Treatment for Spinal Stenosis
Many of us experience back pain, but today we are going to talk about what some have called 'Baby Boomer Back' – otherwise known as spinal stenosis.
This relatively common condition affects 8 to 11 percent of the population.
Answering our questions is Dr. Shiveindra Jeyamohan, a neurosurgeon with EvergreenHealth Spine & Neurological Care.
So, what exactly is this ‘baby boomer back’ or spinal stenosis?
Dr. Shiveindra Jeyamohan: With so many of us spending time sitting at computer screens, it’s no wonder that experts estimate up to 80 percent of Americans will experience a back problem at some point in their lives.
The estimated cost of back problems to the US is somewhere between 100 and 200 billion dollars a year!
Spinal stenosis is actually a degenerative spine condition that can cause serious symptoms. People with spinal stenosis experience a narrowing of the spaces within the spine, putting pressure on surrounding nerves.
With age, the soft discs that act as cushions between the spine's vertebrae dry out and shrink, narrowing the space between vertebrae. This can result in bone spurs— overgrowth of bone – within the spinal canal.
The cervical (neck) and lumbar (lower back) sections are the areas most commonly diagnosed with spinal stenosis because these more routinely support our body’s bending, moving and flexibility – making them more susceptible to the wear and tear that can cause stenosis.
What causes stenosis?
Dr. Jeyamohan: Spinal stenosis is most commonly a result of changes in the spine related to osteoarthritis.
Osteoarthritis is the most common chronic condition of the joints, occurring when the cartilage or cushion between joints breaks down, leading to pain, stiffness and swelling.
As we get older, we are at risk of developing osteoarthritis of the spine, resulting in thicker and compressed ligaments, bone spurs, and deteriorated or misaligned discs. All can cause the spinal canal to narrow.
Other causes of spinal stenosis include:
- Inherited conditions, like being born with a small spinal canal or a curved spine
- Spinal tumors, trauma, injuries or herniated discs
- Overgrowth of bone (spurs)
- Thickened ligaments
So if I have stenosis, what might my symptoms be?
Dr. Jeyamohan: In some cases, bone spurs on the spine can pinch a nerve root and sometimes even the spinal cord – causing symptoms of pain, weakness, tingling or numbness in the spine, arms and/or legs.
Other symptoms can include numbness and tingling in your hands and feet, or more difficulty with using your hands, eating with a fork and knife, changes in your handwriting, dropping your morning coffee, etc.
Low back/lumbar stenosis most often presents as heaviness, cramping, or pain in the buttocks and legs with walking or activity, but usually quickly go away with sitting and leaning forward.
Most of my patients notice they can walk all day long in the grocery store when leaning over a cart, but the second they leave the cart behind and walk to their car, their leg pain comes back pretty quickly.
Discomfort is often relieved once sitting or lying down. In severe cases, bowel and bladder dysfunction may develop.
Can spinal stenosis be prevented?
Dr. Jeyamohan: We can’t always prevent the wear-and-tear that comes with aging, but symptoms can sometimes be managed with lifestyle changes.
- Get plenty of exercise and maintain a healthy diet
- Practice good posture
- Don’t smoke
- Ask your doctor for a referral to a physical therapist
- And, surgery is also an option if the discomfort is affecting your day-to-day life
- Be careful not to gain too much weight
If I think I am experiencing symptoms of spinal stenosis, what type of doctor should I see? Some of the symptoms you mentioned, like the numbness in the arms and legs, might make me think my symptoms could be neurological? What specialist should I make my first appointment with?
Dr. Jeyamohan: A neurosurgeon or spinal orthopedic surgeon would be a great choice!
We would work you up with the conservative therapies first, including physical therapy, medications, and an MRI. If things don’t improve, surgery might be a good option.
How is spinal stenosis treated?
Dr. Jeyamohan: At EvergreenHealth, we partner with patients to determine the best treatment options – often starting with the least invasive interventions, including medication and physical therapy. If necessary, surgery is an option as well.
- Local anesthesia, steroid injections or an epidural in the spinal canal
- Anti-inflammatory medications like Ibuprofen or aspirin
- Antidepressants or anti-seizure drugs can help ease chronic pain by targeting the nerves
Less invasive options:
- Physical therapy: teaches exercises to build strength and endurance, maintain the flexibility and stability of the spine and improve balance
- Injections: We work with a team of great physiatrists and pain specialists in EvergreenHealth who can inject steroids around the nerves to provide relief which can sometimes stave off the need for formal surgery
- Diet, weight loss, lifestyle changes
- Minimally Invasive Laminectomy: using small tubes and tiny instruments with a microscope, we can drill off bone spurs and bony abnormalities that push on the spinal nerves and remove the ligaments that make the spinal canal narrow as we age. Sometimes, especially if the bones are “slipped”, a fusion might be needed to provide stability to the spine, and can also be done minimally invasively.