref> Epidural steroid for spinal stenosis: a living systematic review. GitHub. Available at https://github.com/openMetaAnalysis/Epidural-corticosteroids-for-spinal-stenosis. Accessed November 9, 2014</ref>
*Pharmacologic medical therapy is the first step in treatment of patients with spinal stenosis.<ref name="pmid20227646">{{cite journal| author=Genevay S, Atlas SJ| title=Lumbar spinal stenosis. | journal=Best Pract Res Clin Rheumatol | year= 2010 | volume= 24 | issue= 2 | pages= 253-65 | pmid=20227646 | doi=10.1016/j.berh.2009.11.001 | pmc=2841052 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20227646  }} </ref><ref name="pmid28461958">{{cite journal| author=Covaro A, Vilà-Canet G, de Frutos AG, Ubierna MT, Ciccolo F, Caceres E| title=Management of degenerative lumbar spinal stenosis: an evidence-based review. | journal=EFORT Open Rev | year= 2016 | volume= 1 | issue= 7 | pages= 267-274 | pmid=28461958 | doi=10.1302/2058-5241.1.000030 | pmc=5367584 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28461958  }} </ref>
*Pharmacologic medical therapies for spinal stenosis include [[Non-steroidal anti-inflammatory drugs]], [[muscle relaxants]], [[opioid]] analgesics and injectable [[calcitonin]].<ref name="pmid25050056">{{cite journal| author=Witenko C, Moorman-Li R, Motycka C, Duane K, Hincapie-Castillo J, Leonard P et al.| title=Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. | journal=P T | year= 2014 | volume= 39 | issue= 6 | pages= 427-35 | pmid=25050056 | doi= | pmc=4103716 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25050056  }} </ref><ref name="pmid28187073">{{cite journal| author=Tye EY, Anderson JT, Faour M, Haas AR, Percy R, Woods ST et al.| title=Prolonged Preoperative Opioid Therapy in Patients With Degenerative Lumbar Stenosis in a Workers' Compensation Setting. | journal=Spine (Phila Pa 1976) | year= 2017 | volume= 42 | issue= 19 | pages= E1140-E1146 | pmid=28187073 | doi=10.1097/BRS.0000000000002112 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28187073  }} </ref><ref name="pmid20227646">{{cite journal| author=Genevay S, Atlas SJ| title=Lumbar spinal stenosis. | journal=Best Pract Res Clin Rheumatol | year= 2010 | volume= 24 | issue= 2 | pages= 253-65 | pmid=20227646 | doi=10.1016/j.berh.2009.11.001 | pmc=2841052 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20227646  }} </ref><ref name="pmid28461958">{{cite journal| author=Covaro A, Vilà-Canet G, de Frutos AG, Ubierna MT, Ciccolo F, Caceres E| title=Management of degenerative lumbar spinal stenosis: an evidence-based review. | journal=EFORT Open Rev | year= 2016 | volume= 1 | issue= 7 | pages= 267-274 | pmid=28461958 | doi=10.1302/2058-5241.1.000030 | pmc=5367584 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28461958  }} </ref><ref name="pmid1596776">{{cite journal| author=Eskola A, Pohjolainen T, Alaranta H, Soini J, Tallroth K, Slätis P| title=Calcitonin treatment in lumbar spinal stenosis: a randomized, placebo-controlled, double-blind, cross-over study with one-year follow-up. | journal=Calcif Tissue Int | year= 1992 | volume= 50 | issue= 5 | pages= 400-3 | pmid=1596776 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1596776  }} </ref>
*The use of epidural steroid injections is controversial and evidence of their efficacy is contradictory.<ref name="pmid28461958">{{cite journal| author=Covaro A, Vilà-Canet G, de Frutos AG, Ubierna MT, Ciccolo F, Caceres E| title=Management of degenerative lumbar spinal stenosis: an evidence-based review. | journal=EFORT Open Rev | year= 2016 | volume= 1 | issue= 7 | pages= 267-274 | pmid=28461958 | doi=10.1302/2058-5241.1.000030 | pmc=5367584 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28461958  }} </ref>
*Physical therapy is recommended for all patients with spinal stenosis.<ref name="pmid23886845">{{cite journal| author=Macedo LG, Hum A, Kuleba L, Mo J, Truong L, Yeung M et al.| title=Physical therapy interventions for degenerative lumbar spinal stenosis: a systematic review. | journal=Phys Ther | year= 2013 | volume= 93 | issue= 12 | pages= 1646-60 | pmid=23886845 | doi=10.2522/ptj.20120379 | pmc=3870489 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23886845  }} </ref><ref name="pmid28461958">{{cite journal| author=Covaro A, Vilà-Canet G, de Frutos AG, Ubierna MT, Ciccolo F, Caceres E| title=Management of degenerative lumbar spinal stenosis: an evidence-based review. | journal=EFORT Open Rev | year= 2016 | volume= 1 | issue= 7 | pages= 267-274 | pmid=28461958 | doi=10.1302/2058-5241.1.000030 | pmc=5367584 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28461958  }} </ref>
**No conclusions could be drawn from the review regarding which physical therapy treatment is superior for spinal stenosis.<ref name="pmid23886845">{{cite journal| author=Macedo LG, Hum A, Kuleba L, Mo J, Truong L, Yeung M et al.| title=Physical therapy interventions for degenerative lumbar spinal stenosis: a systematic review. | journal=Phys Ther | year= 2013 | volume= 93 | issue= 12 | pages= 1646-60 | pmid=23886845 | doi=10.2522/ptj.20120379 | pmc=3870489 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23886845  }} </ref>
 
