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The disease itself is usually diagnosed initially by good historical evidence. Sometimes plain X-rays may show disc narrowing as well as facet hypertrophy or enlargement. Special oblique X-rays may show foramenal stenosis. Usually a CT scan or MRI scan will be ordered to complete the diagnosis and identify the exact levels and extent of the compression.
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MRI with moderate canal stenosis | Treatment is often accomplished with anti inflammatory agents, and modification of activities. Sometimes a steroid injection into the epidural space surrounding the spinal sac may help to reduce the inflammation around the nerves. This is best accomplished under X-ray guidance to make sure that the steroid medicine gets to the appropriate place in the spine. If one or two nerve roots are involved a special root or transforamenal block may be done. This effectively puts the steroid exactly on the area of maximum inflammation.
Once maximum medical therapy has been exhausted and the patient is unable to perform normal daily activities and has
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CT Scan of severe facet arthropathy with canal narrowing | considerable discomfort with any activity then surgery is recommended. This involves performing a laminectomy or laminotomy where the posterior bones and ligaments of the spine are removed carefully and exposure is gained to the spinal sac and nerve roots. Using very fine instruments and magnification the nerve roots are freed up of pressure from bone and disc material. Care is taken not to remove so much bone to cause the spine to become unstable but in rare instances this is unavoidable and a fusion is done using bone graft and possibly screws and rods. Injury to nerve roots is uncommon but can occur in severe foramenal stenosis.
Generally patients get quick relief of their symptoms and leave the hospital in two to five days depending on the extent of the surgery and general medical condition. A soft lumbar corset is usually worn to help with muscle strength and mobility until the individual has recovered from the surgery itself in a few weeks.
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