A recent study published by Boston University has determined that lumbar spinal stenosis affects 4.71% of the general population, seemingly a very low number. However, 47.2% of individuals in the 60-69 age group have lumbar spinal stenosis on their MRI scan, which is a significant number. The individuals that actually are diagnosed with severe stenosis will approach 20%. These patients with significant spinal stenosis have a 3 times higher incidence of back pain than the general population. As our population continues to live longer, spinal stenosis will certainly be a significant health problem.
Spinal stenosis is the progression of arthritis in the spine occurring in the neck, as well as in the lower back. As we age, the cartilage in the discs of our spine will lose their ability to hold water. The water in the discs is what helps the disc move and remain flexible to bending and compression. As the discs lose their water content, they become more fragile. If the fragile cartilage breaks, the condition is called degenerative disc disease. As discs degenerate, they will begin to bulge and put pressure on the spinal canal and nerve roots. This disc bulging will decrease the diameter of the spinal canal,a condition referred to as spinal stenosis. This slows the information that flows between the brain and the extremities. The arms will be affected by spinal stenosis in the neck and the legs will be affected by lower back (lumbar) spinal stenosis.
Patients with lumbar spinal stenosis will feel back pain, as well as leg pain or fatigue. Because of the fatigue in the legs, patients will have to sit frequently during walks. Lumbar spinal stenosis will also cause patients to find benches in the mall and grab the cart at the grocery store, in order to make it through their errands. Some patients may attribute their fatigue to age and as they continue to remain active later in life, this may severely limit their ability to join in their families activities. The leg fatigue can cause significant pain and cramping during activity, but dissipates when the patient sits down. The act of sitting opens the spinal canal by decreasing the curve in the lower back,which also occurs while the patient is leaning on the grocery cart.
Spinal stenosis in the neck may cause more severe symptoms. The cervical spine protects the spinal cord as it descends from the base of the brain. Because spinal stenosis in the neck puts pressure on the spinal cord, the disc pressure will cause symptoms related to the spinal cord. These include a decrease in the ability to walk as well as problems with the hands. Patients may find they tend to stumble, as it becomes harder to control the feet and legs. They may also find their handwriting getting severely worse and that they have difficulty differentiating the size and feel of coins or shirt buttons.
Spinal stenosis is usually treated with physical therapy and anti-inflammatory medications. Physical therapy is intended to help position the spine and open the spinal canal. With better posture and stronger core muscles, patients may find their leg symptoms and fatigue improve. They may find they are able to walk farther or faster. Oral anti-inflammatory medications are a first-line option for improving the inflammation related to the degenerating discs. When physical therapy and oral medications no longer provide relief, injections of steroid around the discs and nerves may decrease the pain and symptoms related to the nerve pressure. Some patients are able to tolerate their symptoms with a few injections per year.
When all of these efforts fail, surgery becomes an option for improving the patient’s pain. Surgery is directed toward relieving the pressure from the arthritis on the spinal canal and nerves. The mechanical pressure can only be relieved by physically removing the bone spurs or disc protrusions. The surgical procedures involve removal of bone and disc, as well as protecting the nerve roots. Fellowship-trained orthopaedic spine specialists have undergone the most intense training available in the treatment of the spine and are uniquely qualified to treat patients with spinal stenosis.
Dr. Jeffrey R. Carlson is a doctor at the Orthopaedic and Spine Center, a leading provider of Hampton Roads orthopedics services such as Hampton Roads spine surgery, Hampton Roads custom fit knee replacement, and many other services. The Orthopaedic and Spine Center can be found online at: OSC-Ortho.com
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