We have prepared this spinal stenosis guide as a must-read resource for every diagnosed patient. We have seen time and time again that a lack of knowledge is disastrous for people with spinal and neuroforaminal stenosis. This is the primary reason why we stress the need for education in the patient community, in order to better the chances for positive and satisfying therapy outcomes.
Battling stenotic changes in the spine can be difficult at several key stages of the process. Diagnosis is only the first step in the journey and is the place where many patients go astray. Treatment is the next stage of the path to better health and once again, many patients make poor choices that may lead to chronic symptoms or even worsened symptoms, despite active care. Finally, for patients who successfully navigate diagnosis and treatment, the recovery process is just as important to reestablish a normal life and reduce the possibility of suffering a symptomatic recurrence in the future.
In this vital patient guide, we tackle these three crucial steps in the stenosis therapy path and shed light on the common mistakes made by doctors and patients alike. Understanding why stenosis treatment goes wrong will help every diagnosed patient to improve their odds of enjoying successful care, regardless of the treatment practices utilized.
Spinal Stenosis Guide to Diagnosis
The diagnosis of spinal stenosis is easy to achieve using modern imaging tools, such as x-ray, MRI and CT scan. Narrowed central or foraminal canals can be visualized and judged to be stenotic to various degrees using objective comparative analysis.
It is well known and universally accepted that stenotic changes are normal to experience as we get older. The processes of osteoarthritis, intervertebral degeneration and the general aging of the spinal structures all contribute to a loss of patency in many foraminal openings, as well as a general reduction in the effective diameter of the spinal canal, particularly in areas of high activity, such as the mid to low cervical and lower lumbar regions.
Finding stenotic changes in people past the age of 40 is commonplace and many people demonstrate narrowed central or foraminal canals even younger, especially if they have suffered some known contributory factors, such as a congenital decrease in canal size, some traumatic spinal injury or participation in a risky activity, such as high-level competitive gymnastics. The older we get, the greater the chance of finding ever more drastic versions of stenosis in the spine.
However, discovering the evidence of stenosis is not the difficult or subjective aspect of the diagnostic process. It is the incredibly easy and objective part. Visual evidence can not be easily disputed, so stenosis can be judged as being present in some form, based exclusively on images taken during the above mentioned exams.
The problem in the diagnostic process occurs when the stenosis is evaluated as to its ability to cause symptoms. This is where things can go completely wrong for the patient. Stenosis is normal to experience and we will all demonstrate it to some degree as we age. Finding stenosis in people of proper age is virtually a given. However, determining that the stenosis is currently sourcing, or capable of sourcing, symptoms is the highly subjective portion of the diagnostic process that can spell disaster for anyone diagnosed with having a narrowed central vertebral canal or one or more narrowed foraminal canals.
Research, clinical practice and medical fact dictate that most mild to moderate degrees of stenotic change will not cause symptoms now or ever. These same protocols tell that even the most severe-looking cases of stenosis are often asymptomatic. Meanwhile, many patients are told that their stenosis is indeed responsible for causing pain and/or neurological effects right now, explaining a current symptomatic complaint, when there is simply no evidence of any nerve compression occurring in the imaged location.
Other patients do not have symptoms currently, but are so frightened of the diagnostic process that they suffer a documented negative occurrence called the nocebo effect. The psychological conditioning process causes them to develop symptoms through psychogenic mechanisms, due to fear and the expectation of pain and neurological effects incited by the doctor’s often illogical warnings during the stenosis evaluation.
In rare cases, truly symptom-generating stenosis is discounted as the cause of symptomology, failing to get patients into treatment when they actually need it and can benefit from it. This last example is truly uncommon, but we have seen it happen in some select instances.
The key thought to understand here is that the physical changes associated with stenosis are easy to diagnose. However, linking these changes to present symptoms or the possibility of developing future symptoms is an incredibly subjective practice in many instances that leads directly to inappropriate and unneeded treatment, poor treatment results, the denial of needed treatment or the development of psychogenic pain based on diagnostic nocebo, rather than actual structural pathology.
Spinal Stenosis Treatment Guide
If the diagnostic conclusion is incorrect, namely that the stenosis is causing symptoms, when in fact, it is incidental, than treatment is usually doomed from the beginning. Any therapy that targets the stenosis as the underlying cause of pain is unlikely to resolve the true causative source, since this process remains unknown and unidentified. Worse still, since a diagnosis has been firmly established, often without proper supportive evidence, the patient is likely to move from one treatment to another, each failing worse than the one before, since all will seek to cure the underlying stenotic narrowing.
In cases where the diagnosis of symptomatic stenosis is valid and correct, there are still potential problems in the treatment phase that affect a tremendous number of patients. The first typical problem is the decision to treat the condition conservatively, even though the methods of care used will never do anything to act on the stenosis itself. Unfortunately, doctors might be required by health insurance policies to provide conservative care before the company will even consider covering expensive surgical endeavors that can actually cure the stenosis. This is a waste of time, pain and hope for the patient who is stuck in neutral, not able to move forward towards a cure while being subjected to therapies that may qualify as the worst examples of symptomatic care. In even sadder instances, the decision to keep the patient in conservative care is made by the treating care provider, who realizes that profitability of extended duration treatment and does not want to lose a valuable money-generating customer to a surgical referral. This is borderline criminal activity, but it happens to hundreds of thousands of patients each year.
Even when curative measures are implemented towards ending stenotic blockages that have been definitively proven to be symptomatic, things can still go awry. Treatment choices vary considerably, even among surgical interventions. Choosing the wrong path can dramatically increase the odds of suffering a poor outcome or a treatment-related complication. This is why it is so crucial to research every possible path towards treatment and consult with several doctors before deciding on the best path to a cure.
Spinal Stenosis Guide to Recovery
If the diagnostic process goes smoothly and returns accurate results and the treatment phase also generates good outcomes, then the patient has a very good chance of recovering from the stenosis and moving on with life. However, certain factors can still become serious impediments during the recovery process, so we will address these lesser discussed factors in order to guide patients towards the successful completion of their stenosis battles:
First, it is necessary to do everything possible to adhere to post-treatment instructions and guidelines provided by caregivers in order to maximize the beneficial results of therapy. Failure to follow commonsense and specifically-dictated physician advice causes some patients to suffer horrific complications due to injury or the development of other spinal woes following successful stenosis care.
Next, it is necessary to be actively involved in the diagnostic and treatment processes on a cerebral level and to completely understand the types of practices used during these steps of the stenosis therapy process. This knowledge will provide the logic and confidence to battle the common development of post-therapeutic psychogenic pain conditions that may develop and lead to symptomatic recurrence, despite no presence of a structural spinal pathology after treatment.
Post-treatment monitoring is crucial to make sure that additional areas of stenosis do not develop in the same region or in different regions of the spine. Unfortunately, most surgical stenosis interventions actually increase the likelihood of developing additional areas of focal stenosis due to many different factors. Additionally, the passage of time alone will cause the body to continue to generate stenotic changes as a normal part of getting older.
Following the simple steps outlined in this guide and those further detailed throughout this web resource will help any patient improve their chances of living well despite spinal stenosis. If you still have specific questions about stenosis, you will find the answer in our popular FAQ section.
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