Posts Tagged ‘lumbar spinal stenosis’

Spinal Stenosis: Treatment Options

spinal stenosisSpinal stenosis is a condition that occurs when the small spinal canal, which contains the nerve roots and spinal cord, becomes compressed (or narrowed). This narrowing occurs most often in the lower back or neck, and can put pressure on the spinal cord and nerves, causing a “pinching” of the spinal cord and/or nerve roots. The pinching can lead to a variety of symptoms, including pain, weakness and numbness. Symptoms often start slowly and get worse over time, and typically a person with this condition complains of severe pain in the legs, calves or lower back when standing or walking. Other symptoms include abnormal bowel/and or bladder function and loss of sexual function. Depending on where the narrowing takes place, you may feel these symptoms in the lower back and legs, neck, shoulder or arms. Usually, it is relieved by sitting down, leaning over or sitting forward.

In most cases, the narrowing is caused by osteoarthritis of the spinal column and discs between the vertebrae. It may also be caused by a thickening of the ligaments in the back, as well as by a bulging of the discs that separate the vertebrae. If you suffer from any or all of the above you should schedule an appointment with an orthopaedic spine specialist to determine if you have spinal stenosis.

How is Spinal Stenosis Treated?

The preferred treatment for cases of persistent back pain from spinal stenosis is a combination of physical therapy, prescribed exercise, and medications for chronic pain. Only if you have persistent pain, or if your pain does not respond to these efforts, will your physician consider surgery to relieve the pressure on the affected nerves or on your spinal cord. Here is what you can do:

  • Exercise: Regular exercise can help you build and maintain strength in the muscles of your arms and upper legs. This will help to improve your balance, ability to walk, bend and move about, as well as control pain. A physical therapist will identify and show you what exercises are right for you.
  • Medications: The most common treatment for chronic pain in spinal stenosis is non-steroidal anti-inflammatory drugs (NSAIDs). These include: ibuprofen (Advil, Motrin), acetaminophen (Tylenol) and Naproxen (Aleve). Your physician may also prescribe other medications to help with pain and/or muscle spasm.
  • Cortisone injections: Injections directly into the area around the spinal cord (known as epidural injections) may provide a great deal of temporary, sometimes permanent, relief. These medications include: Cortisone (Celestone, Kenalog) and methylprednisolone acetate (Depo-Medrol, Medrol).
  • Surgery: In some cases you may need surgery to relieve spinal stenosis, particularly if a disc fragment is lodged in your spinal canal and is pressing on a nerve, which can cause significant loss of function. Some patients with severe or worsening symptoms (but who are otherwise healthy) may be candidates for what is known as a decompression laminectomy. This surgery removes the bone spurs and buildup of bone in the spinal canal, freeing space for the nerves and the spinal cord. This may be done in conjunction with a spinal fusion to connect two or more vertebrae and better support for the spine. It should be noted that while surgery may bring some relief, it will not cure spinal stenosis and symptoms may recur.

Living With Spinal Stenosis:

Spinal stenosis can be a real challenge day to day, but certain steps can be taken to ease some of the symptoms. Some treatment options include:

  • Get moving. If you’re capable, regular exercise is very important and you should do it often – at least three times a week for about 30 minutes. Start slowly and as you begin to feel stronger, add walking or swimming to your plan.
  • Modify activity. Don’t do anything that can trigger or worsen pain and disability such as lifting heavy objects or walking long distances.
  • Hot or cold packs. Some symptoms of cervical spinal stenosis may be relieved by applying heat or ice to your neck.
  • Canes or walkers. In addition to providing stability, these assistive devices can help relieve pain by allowing you to bend forward while walking.

About Dheera Ananthakrishnan, MD

Dheera Ananthakrishnan, MDDr. Ananthakrishnan trained with one of the pioneers of scoliosis surgery, Dr. David Bradford, at the University of California at San Francisco. After completion of her fellowship, she practiced orthopedic and spine surgery for over three years at the University of Washington in Seattle. In 2007, she left Seattle to work with Medecins Sans Frontieres/Doctors without Borders in Port Harcourt, Nigeria. She then worked as a volunteer consultant at the World Health Organization in Geneva, Switzerland, before starting her position at Emory University, where her focus is on adult and adolescent scoliosis.

In 2009, Dr. Ananthakrishnan co-founded Orthopaedic Link, a non-profit dedicated to improving orthopaedic care in the developing world by mobilization of unused implants from the United States. She is also a candidate member of the Scoliosis Research Society. Although Dr. Ananthakrishnan routinely performs complex spinal reconstruction surgery, an injury in 2012 caused her to reevaluate her own approach to musculoskeletal health. Her practice philosophy now focuses on strengthening, stretching and general conditioning as an adjunct to surgical care of her patients.

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Spinal Stenosis: Diagnosis and Symptoms

Spinal StenosisAs the baby boomer population ages, approximately 2.4 million Americans will experience lumbar spinal stenosis by 2021, according to the American Academy of Orthopaedic Surgeons.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases describes spinal stenosis as the narrowing of the spaces in the spine. This results in pressure being applied on the spinal cord and nerve roots. This narrowing condition can happen in three parts of the spine:

  1. The canal in the center of the spinal column, which holds the spinal cord and nerve roots
  2. The canals at the base of nerves that branch out of the spinal cord
  3. The openings between the vertebrae, which the nerves leave through to spread to the rest of the body

Sometimes this narrowing of the space inside the spinal canal produces no symptoms. However, if this places pressure on the spinal cord, cauda equina (a bundle of spinal nerves and nerve roots at the base of the spinal column), or nerve roots, there could be a slow onset and progression of symptoms. The neck or back may or may not hurt. Most often, people suffering from spinal stenosis experience weakness, cramping, numbness or pain in their arms or legs. If the pressure is mainly on a nerve root, they could experience a shooting pain down their leg, also known as sciatica.

