Treatments For Spinal Stenosis
Thankfully, spinal stenosis can often be treated, first with anti-inflammatories, physical therapy, and epidural steroid injections, which can decrease inflammation and pain. Minimally invasive surgery can also be performed in an outpatient procedure with a small incision and no stiches.
When its time to see a doctor for treatment for back pain that wont go away or is worsening, seek out a leader in minimally invasive procedures. Advances in minimally invasive treatments means treating chronic back pain is easier than ever. Between outpatient treatments and minimally invasive surgical procedures using small incisions, you can expect a quicker recovery time instead of a long hospital stay.
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Bottom Line: Only Select Cases Appear To Benefit
This study is the first to characterize clinical and QOL outcomes following cervical decompression among patients with concomitant PD and CSM. Matched-pair analysis showed that patients with PD experienced diminished symptomatic and QOL improvement relative to controls.
Although decompression may have a role in alleviating pain-related disability in the PD population, this intervention appears to offer marginal benefit with respect to improving myelopathy and overall QOL. It is possible that only select patients with coexisting PD and CSM respond favorably to cervical decompression. Accordingly, preoperative pharmacologic optimization of PD should precede surgical correction of the spine. Further studies are needed to determine which patients with PD may benefit from surgical intervention for their myelopathy.
Mr. Xiao and Mr. Miller are medical students at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.
Dr. Krishnaney is a neurosurgeon in Cleveland Clinics Center for Spine Health and Department of Neurological Surgery.
Glucocorticoid Regulation Of Inflammation Through Gr
In brain, GC signaling is mediated by almost ubiquitously expressed GRs as well as mineralocorticoid receptors that have restricted expression in neurons. However, it should be noted that MR is also expressed in glia . GR, a prototype member of nuclear receptor superfamily is a ligand-activated transcription factor, it can also exert non-genomic actions . GR is a modular protein with an N-terminal transactivation domain, a C-terminal ligand binding domain and a central Zinc fingers-containing DNA-binding domain that recognizes a specific DNA sequence. The LBD is the high affinity binding site for cortisol and other ligands. In humans, two major isoforms of GR, hGR and hGR arising from alternative splicing have been described and they differ in their C-terminal ligand-binding domain such that hGR cannot bind to endogenous or synthetic GCs. Experimental evidence indicates that hGR is expressed at low levels and it antagonizes the transcriptional activity of hGR thus acting as dominant negative inhibitor of hGR. However, recent genome-wide microarray studies indicate that hGR also regulates gene transcription . Interestingly, reduction in hGR:hGR ratio has been associated with behavioral and mood disorders such as depression and schizophrenia . In addition, alternative translational initiation sites generating 8 different GR proteins both in mouse and humans have been described .
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Stay Safe With Your Medicines
Read all labels carefully.
- Tell all your health care providers about all the medicines and supplements you take.
- Know all the medicines and foods youâre allergic to.
- Review any side effects your medicines can cause. Most reactions will happen when you start taking something, but thatâs not always the case. Some reactions may be delayed or may happen when you add a drug to your treatment. Call your doctor right away about anything unusual.
- Use one pharmacy if possible. Try to fill all your prescriptions at the same location, so the pharmacist can watch for drugs that might interact with each other.
- You can use online tools to see if any of your medicines wonât work well together.
You have the right and responsibility to know what medications your doctor prescribes. The more you know about them and how they work, the easier it will be for you to control your symptoms. You and your doctor can work together to create and change a medication plan. Make sure that you understand and share the same treatment goals. Talk about what you should expect from medications so that you can know if your treatment plan is working.
What Are The Symptoms Of Spinal Stenosis
Symptoms of spinal stenosis happen when the spaces within the spine narrow and put pressure on the spine. This occurs most often in the lower back and neck. For most people, symptoms develop slowly, and some people may not have any symptoms.
Symptoms of spinal stenosis in the lower back can include:
- Pain in the lower back.
- Burning pain or ache that spreads down the buttocks and into the legs, that typically worsens with standing or walking and gets better with leaning forward.
- Numbness, tingling, or cramping in the legs and feet. These may get worse when you stand or walk.
- Weakness in the legs and feet.
Symptoms of spinal stenosis in the neck may include:
- Neck pain.
- Numbness or tingling that spreads down the arms into the hands.
- Weakness in a hand, arm, or fingers.
