Spinal Stenosis is the shrinking or narrowing of the spinal canal. This narrowing of the canal can be congenital (present at birth) or more commonly occurs, as we grow older. As the spinal canal narrows, there is less room for the nerves to move freely. As a result, swelling and inflammation occurs, which can cause pain. Arthritic changes, injury or surgery can also cause spinal stenosis.
Symptoms may progress slowly or occur as a sudden onset of pain. Spinal stenosis affects both males and females and is most common between the ages of 50 and 70. Individuals with spinal stenosis may experience vague pain in the low back and legs when walking or standing. Usually there is none to minimal pain with rest, sitting or laying down. Standing upright further decreases the space available for the nerve roots, and can block the outflow of blood from around the nerve. Congested blood then irritates the nerve and the pain travels into the legs. As the stenosis progresses, the symptoms increase with walking shorter distances.
Conservative Treatment: (Non-surgical treatment for stenosis can include):
- NSAIDs (Non-steroidal anti-inflammatory medications).
- Physical therapy.
- Rest and lifestyle modification.
- Ice or heat treatment.
- Pain management.
Activity modification. Since patients are more comfortable when they are flexed forward, they can concentrate their activity in that position and exercise can include stationary biking and using a cane or walker for walking while flexed forward.
Epidural steroid injections. Steroids and a numbing agent is injected into the epidural space of the spine, which helps, reduce the swelling and inflammation of the nerves. Epidurals. Approximately 50% of patients will experience good relief after an epidural injection, although the results tend to be temporary. If the injection is helpful it can be done up to three times annually. The action of the injection is not clearly known, but is probably a combination of the anti-inflammatory effect of the steroid and a flushing effect due to injecting a volume of fluid.
Spine surgery (an open decompression or laminectomy) is the only way to change the anatomy of the spine and give the nerves more room. Decompressing the nerves by removing a portion of the enlarged facet joint prevents the nerve pinching when the patient stands up. It is effective in approximately 80% of cases, although over a 5-year period of time the results tend to deteriorate. Part of this deterioration is due to the progressive nature of osteoarthritis, and part is due to the overall aging process.
It should be noted that lumbar spinal stenosis rarely causes nerve damage, and surgery is almost always elective. The results seem to be as good if the surgery is done early or delayed, even for years.
13710 Olive Boulevard (Primary Office)
Chesterfield, MO 63017
Telephone: 314-469-PAIN (7246)
Exchange: 314-441-6965 (for after-hour Emergencies Only)
Monday thru Friday
8:30 AM – 4:30 PM