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Lumbar Spinal Stenosis – An Introduction

Lumbar Spinal Stenosis pic

Lumbar Spinal Stenosis

Brian Klagges, MD, serves as an anesthesiologist and pain interventionist in Manchester, New Hampshire. Dr. Brian Klagges stands out as the first in New Hampshire to offer minimally invasive lumbar decompression for lumbar stenosis.

Lumbar stenosis is the narrowing of the spinal canal in the lumbar (lower) spine. The lumbar spine consists of five vertebrae, each of which contains small openings that allow nerves to extend outward from the spinal cord to the lower extremities.

In some patients, these small openings or the spinal canal itself can begin to narrow. The condition may be congenital, although it is most common in adults aged 50 and older. This narrowing causes a compression of the spinal cord or nerves.

Patients may experience this compression as pain or numbness in the lower back, buttocks, or legs. The condition usually worsens with activity and improves with periods of rest. Many patients find relief from the symptoms through medical intervention or physical therapy, although some patients need surgery to remove the structures causing the compression.


Treating Spondylolisthesis

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An award-winning anesthesiologist and pain interventionalist, Dr. Brian Klagges serves as director of interventional pain management at the Interventional Spine Center at Elliot Hospital in Manchester, New Hampshire. Brian Klagges, MD, stands out as the first doctor in the state to perform lumbar facet arthrodesis, which is a possible treatment for conditions such as spondylolisthesis.

Spondylolisthesis occurs when a vertebra in the spine shifts out of place and slides forward or backward along the adjacent vertebra. This may occur as the result of an injury, such as a crack in the vertebra, although it may also be a result of a tumor, degenerative condition, or birth defect.

Patients with the condition typically experience lower back pain, which tends to worsen with exercise. Patients may also notice hamstring tightness, decreased range of motion in the lower back, and pain, numbness, or tingling in the legs due to nerve compression.

Many cases of spondylolisthesis can be treated conservatively through rest, medication, and physical therapy. If the patient does not respond to this form of treatment, surgery may be necessary. Patients whose spondylolisthesis is due to a structural defect will typically undergo repair of the defective vertebral area. Others may undergo a fusion procedure such as facet arthrodesis, which permanently connects the affected vertebrae and thus prevents the motion that causes symptoms.

Modifying Exercise to Minimize Osteoarthritis Progression


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Dr. Brian Klagges is a pain interventionist and anesthesiologist and the director of the Elliot Hospital Interventional Spine Center in Manchester, New Hampshire. Brian Klagges, MD, emphasizes an innovative care approach and was the first in New Hampshire to offer genicular nerve ablation as an alternative to total knee replacement for patients suffering from severe osteoarthritis.

Associated with “wear and tear” experienced by the joints over the years, often in combination with hereditary factors, osteoarthritis is a degenerative condition experienced by approximately 30 million people nationwide.

A recent U.S. News & World Report article brought attention to the quandary faced by athletes and others who lead an active life. While wanting to continue physical activities, they must consider the negative impact of placing heavy loads on joints and bones that are compromised.

One solution involves tailoring physical therapy toward increasing strength in the muscles that give support to the arthritic joint. For example, someone with a knee issue should work toward strengthening and stretching the hip muscles, quadriceps, and hamstrings.

Low-impact exercise can play an important part in preventing the progression of osteoarthritis, as cartilage stays healthy and properly functioning through load carrying activities. Cycling, swimming, and elliptical machine workouts exercise the joints and support muscles, while ensuring that a reasonable load is placed on the joints. Beyond modifying exercise routines, another simple step to take when coping with osteoarthritis involves weight loss, as one pound lost relieves four pounds of pressure from the knee.

ASA Makes Recommendations to Congress about Opioids

American Society of Anesthesiologistspic

American Society of Anesthesiologists

A seasoned physician with more than two decades of experience in pain medicine, Brian Klagges, MD, currently works at Elliot Hospital in Manchester, New Hampshire, where he serves as the Interventional Spine Center’s director of interventional pain management. Outside of his everyday work, Brian Klagges, MD, keeps up with ongoing advances in his field through membership in the American Society of Anesthesiologists (ASA).