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Can Parkinsons Disease Be Prevented
Unfortunately, no. Parkinsons disease is long-term disease that worsens over time. Although there is no way to prevent or cure the disease , medications may significantly relieve your symptoms. In some patients especially those with later-stage disease, surgery to improve symptoms may be an option.
Endogenous Androgens And Animal Models Of Pd
The effect of castration to reduce gonadal endogenous androgen levels was investigated on brain DA markers. Whereas castration in very young male mice increased glial activation, decreased striatal DA levels and tyrosine hydroxylase positive cells in striatum and substantia nigra, and impaired locomotor activities, this effect was age dependent, and castration in adult male mice did not induce any of these effects.33 Furthermore, in the 6-hydroxydopamine -lesioned rat model of PD, castration is reported to reduce 6-OHDA-induced toxicity : castrated male rats having less DA content or neuronal loss and a decrease in motor asymmetry and oxidative stress generation following a 6-OHDA lesion.3436
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What Is The Outlook For Persons With Parkinsons Disease
Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.
Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.
The future is hopeful. Some of the research underway includes:
- Using stem cells to produce new neurons, which would produce dopamine.
- Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
- Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.
Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.
Evaluating Lower Back Pain
When a person develops lower back pain, a neurological history and exam can help rule out serious medical conditions that may need further evaluation and intervention. The neurological history will collect information about other neurological symptoms such as numbness, tingling, weakness, new bowel or bladder symptoms, etc. The neurologic exam will assess strength, sensory changes and reflexes, among other things, which can shed light on spine function and help determine if a serious medical condition is present. Lower back pain caused by a serious medical condition is rare . Nevertheless, be sure to tell your neurologist about any new symptoms that you may have.
For most people, neurologic history and exam will confirm that lower back pain can be managed conservatively. When this is the case, treatment of the pain with exercise and physical therapy is the best course forward. Your neurologist may determine that imaging of the lower back will be helpful. If that is the case, he/she may order an MRI of the lower spine. An MRI will show structural changes to the lower spine but will not visualize PD-specific causes of lower back pain such as rigidity, dystonia, or central pain.
Studies have shown that MRIs can reveal structural changes that do not result in pain at all. So, it is important not to let imaging be the sole guidance of lower back pain management.
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How Is Parkinsons Disease Diagnosed
Diagnosing Parkinsons disease is sometimes difficult, since early symptoms can mimic other disorders and there are no specific blood or other laboratory tests to diagnose the disease. Imaging tests, such as CT or MRI scans, may be used to rule out other disorders that cause similar symptoms.
To diagnose Parkinsons disease, you will be asked about your medical history and family history of neurologic disorders as well as your current symptoms, medications and possible exposure to toxins. Your doctor will look for signs of tremor and muscle rigidity, watch you walk, check your posture and coordination and look for slowness of movement.
If you think you may have Parkinsons disease, you should probably see a neurologist, preferably a movement disorders-trained neurologist. The treatment decisions made early in the illness can affect the long-term success of the treatment.
Is Spinal Stenosis Causing Your Chronic Back Pain
Back pain is something that most people will encounter in their lifetimes. Almost 65 million people in the United States reported experiencing some form of back pain recently, and about 16 million adults have chronic back pain that interferes with their daily activities.
While back pain can be caused by a myriad of factors, one condition tends to afflict aging adults more than any other age groupspinal stenosis. The expert team at Cerebrum MD, led by board-certified neurosurgeon Dr. Joseph Watson, is here to help you understand what causes spinal stenosis and what treatment options are available.
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Treatment With Androgens In Animal Models Of Pd
In male mice, testosterone treatment failed to induce any protective effect against MPTP toxicity38,50 . However, the lack of effect of testosterone may be the result of insufficient conversion to estradiol, or the lack of beneficial effect of androgen receptor stimulation. To specifically investigate the role of androgen receptor stimulation in neuroprotection, dihydrotestosterone, which is the most potent androgen, is a more appropriate compound than testosterone since it is not aromatized to estradiol. Studies performed in MPTP-treated male mice and 6-OHDA-lesioned gonadectomized female and male rats reported no beneficial effect of dihydrotestosterone treatment,34,50,51 suggesting that stimulation of the androgen receptor was not effective in inducing a protective effect. Given the absence of protection with both testosterone and dihydrotestosterone, these results suggest that testosterone is not converted in the brain into estradiol in sufficient concentration to achieve neuroprotective levels.
