But if the anti-inflammatories fail, then the next step is the diagnostic tests and that generally in a patient who’s a nonsmoker, non-diabetic without hyperlipidemia is going to be an MRI of the lumbar spine. If you have any of those vascular risk factors, then it’s reasonable also to get what are called noninvasive arterial studies. That’s generally where you get on a treadmill and your blood pressure in your legs is compared to the blood pressure in your arms. Although there are some variations on a theme where ultrasound looks at the arteries as well and sees if they’re open and with exercise and without exercise. And that helps sort things out. Well, so now we have a diagnosis of Lumbar stenosis and it’s causing the back pain that goes down the leg or legs. What are we going to do in terms of treatment? Number one is is potentially the lumbar epidural steroids, and again, these are injections of the steroid into the spine. Something either like prednisone or a variation on a theme of that. It’s a steroid, it’s at ground zero there so it gets the highest quantity there. It’s almost counterintuitive to think that somehow adding something extra is going to make it so that things have more room, but what it’s doing is by being an anti-inflammatory, it’s getting rid of the redness, the swelling, and buying time and probably best guess, 30% of patients, maybe 40% of patients, some people say it’s as low as 10 some people say it’s as high as 60 you can find many articles will have improvement. Have an injection, wait and see if you’re all better, don’t need another injection. You have an injection. Gee, doc, I think I’m 50% better. Might be worth a second injection. Is 50% good enough? Might be for some, Gee, I have an injection. Didn’t make me any better. Probably not worthwhile to do another one. Although one can make a case for certain individualized patients that it might be better to go ahead and give them a second or third, particularly if they’re not a surgical candidate for a variety of reasons.
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