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Fighting Back Father Time

iStock_000049395084_SmallSpinal stenosis is one of the most common age-related back problems. And it isn’t pleasant. It usually results from years of osteoarthritis, a thickening of the body’s ligaments that connect the bones to the spine and a deterioration of the cushioning between discs in the vertebrae – all of which cause the spinal canal to narrow. As a result, nerves traveling down to the legs can become pinched near the bottom of the spine, causing pain and an inability to walk properly.

The condition affects 8 to 11 percent of Americans, mostly those over age 50, according to the American Academy of Orthopedic Surgeons.

The telltale symptoms of spinal stenosis are numbness, weakness and cramping or pain in the legs, thighs or feet, which interferes with the ability to walk. While symptoms of spinal stenosis start slowly and tend to worsen over time, leg pain can become so severe, sufferers find themselves unable to stand or walk for more than a few minutes.

Patients suffering from spinal stenosis in the Seattle area can make an appointment with a back and neck pain specialist at Microsurgical Spine Center by visiting www.mybackmylife.com or calling 800.890.1964 and received personalized care from NeoSpine physicians, which is a combination of neurosurgeons and orthopedic surgeons who perform neck, back and spine surgeries at our facility.

“Spinal stenosis doesn’t really cause back pain, but pain that radiates down into the buttocks and lower legs,” says Jean-Pierre Mobasser, a neurosurgeon at St. Vincent Carmel Hospital in Indianapolis. “The narrowing of the spinal canal reduces blood flow to nerves in the lower back.” The pain often diminishes or disappears altogether when a patient is sitting or lying down – unlike a pinched nerve caused by a bulging disc, which may hurt all the time.

While a pinched nerve due to a protruding disc  often resolves on its own, there’s no cure for spinal stenosis. Regular exercise can help maintain blood flow to the nerves to reduce leg pain and numbness, says Santhosh Thomas, medical director of the Center for Spine Health at the Cleveland Clinic. People can help keep their mild symptoms from turning severe by staying active.  Many patients, however, are unable to exercise by the time they receive a diagnosis, and are often caught in a vicious cycle of forced inactivity, which only exacerbates symptoms.

As a conservative treatment approach, doctors usually try first prescribing anti-inflammatory painkillers or injecting corticosteroids along with a short-acting the numbing medication lidocaine to reduce inflammation in the nerves. Patients who get enough pain relief from these remedies to increase physical activity might be able to avoid surgery. For many sufferers; however, such treatments don’t offer a long-term solution.

A study published last July in the New England Journal of Medicine found patients receiving corticosteroids with lidocaine experienced no additional pain relief compared to those who received lidocaine injections alone, which caused researchers to conclude that this therapy may not be helpful at all, even for the temporary relief of pain.

Surgery can be a successful strategy to restore mobility in those who are unable to walk due to spinal stenosis, according to Mobasser. “The goal is to get patients up and walking again, but surgery won’t take away back pain caused by other factors like arthritis,” he adds, “and patients need to understand that.”

If you have spinal stenosis and determine that surgery is best for you, here are options to consider:

Lumbar laminectomy. This is the traditional approach, also called decompression surgery, where surgeons create space by removing the lamina – the part of the vertebra covering your spinal canal. Laminectomy enlarges your spinal canal to relieve pressure on the spinal cord or nerves, and has about an 80 percent success rate in improving walking abilities. In some cases, surgeons also perform spinal fusions, connecting two or more bones in the back, to help stabilize the spine.

“The downside to the traditional open laminectomy is a longer recuperation time because surgeons need to disrupt more tissues and muscles to get to the lamina,” Mobasser says.

Serious complications can occur in rare cases, including blood clots in the legs and spinal cord injury that results in weakness or numbness.

Minimally invasive laminectomy. Spinal surgeons like board certified neurosurgeons Dr. Richard Wohns and Dr. Trent Tredway of Microsurgical Spine Center near Puyallup, Washington, learned this technique nowadays in their residency training because it involves tiny incisions – through which a small camera, called a laparascope, and surgical tools are inserted to perform the lamina removal and spinal fusion if needed – and has a much faster recuperation time.

Patients often find it easier to walk immediately after the procedure is performed, Mobasser says, and often experience only a few days of soreness as the incisions heal, rather than the few weeks of healing associated with a traditional laminectomy.

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