The Geriatric Spine Syndrome: Treatment, Hypertrophic Form

By | June 20, 2011

Injections or Radio Frequency Ablations directed at the facet joints are rarely effective due to the widespread nature of the disease.

When it comes to treatment the two subtypes of the Geriatric Spine Syndrome being to diverge. A brief trial of Lumbar Epidural Steroid Injections is warranted in either case although it is more likely to be effective in the hypertrophic form. Therapy directed at the facet joints, either joint injection or Radio Frequency Ablation (RFA) is usually not effective because of the widespread nature of the disease. When conservative therapy proves ineffective the next step is neurosurgical consultation as discussed before.


The best choice of therapy for the hypertrophic form is usually surgery. Occasionally outpatient spinal realignment procedures such as the X-Stop can produce remarkable relief. In more severe cases a one or two level laminectomy with or without foramenotomies is usually quite effective and well tolerated. Recovery from this type of surgery usually takes only a matter of weeks with return to full activity in 6 months or less.


I usually reserve neuromodulation for patients who have failed the above procedures or who would not be able to tolerate them. This is because in cases of nerve entrapment or compression complete relief of pain with either chemical or electrical neuromodulation is not possible and relief will diminish as the compression worsens. On the contrary, cases of persistent pain after adequate surgical decompression usually respond very well to neuromodulation, usually combined with physical therapy or yoga therapy.


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