In 2006, Nancy, a 71-year-old woman who considered herself extremely healthy (even though she's been smoking since she was a teenager and rarely gets exercise beyond very slow dog-walking), began having severe pain in her lower back. The pain traveled down to her legs as well. Standing and walking were extremely painful. Nancy had never had this kind of pain in her life.
The pain was limiting her activity. Even though Nancy didn't get a lot of exercise, she had an active social life and enjoyed going out with friends on a regular basis. But the back pain was keeping her at home, making her feel miserable.
She went to the doctor and learned she had spinal stenosis, a narrowing of the spinal canal.
As you age, the discs of your spine can change. They may lose some of their fluid and become less spongy and they lose some of their height. This can make them bulge into the spinal canal. Additionally, arthritis can cause bones and ligaments in the spine to become thicker, and they too can protrude into the spinal canal.
Some people describe spinal stenosis using the image of a garden hose that has a build-up of lime inside, making the inside passageway narrower and narrower. The narrowing that spinal stenosis causes in the spine puts pressure on nerves in the spinal cord, and that pressure is what causes the pain.
Symptoms of spinal stenosis
There are people who have spinal stenosis but have no symptoms. But for those who do, symptoms of include
- Pain in your back or neck
- Pain or weakness in your arms or legs
- Problems with your feet
- Problems with your bowel or bladder (this is rare)
Causes of spinal stenosis
Some people are born with a narrow spinal canal, but in most cases, spinal stenosis is a result of the aging process. Degenerative disc disease is the most common cause. Osteoarthritis and rheumatoid arthritis are other common causes. Other causes can include injury and tumors of the spine.
Whenever possible, doctors recommend conservative, non-surgical treatments for spinal stenosis. These can include:
- Taking NSAID medication to relieve inflammation and pain
- Taking analgesics to relieve pain
- Injections of corticosteroids into the membranes covering the spinal cord and nerve roots
- Anesthetic injections, also called nerve blocks, to relieve pain temporarily
- Restriction on activity
- Exercises or physical therapy that can help to stabilize the spine
- A brace or corset that can provide support for the spine
- Chiropractic treatment
If these approaches don't provide enough relief, there are surgical options as well.
The purpose of surgery is to relieve pressure on the spinal cord or nerves and to restore the alignment and strength of the spine. Procedures include a laminectomy, which removes the roof of one or more vertebrae to create more space for nerves, and a laminectomy with spinal fusion, which fuses vertebrae together.
In 2005, the Food and Drug Administration approved a device called the X Stop, which can be surgically implanted in the lower spine. It's made of titanium, and it's used as a spacer to help keep the spine in a position that is less painful for the person who has spinal stenosis. It's considered appropriate for patients 50 and older who have pain in the legs due to spinal stenosis who also meet other specific criteria.
Nancy, the woman we mentioned earlier who found out last year that she had spinal stenosis, took medications that provided little relief. Then she had anesthetic injections twice. The first injection provided relief for several months, but the second one didn't last as long. She then decided to have surgery using the X Stop.
The surgery was about two months ago. She no longer has pain in her legs, but she does feel soreness at the site of the surgery, which her doctor assures her is normal.
Geriatric Times, "Lumbar Spinal Stenosis: Clinical Features and New Trends in Surgical Treatment," July/August 2004; The National Institute of Arthritis and Musculoskeletal and Skin Diseases; The North American Spine Society; The U.S. Food and Drug Administration;