If the spinal stenosis is severe, people may have issues with their bowel and bladder function, or even disorders of the foot. Cauda equina syndrome is an extremely rare, but serious form of spinal stenosis, and can cause loss of control of the bowel, bladder, sexual function, and/or loss of feeling, weakness or pain in the legs. This is a serious condition that requires immediate medical attention.

Because of the range of severity and symptoms, it is important to get a proper diagnosis from your doctor. They can use several methods to diagnose spinal stenosis and to rule out other conditions:

  • Questions about your medical history: you may have to explain details about any injuries, conditions or general health problems that could be causing these symptoms.
  • Physical examination: Your doctor will examine you to determine your range of movement, to see if you have pain or other symptoms when you bend backwards, and if you have normal neurologic function (sensation, muscle strength, and reflexes) in your arms and legs.
  • X-Ray: An x-ray of your back may be taken to find signs of an injury, tumor, or other problem. It will show the structure of the vertebrae and if there is any calcification.
  • MRI (Magnetic Resonance Imaging): An MRI can produce cross-sectional 3D images of your back, and can detect damage or disease of the soft tissues in your spine, and can show enlargement, degeneration or tumors.
  • CAT (Computerized Axial Tomography) Scan: This method can also show cross-sectional and/or 3D images, but can also display the shape and size of the spinal canal, what is in it, and the structures around it.
  • Myelogram: This is a liquid dye that x-rays can’t go through. It is injected into the spinal column and circulates around the spinal cord and nerves, which show up as white on the x-ray film. It can show the doctor if there is any pressure on the spinal cord or nerves from herniated disks, tumors or bone spurs.
  • Bone Scan: Your doctor may inject radioactive material that can attach to bone, especially where the bone is breaking down or being formed. This helps detect fractures, infections, tumors and arthritis (though it’s hard to tell between them). So a bone scan might be done along with other tests.

If you feel any of the symptoms outlined above, contact your doctor for a diagnosis. Though there is no complete cure for this ailment, with the guidance of your physician, steps can be taken to reduce pain and discomfort, and improve flexibility.

About Dr. Howard Levy

Howard Levy, MDDr. Levy is an Assistant Professor in the departments of Orthopaedics and Physical Medicine & Rehabilitation at Emory University School of Medicine. Dr. Levy specializes in non-operative spine care and focuses on helping patients achieve their best functional level. Dr. Levy started practicing at Emory in 1993.

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What is the Sciatic Nerve? What is Sciatica? 

When Does Back Pain Call for an Epidural Steroid Injection? 

Ironman Triathlete Back on Track after Lumbar Laminectomy

Dr. Tim YoonWhen it comes to spinal disorders, there’s good news for the weekend warrior who enjoys vigorous athletic training and competitive sports activities. Being in great physical shape plays a large role both in your recovery and getting you back to an active lifestyle.

Joann Pope, one of my current patients, has an impressive athletic resume. She completed the half Ironman in Panama City, Florida, 21 times straight. She qualified for the world-famous Hawaiian Ironman seven times and finished four times. But two years ago, at the age of 74, her back started hurting and she had to stop racing due to lumbar spinal stenosis.

Lumbar spinal stenosis is a degenerative condition that causes a narrowing of the spinal column in the lower back, known as the lumbar area. This narrowing occurs when the growth of bone or tissue or both reduces the size of the openings in the spinal bones. This narrowing can squeeze and irritate the nerves that branch out from the spinal cord. It can also squeeze and irritate the spinal cord itself, causing pain, numbness, or weakness, most often in the legs, feet, and buttocks.

You might think that the physical stress of being a triathlete took its toll on Joann’s back, but that isn’t the case. In fact, if she hadn’t been in such great shape, her spine might have begun degenerating long before it did. For more than 20 years, Joann has been running, biking, and swimming. She was 47 when she started running, back in 1984. After she ran the Boston Marathon, her daughter talked her into doing a triathlon, the ultimate endurance test – a grueling three-part race with no stops.

So, thanks to her level of fitness, it’s as if Joann has the body of someone 20 years younger. Despite her active lifestyle , the lumbar stenosis progressed, and Joann’s pain, which came on slowly, continued to get worse.

Before Joann came to see me, she’d been experiencing lower back pain for a year. To address it, she’d been taking pain pills twice a day and was undergoing physical therapy, the first line of defense for lumbar stenosis. But when therapy didn’t ease her pain, her physical therapist told her she needed to see a surgeon. She chose to come to the Emory Orthopaedics & Spine Center.

In July of 2010, I performed a lumbar laminectomy and fusion on Joann. This procedure, also called a decompression, relieves pressure on the spinal cord or spinal nerve by widening the spinal canal. In Joann’s case, I removed the portion of the bony roof of the spine, or lamina, that was pressing on her lumbar nerves. Then I fused the two lowest lumbar vertebra, L4 and L5, with screws. When she woke up, the pain she had before surgery was gone.

Because Joann had been in such great physical shape before the surgery, she recovered rapidly and was swimming and walking again quickly. Now she’s walking two miles a day and is working up to getting back on her bike. Joann remains pain free and plans to go back to racing.

Have you had a lumbar laminectomy, or would you like to learn how spine surgery at Emory can get you back to the active life you enjoy? We welcome your questions and feedback in the comments section below.

About S. Tim Yoon, MD:
S. Tim Yoon, MD, PhD, specializes in minimally invasive surgery and cervical spine surgery. He is board certified in orthopedic surgery. Dr. Yoon started practicing at Emory in 2000.