Gulf Coast Pain Management
SPINAL STENOSIS
 
 

Definition

Spinal stenosis is defined as narrowing of the bony spinal canal which pinches the nerves traveling through the lumbar spine into the legs. This usually occurs in elderly patients, and always worsens with time and age.

What kind of pain and other symptoms will I experience?

Spinal stenosis typically produces an aching, sometimes sharp pain into both buttocks, thigh regions and sometimes into the calves and feet. The pain is usually in both legs, but may involve only one leg; it is worsened by walking even short distances, and is relieved by rest.

Spinal stenosis causes the patient to lean forward while standing or walking, and prevents them from standing up in a fully straightened posture. This is due to the arthritis in the facet joints of the spine, which are enlarged. This enlargement of the facet joints of the spine is what produces the narrowed spinal canal and the pinching of nerves in the spinal canal, which is partially relieved by a flexed forward posture.

Findings on examination typically show no weakness of the legs, only pain. Reflexes may be absent. Low back pain is not a characteristic finding of spinal stenosis; however, when it is present in association with spinal stenosis, it is a result of arthritis.

What diagnostic tests are used for evaluation?

MRI is an excellent initial evaluation, as this will demonstrate spinal stenosis. More importantly, this will reveal any tumor or herniated disc which must be differentiated from spinal stenosis. Plain x-rays of the lumbar spine will demonstrate arthritis, which is the precursor to spinal stenosis with disc space narrowing and straightening of the spine, However, x-rays will not show pinching of the nerve roots, as demonstrated on MRI tests.

Non-invasive Doppler studies are used to diagnose lower extremity vascular problems often confused with spinal stenosis. Nerve testing (EMG) is beneficial to confirm nerve involvement and degree of damage.

A lumbar myelogram with subsequent computerized axial tomography or MRI Magnetic Resonant Imaging) are the best tests to diagnose lumbar spinal stenosis. These tests are significantly better than a CT scan without intrathecal contrast, as they can detail nerves, soft tissue such as disc, as well as bony detail.

Treatment

Treatment frequently includes non-steroidal anti-inflammatory medications such as Motrin, Voltaren, Naprosyn, Lodine, FeIdene, Indocin, Clinoril, Tolectin, Dolobid, Advil or Nuprin. Initially, treatment commonly involves postural training with physical therapy to flex the spine forward. This creates a postural decompression of the nerve roots. Also, swimming pool
exercises may be beneficial. Lumbar epidural steroid injections may be helpful in relieving the inflammation of the pinched nerves, which can relieve the pain in the legs and buttocks region. Spinal stenosis patients may require surgical decompression in the form of lumbar laminectomy at the involved narrowed spinal levels where the nerve roots are being pinched.

This surgery is indicated if:

The patient's pain is severe enough to warrant it or if there is increasing muscle weakness, despite the use of anti-inflammatory medications, physical therapy, and epidural steroid injections. Notably, patients with spinal stenosis are generally in the older age group and, therefore, their general medical condition must also be considered. The operation is usually very successful in relieving spinal pain. The procedure takes one to two hours and involves minimal blood loss.

Prognosis

The prognosis without surgery is for recurrent episodes of spinal stenosis type pain, with achiness as described. This sometimes includes weakness in both legs which can be treated with  repeated epidural steroid injections, anti-inflammatory medications, and short courses of physical therapy. However, if these treatment methods do not offer relief, then surgery becomes necessary.

The overall prognosis of spinal stenosis, without surgery, is to progressively increase, consistent with the rate of progression of spinal arthritis as it further narrows down the spinal column, pinching the nerves traveling down the spinal canal down into the legs.

Recommendations

The recommendations for spinal stenosis are the same for any arthritis. Lynne Carr Columbus,D.O. recommends the following: Lose weight, if overweight, down to your ideal body weight, so as to put less force on the joints of the spine and consequently lessen spinal stenosis symptoms. Since the patient already has the condition of spinal stenosis by the time these recommendations are made, the patient should remain as active as possible with low-impact exercises, primarily walking and swimming; short courses of anti-inflammatory medications as listed above may be helpful. A back support brace, such as a lumbar corset, may be beneficial; however, a lumbar support seat is not usually helpful. If you smoke, QUIT! This may be beneficial in allowing the pinched, compromised nerves in the spinal canal to obtain improved
blood flow and oxygen, to heal. Circulation of blood carrying oxygen is restricted with smoking.