Thus, animal and clinical studies do not support that androgens may modify the risk to develop PD. The potential beneficial effect of testosterone when combined with antiparkinsonian medication to improve PD symptoms requires larger studies to draw a clear conclusion.
Causes Of Lower Back Pain
People with PD may have the same lower back issues that affect the general population.
Here is a picture of the spine and its surrounding structures.
There are specific structural problems of the lower spine that can lead to pain. Primarily the structural problems fall into two categories:
- Narrowing of the central spinal canal through which the spinal cord travels. This can cause spinal stenosis and typically manifests as pain with standing or walking that improves with bending forward or sitting.
- Narrowing of the exit holes through which the spinal nerves travel. This can cause what is known as radiculopathy, pinched nerve, or sciatica and typically manifests as pain that travels down a leg.
There are many causes of these narrowings including:
Much less common, are infections of the spine or cancers growing around the spine. Both of these conditions can push on the spine or spinal nerves and cause pain.
Surprisingly, all of these causes together typically account for a small percentage of lower back pain. For most people with lower back pain, no specific structural cause can be identified.
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A Dilemma Of Symptom Overlap
Patients with Parkinsons disease may exhibit symptoms similar to those observed in cervical spondylotic myelopathy , including ataxia, weakness, and bowel or bladder dysfunction. These similarities present diagnostic and therapeutic challenges when PD and CSM coexist. While CSM is typically treated with surgical decompression , PD requires pharmacologic therapies and is expected to derive little benefit from decompression. This poses a dilemma for both neurologists and spine surgeons treating patients with PD who may have evidence of cervical spondylosis and myelopathy.
Clinical and quality-of-life outcomes following cervical decompression in the PD population remain undefined. Defining these outcomes may improve patient management and help avoid unnecessary surgical intervention. To that end, Cleveland Clinic Center for Spine Health clinicians and researchers recently sought to investigate clinical and QOL outcomes following cervical decompression among patients with CSM with and without coexisting PD. We hypothesized that both groups would benefit from surgery but that patients with concomitant PD would experience inferior outcomes.
Figure. Preoperative sagittal T2 MRI of a patient with coexistent cervical spondylotic myelopathy and Parkinson disease. Note the severe cervical stenosis and cord compression at C3-4and C4-5 . Postoperative X-ray after the patient underwent laminectomies at C3 through C5 and extension of her fusion to C3 via a dorsal approach.
Results: Pd Attenuates Clinical And Qol Improvements
Fifty-five patients met the studys inclusion criteria: 11 with both PD and CSM and 44 with CSM alone.
We found that symptoms improved postoperatively in both cohorts however, back pain, radiculopathy, and bowel/bladder dysfunction persisted among patients with PD relative to those without PD. Moreover, patients with PD experienced poorer improvement on both the Nurick and mJOA scales. PD was identified as a significant independent predictor of decreased improvement in patients functional status.
In the QOL analysis, while the control cohort experienced improvement across all measures examined, PD patients improved in only one . Despite an absence of significant differences between the cohorts in preoperative QOL, patients with PD had poorer QOL at last postoperative follow-up as measured by the EQ-5D and PDQ , and a smaller proportion of PD patients achieved the prespecified minimal clinically important difference in EQ-5D . No between-cohort differences in achieving a minimal clinically important difference were observed for the PDQ or PHQ-9.
Multivariable regression identified PD as a significant independent predictor of poorer improvement in EQ-5D and of failure to achieve a minimal clinically important difference in EQ-5D . Results of this QOL analysis were recently published in The Spine Journal.
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What Are The Different Stages Of Parkinsons Disease
Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.
In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:
Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.
Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.
Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.
How Do I Prevent Falls From Common Hazards
- Floors: Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its usual place.
- Bathroom: Install grab bars and non-skid tape in the tub or shower. Use non-skid bath mats on the floor or install wall-to-wall carpeting.
- Lighting: Make sure halls, stairways, and entrances are well-lit. Install a night light in your bathroom or hallway and staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
- Kitchen: Install non-skid rubber mats near the sink and stove. Clean spills immediately.
- Stairs: Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it might be helpful to arrange most of your activities on the lower level to reduce the number of times you must climb the stairs.
- Entrances and doorways: Install metal handles on the walls adjacent to the doorknobs of all doors to make it more secure as you travel through the doorway.
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