==References==
{{Reflist|2}}


[[Image:Epidural_steroids_for_spinal_stenosis_-_Forest_plot_for_improvement.png|400px]]
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==References==
==References==

Revision as of 13:55, 27 July 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]


Overview

Medical Therapy

  • Pharmacologic medical therapy is recommended among patients with spinal stenosis.[1][2]
  • Pharmacologic medical therapy is the first step in treatment of patients with spinal stenosis.[1][2]
  • Pharmacologic medical therapies for spinal stenosis include Non-steroidal anti-inflammatory drugs, muscle relaxants, opioid analgesics and injectable calcitonin.[3][4][1][2][5]
  • The use of epidural steroid injections is controversial and evidence of their efficacy is contradictory.[2]
  • Physical therapy is recommended for all patients with spinal stenosis.[6][2]
    • No conclusions could be drawn from the review regarding which physical therapy treatment is superior for spinal stenosis.[6]

References

  1. ↑ 1.0 1.1 1.2 Genevay S, Atlas SJ (2010). "Lumbar spinal stenosis". Best Pract Res Clin Rheumatol. 24 (2): 253–65. doi:10.1016/j.berh.2009.11.001. PMC 2841052. PMID 20227646.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Covaro A, Vilà-Canet G, de Frutos AG, Ubierna MT, Ciccolo F, Caceres E (2016). "Management of degenerative lumbar spinal stenosis: an evidence-based review". EFORT Open Rev. 1 (7): 267–274. doi:10.1302/2058-5241.1.000030. PMC 5367584. PMID 28461958.
  3. ↑ Witenko C, Moorman-Li R, Motycka C, Duane K, Hincapie-Castillo J, Leonard P; et al. (2014). "Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain". P T. 39 (6): 427–35. PMC 4103716. PMID 25050056.
  4. ↑ Tye EY, Anderson JT, Faour M, Haas AR, Percy R, Woods ST; et al. (2017). "Prolonged Preoperative Opioid Therapy in Patients With Degenerative Lumbar Stenosis in a Workers' Compensation Setting". Spine (Phila Pa 1976). 42 (19): E1140–E1146. doi:10.1097/BRS.0000000000002112. PMID 28187073.
  5. ↑ Eskola A, Pohjolainen T, Alaranta H, Soini J, Tallroth K, Slätis P (1992). "Calcitonin treatment in lumbar spinal stenosis: a randomized, placebo-controlled, double-blind, cross-over study with one-year follow-up". Calcif Tissue Int. 50 (5): 400–3. PMID 1596776.
  6. ↑ 6.0 6.1 Macedo LG, Hum A, Kuleba L, Mo J, Truong L, Yeung M; et al. (2013). "Physical therapy interventions for degenerative lumbar spinal stenosis: a systematic review". Phys Ther. 93 (12): 1646–60. doi:10.2522/ptj.20120379. PMC 3870489. PMID 23886845.

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