As we age, our spines change. The everyday, normal wear-and-tear effects of aging can lead to a narrowing of the spinal canal. This condition is called Spinal Stenosis.
Up to 95% of the population experience degenerative spinal changes over the age of 50. Spinal stenosis most often occurs in adults 60 years old and older. Pressure on the roots of the nerves are equally common in men and women.
Arthritis is the most common cause of spinal stenosis as a result as the disk degeneration and loss of water content. In children and young adults, disks have high water content; as we get older, the disk begins to dry out and weaken, causing a problem known as settling or collapse of the disk space and loss of disk space height.
Symptoms of Spinal Stenosis include:
Back pain: People with spinal stenosis may or may not have back pain. The degree of arthritic development dictates the pain or lack thereof.
Burning pain in buttocks or legs: Pressure on spinal nerves can result in pain in the areas that the nerves supply. The pain may be described as an ache or a burning feeling. It typically starts in the area of the buttocks and radiates down the leg. As it progresses, it can result in pain in the foot.
Numbness or tingling in buttocks or legs: As pressure on the nerve increases, numbness and tingling often accompany the burning pain. Not all patients have both burning pain and the sensation of numbness and tingling.
Weakness in the legs or “foot drop”: Once the pressure reaches a critical level, weakness can occur in one or both legs. Some patients will suffer from what is referred to as ‘foot-drop,’ the feeling that the foot is slapping on the ground while walking.
Less pain leaning forward or sitting: Studies of the lumbar spine show that leaning forward can actually increase the available nerve space. Many patients may feel relief when leaning forward and when sitting. Pain is usually worsened by standing or walking. Some patients find relief riding a stationary bike or walk more comfortably leaning on a shopping cart. Walking more than a short distance (1 or 2 blocks) may bring on severe sciatica, discomfort and weakness.
Non-Surgical:
Nonsurgical treatment focuses on restoring function to the extremities and pain relief. Although nonsurgical methods do not improve the narrowing of the spinal canal, many patients report that such treatment helps to relieve manny of the symptoms.
Physical therapy: Stretching exercises, massage as well as lumbar and abdominal strengthening are used to help manage the noted symptoms.
Lumbar traction: Although helpful with select patients, traction delivers limited results. There is no scientific evidence of traction’s effectiveness in treatment.
Anti-inflammatory medications: Because stenosis pain is caused by pressure on a spinal nerve, reducing inflammation (swelling) around the nerve may relieve pain. Non-steroidal anti-inflammatory drugs (NSAIDs) provide initial pain relief. When used over the course of 5-10 days, they can also have an anti-inflammatory effect.
Most people are familiar with non-prescription NSAIDs, such as aspirin and ibuprofen. Whether over-the-counter or prescription strength, these medicines must be used carefully. In some cases, they can lead to gastritis or stomach ulcers. If you are planning to take NSAIDs or develop acid reflux or stomach pains as a result of taking any such anti-inflammatory, consult your physician immediately.
Steroid injections: Cortisone is a powerful anti-inflammatory drug. Cortisone injections around the nerves or in the “epidural space” can decrease swelling as well as pain. They can also reduce numbness, but not weakness, in the legs and lower extremities. Patients should receive no more than three injections in the course of a year.
Acupuncture: Acupuncture can be helpful in treating some of the pain for less severe cases of lumbar stenosis. Although it can be very safely administered, long-term efficacy of this treatment has not been proven scientifically.
Chiropractic manipulation: Chiropractic manipulation administered by a professional is generally considered safe and may help to alleviate some pain associated with lumbar stenosis. Care should be taken if a patient has osteoporosis or disk herniation as manipulation of the spine can worsen symptoms or cause other injuries in such cases.
Surgical:
Surgery for Spinal Stenosis is generally reserved for patients who experience poor or reduced quality of life due to enduring pain and general weakness. Patients may complain of difficulty walking for extended periods of time.
There are two main surgical options to treat lumbar spinal stenosis: laminectomy and spinal fusion. Both surgical options may result in long-term pain relief. Be sure to discuss the advantages and disadvantages of both surgical procedures with your doctor.
Laminectomy: This procedure involves removing the bone, bone spurs, and ligaments that are compressing the nerves. This procedure is also commonly referred to as “decompression.”
Spinal fusion: If arthritis has progressed to spinal instability, a combination of decompression and stabilization or spinal fusion may be recommended by your doctor.
Michigan Orthopaedic Surgeons (MOS) is a group of over fifty of Michigan’s finest orthopaedic and musculoskeletal surgeons, specialists and research pioneers. – Learn More
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