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Spinal Stenosis
Spinal stenosis refers to narrowing of the spinal canal,
which causes pressure on the spinal nerves or cord. This
condition is mostly seen in patients over the age of 50.
Although the cause of spinal stenosis is not clear, two
types have been described.
The congenital form of spinal stenosis is seen in individuals
who are born with a narrow spinal canal. In these individuals,
minimal changes in the structure of the spine can cause
severe spinal stenosis.
The more common acquired form of stenosis is caused by
progressive changes in different spinal elements (such as
the discs, joints, ligaments, etc.) As people age, all these
different elements sag or bulge and form arthritis that
narrows the spinal canal.
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Epidural Injection
The epidural space is within the spinal canal and surrounds
the spinal cord and spinal fluid. Steroid
injections into this space can help to decrease inflammation
of nerves and other soft tissues in the
problematic area. They are used for problems such as: Herniated
discs, Sciatica, Radiculopathy, and
Narrowing of the Spinal Canal (Spinal Stenosis). They can
be given in the neck (cervical spine), upper
back (thoracic spine), lower back (lumbar spine), and from
the level of the tailbone (caudal approach).
Selective Epidural Injection
A common type of epidural is a selective nerve injection.
When a nerve root becomes compressed and inflamed, it can
produce leg and possibly back pain. In a selective injection,
the nerve is approached at the level where it exits the
hole between the vertebral bodies. The injection is done
both with an antiinflammatory medication and a numbing agent.
Fluoroscopy (live x-ray) is used to ensure the medication
is delivered to the correct location. Following the injection,
the steroid helps reduce inflammation around the nerve root.
IInterlaminar Epidural Injection
As an alternative approach, medication may also be put into
the epidural space via the interlaminar approach. In this
technique, fluoroscopy is again used to confirm correct
delivery of the medication. The physician will place a needle
between the bones of the spine at the midline and using
a special technique, he will be able to find the epidural
space. Once found, a diluted solution of an anti-inflammatory
and local anesthetic will be injected. Your physician will
make the decision which approach will be the best for your
problem.
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