By Dr. W. Gifford Jones
January 19, 2003
Ask most people what causes back pain and you get a variety of answers. Many mention sciatica, lumbago, a slipped disk or chronic back strain. But few mention or have ever heard of a condition called "spinal stenosis". Yet it's a disease that we will hear more and more about with an aging population.
Years ago spinal stenosis was called creeping paralysis. It was accepted that if you lived long enough you would eventually get it and learn to live with it.
Today we know that spinal stenosis is due to a narrowing of the spinal canal (the cavity in the vertebral column through which the spinal cord runs). This can occur in the cervical and thoracic spine but is more commonly seen in the low back, lumbar spinal stenosis (LSS) . It's estimated that over 400,000 North Americans suffer from LSS and it's one of the most common reasons for surgery in people over 60 years of age.
The most common cause of spinal stenosis is osteoarthritis, the wear and tear type of arthritis. Like osteoarthritis of the knee or hip the symptoms of lumbar spinal stenosis are normally mild at the start.
But looking back many patients have had warning symptoms for years. Some will recall bouts of low back pain due to degeneration of the spinal disk. Others remember sciatic pain associated with pain in the buttocks that radiates down the back of the leg due to pressure on the sciatic nerve.
What is often less noticeable are vague unusual feelings in the legs. Some patients complain that their legs feel like rubber. Others experience pins and needles feeling, numbness or a burning sensation in the legs.
But eventually the classic symptom, pain in the legs, increases as the bony spinal canal decreases in size. And as the pressure increases in the spinal canal the spinal cord and the emerging nerves become swollen which may cause excruciating and debilitating pain.
The pain is usually present in both legs and is brought on by walking and sometimes even by standing. Patients with spinal stenosis usually find the pain is eased when bending forward or sitting. This creates a larger vertebral space which temporarily decreases nerve compression. Standing erect, on the other hand, increases the pain due to narrowing of the vertebral space.
Ordinary X-rays do not normally detect spinal stenosis. Rather it requires the use of computerized tomogram and magnetic resonance image (MRI). Or a myelogram will be performed in which a liquid dye is injected into the spinal column.
Pain can sometimes be eased by the use of non-steroidal anti-inflammatory drugs (NSAIDs), such as Aspirin, ibuprofen and naproxen sodium. Physical therapy and braces may be helpful for other patients.
Epidural steroid injections are occasionally used to provide short-term relief. In one study 50 percent of patients reported favourable results.
Patients may have to resort to surgery. It's often been referred to as "unroofing" the spinal canal. surgery when it's impossible to carry on with daily activities. Surgery to decrease the pressure on the nerves is called decompression surgery.
To carry out this operation surgeons open the spinal column at specific points where the narrowing has occurred. They then remove the bone or fibrous tissue causing the obstruction. The opening through which the spinal nerves emerge may also be enlarged and often part of the disk removed.
The decision for or against surgery depends on the degree of disability. Since spinal stenosis is not life-threatening it's an operation that should not be rushed into without a thorough discussion with your doctor.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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