By Becky Weise
Lumbar spinal stenosis is a common, but painful, malady often associated with aging. The lumbar, or lower back, is made up of the five largest and strongest vertebrae between the diaphragm (just below the ribs) and the pelvis — the backside of the abdomen.
Stenosis is a narrowing of the spinal column that is caused by the natural wear and tear on the body which leads to contributing factors such as thickening of ligament tissue, formation of excess bone, and compression or bulging discs. Stenosis often results in neurological issues such as pain, numbness, or tingling that radiates down through the buttocks and legs.
“Usually lumbar spinal stenosis is an aging issue, characterized by complaints of positional back pain,” says Dr. Benyamin, Medical Director at Millennium Pain Center. “Patients will have pain in their back, buttocks, and legs, especially after standing or walking. Sitting down or laying down usually helps alleviate the pain, but it can eventually become so painful and more consistent that it sends the patient to a wheelchair. It definitely causes limitations in activity because walking or standing for periods of time make it worse.”
Dr. Benyamin goes on to explain that quality of life becomes an issue as more walking increases the pain, even during regular activities such as grocery shopping. “That’s a telltale symptom — leaning on the shopping cart to relieve the pain.”
Treatment options for lumbar spinal stenosis used to be extreme.
Conservative treatment includes physical therapy, over-the-counter anti-inflammatory drugs, and steroid injections. While these treatments carry low risk for complications and no need for hospitalization, they also provide variable results and usually only short-term relief.
At the other extreme is open-back surgery, requiring a three to five day hospital stay, a relatively large incision, general anesthesia, and a much higher risk of major complications. While the success rate of a positive outcome is high — 60 to 80 percent positive outcome — the risk of complications, especially for older patients, is a deterrent, not to mention the often daunting prospect of undergoing and recovering from a major surgery.
As Dr. Benyamin points out, “Older patients also often have multiple issues to consider: hypertension, diabetes, and other health issues that make treatment more difficult.”
Drs. Benyamin and Vallejo are excited, however, about being able to offer their patients other minimally invasive options like the mild® procedure and a spine spacer called Superion.
These procedures now fill the gap between the two extremes, according to Dr. Vallejo, Director of Research at Millennium. The mild® (minimally invasive lumbar decompression) procedure was approved by the FDA several years ago. Initially, it was available only to participants in a clinical research trial as was mandated by Medicare and, “We [Millennium Pain Center] were the only pain practice in Illinois that offered the treatment during the clinical trial,” says Dr. Vallejo. The results of the clinical trial were published in 2017, and the treatment is now available for Medicare recipients. The spinal spacer (Superion) is a small implant that’s placed between the bones through a small incision allowing for opening of spinal stenosis and relieving pressure. He explains that the diagnosis of spinal stenosis is made using an MRI. The procedure itself involves using specialized tools to remove part of the ligament and soft tissues in the spinal canal which are causing the impingement of the nerves.
“We do this by injecting contrast fluid in the epidural space and, utilizing live x-ray, are able to see exactly what needs to be done to open the spinal canal and reduce or remove the impingement that is causing the pain.”
Since the procedure actually restores space in the spinal column, mobility for the patient is actually restored. “This isn’t a Band-Aid — it is a treatment,” says Dr. Benyamin, meaning it does not mask the pain, but actually eliminates the cause of pain — “kind of like a bypass in the spine.”
These procedures have significant benefits because they are non-surgical treatments for treating spinal stenosis using an extremely small incision. The procedure is done on an outpatient basis, so the patient does not require hospitalization, nor does the patient undergo general anesthesia. The majority of patients have positive outcomes similar to the more risky open surgery.
“The mild® and Superion procedures are very safe — are less invasive, less costly, and don’t have the risk of transfusion, and can be done at any level of the lumbar spine — with very few complications,” says Dr. Benyamin.” Since the typical patients are older and surgery is riskier for older people, these non-surgical options are very beneficial.”
For more information on any type of pain, you may contact Millennium Pain Center at 309-662-4321 or www.millenniumpaincenter.com. Their new office is located at 2406 E. Empire in Bloomington. The practice provides the most advanced and comprehensive pain management for a wide variety of conditions. Drs. Benyamin and Vallejo have been selected among 70 of the Best Pain Physicians in America.
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