Last March, the ASA gave Congress a number of recommendations on action steps it can take to help address the ongoing abuse of opioid pain medication across the country. ASA’s approach mainly addresses the ways that pain is treated on a fundamental level, with the organization recommending health insurance coverage that offers a more varied strategy allowing patients to access alternative treatments and interventional management.

ASA also recommends changes to the ways that physicians are reimbursed through systems such as the Merit-based Incentive Payment System (MIPS). This system calls for more financial incentives to be given to physicians who embrace new, non-opioid-based pain management techniques. Finally, the organization suggests that patients who are regularly taking opioids with a prescription be evaluated regularly by a qualified pain doctor, and receive addiction counseling if needed.

Types of Arthrodesis


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A graduate of the University at Buffalo School of Medicine and Biomedical Sciences, Brian Klagges, MD, leverages nearly two decades of medical experience to serve as the director of interventional pain management at Elliot Hospital and an anesthesiologist and pain interventionist at Amoskeag Anesthesia. In addition to his clinical work, Dr. Brian Klagges trains physicians in arthrodesis techniques as a consultant for Vertos Medical and MinSURG.

Arthrodesis of the spine, also known as artificial ankylosis or spinal fusion, addresses joint pain due to injury or degenerative conditions by bonding two affected joints together. This procedure not only stabilizes the affected part of the vertebra but also eliminates the root cause of pain and nerve compression (i.e., bone-on-bone friction).

Although arthrodesis of the spine can be accomplished using traditional open back surgical procedures, there are currently two common minimally invasive options that can be done on an outpatient basis. The first of these, intra-articular arthrodesis, involves exposing the joint prior to fusing it. The other, extra-articular arthrodesis, fuses bone blocks on the outside of the joint. This procedure is commonly used for children or in patients with infections.

Using HydroCision Technology for Surgical Procedures




An experienced physician, Brian Klagges, MD, works at Elliot Hospital in his capacity as director of interventional pain management. Furthermore, Dr. Brian Klagges holds the roles of pain interventionist and anesthesiologist at Amoskeag Anesthesia. Dr. Brian Klagges performs various procedures, including minimally invasive discectomies using technology that the Massachusetts-based company, HydroCision, has developed.

HydroCision technology employs a high-pressure stream of sterile saline and suction to incise and remove tissue. The HydroCision system consists of a power unit with adjustable settings and a single-use handpiece that can be customized for orthopedic and spinal procedures.

The main benefit of the HydroCision system is that it can distinguish between different densities and types of tissue. The device can selectively incise tissue without harming neighboring vital structures and healthy tissue. Moreover, unlike radio frequency or laser technologies, the system cannot cause thermal damage to neighboring tissue. HydroCision’s products have undergone clinical studies to confirm their clinical efficacy.

ASRA Releases New MIPS Fact Sheets

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American Society of Regional Anesthesia and Pain Medicine

An award-winning physician, Brian Klagges, MD, is the director of interventional pain management at Elliot Hospital’s Interventional Spine Center and an anesthesiologist and pain interventionist at Amoskeag Anesthesia, both in Manchester, New Hampshire. When he isn’t working, Dr. Brian Klagges maintains membership in professional associations such as the American Society of Regional Anesthesia and Pain Medicine (ASRA).

In December 2017, ASRA released two updated fact sheets for anesthesiologists to reference as they navigate Medicare’s Merit-based Incentive Payment System (MIPS), now in its second full year of implementation. Under the MIPS program, Medicare looks at a provider’s performance in the areas of quality, cost, practice improvement, and advancing care, scoring the clinician and using the results to determine whether a payment adjustment (positive or negative) is warranted.

The two new MIPS fact sheets are aimed at chronic pain management providers as well as clinicians who work in regional anesthesia and acute pain medicine. Further, the sheets provide a look at some of the ways that Medicare measures quality in each of the scoring areas and the most efficient ways to submit data for each of them. To view the newly updated fact sheets, visit