As you age, the ligaments and tendons (tough, rope-like cords) which hold your spine together, start to thicken and grow larger. At the same time, the intervertebral discs in your spine become drier and start to bulge. These changes cause your spinal column (or backbone) to become more narrow, which leaves less room for the spinal cord and nerve roots inside. Too much narrowing can compress and squeeze the nerves and spinal cord, causing pain, weakness, numbness and other symptoms. This condition is known as spinal stenosis.
Spinal stenosis is most often seen in older people (age 50 and above) who have weakened joints or ligaments in their backs, cartilage loss and spinal degeneration. Certain conditions that are common in this age group, such as osteoarthritis and rheumatoid arthritis, can cause inflammation and put additional pressure on the spinal cord, contributing to spinal stenosis.
Aging is the most common cause of spinal stenosis, but it’s not the only one. Having certain medical conditions such as spinal tumors, herniated (or slipped or ruptured) discs, scoliosis (curvature of the spine), Paget’s disease of the bone (a condition that causes bones to be deformed or abnormally large), or achondroplasia (a type of dwarfism), or any type of spinal injury or fracture (from a car accident, sports injury, fall, etc.), can predispose people of any age to developing spinal stenosis. Additionally, some people are born with a small spinal cord, and may experience symptoms of spinal stenosis at a much earlier age.
Spinal stenosis can occur anywhere along the spine. How much of the spine is affected can vary. Symptoms might appear rapidly, gradually or not at all. They include:
Typically, symptoms will primarily appear on just one side of the body or the other, but still involve both legs. Symptoms commonly start out as minor radiating pain, weakness or numbness in the lower back or neck, and gradually worsen over time. In advanced cases of spinal stenosis, pain in the legs can become so severe that just walking a short distance becomes unbearable.
If you have many of the symptoms of spinal stenosis, the next step is to schedule a medical evaluation. If you live in the Raleigh area, please visit Advanced Pain Consultants. Dr. Pasi will start the evaluation by taking your medical history and performing a physical examination. During the exam, she will check for any limitations of movement in the spine, signs of pain, problems with balance, muscle weakness, sensory loss or abnormal reflexes which may suggest spinal cord involvement.
You may also be advised to undergo a number of imaging procedures, which may include:
Not all of the above tests may need to be done, but probably at least several of them. A combination of testing methods is normally necessary to confirm a diagnosis of spinal stenosis and rule out other conditions that may have similar symptoms.
Whenever possible, Dr. Pasi recommends conservative, non-surgical options for her patients. In cases of mild stenosis, stretching exercises, massage, aquatics, heat or ice packs, abdominal muscle strengthening, physical therapy, bracing, and treatment with nonsteroidal anti-inflammatory (NSAIDs) medications or nerve-stabilizing drugs may help to improve symptoms. Cortisone (a potent anti-inflammatory drug) injections may also be recommended in some cases, to decrease the inflammation around the spinal nerves as well as pain.
For patients who have a poor quality of life due to extreme pain or muscle weakness, Dr. Pasi may recommend surgery to widen the spinal canal or the space around the nerves. Surgical procedures can include laminectomy—removal of the part of the vertebrae or bone spurs that compress the nerves, foraminotomy—surgery to widen the part of the vertebrae where the nerves exit, and for the most severe cases, spinal fusion—surgery which uses bone grafts or metal implants to attach the affected bones of the spine together. Each of these surgeries can result in significant pain relief.
When the condition is diagnosed in its beginning stages and treatment starts early, the long-term outlook for patients with spinal stenosis is quite good. Many people with spinal stenosis lead full lives and remain fairly active. But for this to happen, a proper medical evaluation and diagnosis is needed.
If you live in the Raleigh area and are experiencing any of the signs of spinal stenosis, call Advanced Pain Consultations at (919) 510-7901 to schedule a physical examination with Dr. Pasi. She will conduct a thorough evaluation, discuss the various treatment options and procedures with you, and help you determine which approach is best for you. Your appointment with Advanced Pain Consultants is the important first step to feeling better and getting your life back.
A Holistic Approach to Pain Management