Lumbar Spinal Stenosis
Back pain, part of the future if we live long enough? One particular type of aching back -- lumbar spinal stenosis -- occurs in frequently as a part of the aging process.
Stenosis is a pain condition caused by normal wear and tear on the spine that leads to a narrowing of the spinal canal. The resulting pinching of the nerves causes intermittent or persistent pain in the lower backs, buttocks, or legs; sometimes, it also causes limping, unsteadiness, even falls. Numbness and tingling are frequent symptoms. Typically, during early development of spinal stenosis symptoms are triggered by prolonged ambulation, perhaps for one hour. Later, walking just a few blocks can trigger the discomfort.
Spinal stenosis is like the lime build-up on the inside of a garden hose. Over time, it narrows the diameter of the hose, just as spinal stenosis narrows the spinal canal. Spinal stenosis occurs when the space around the spinal cord narrows, putting pressure on the cord and the roots, and may cause pain, numbness and weakness in the legs.
However it manifests, lumbar spinal stenosis hurts, and it also gets in the way of day-to-day living.
Osteoarthritis is the number 1 cause of spinal stenosis, but frequently in combination with degenerated disc herniation, thickening of ligaments in the canal, and perhaps a congenitally narrowed canal. Arthritis is the degeneration of any joint in the body.
In general, trials, usually several, of conservative, nonsurgical treatment precedes any consideration of surgery in the patient with the typical, gradual onset and worsening over many months or years. There is no diet, medication or life style that will prevent the ageing degeneration of the spine!!
Different diagnoses and treatment options are considered for the patient with more acute symptoms if associated with severe pain, weakness, and/or bladder dyscontrol.
Medications
If over-the-counter pain relievers aren't enough to control your pain, your neurologist may prescribe:
- Antidepressants. Nightly doses of tricyclic antidepressants, such as amitriptyline and nortriptyline, may help ease pain caused by spinal stenosis.
- Anti-seizure drugs. Some anti-seizure drugs, such as gabapentin (Neurontin) and pregabalin (Lyrica), are used to reduce pain caused by damaged nerves.
- Opioids. Drugs such as oxycodone (Percocet) and hydrocodone (Vicodin) contain substances related to codeine, which can be habit-forming.
Therapy
A physical therapist can teach you exercises that may help:
- Build up your strength and endurance
- Maintain the flexibility and stability of your spine
- Improve your balance
- Control your pain
Many different types of exercises are useful, including swimming, yoga, meditation, golf, tennis, biking, Pilates, and...
Whatever seems to work for you can be tried. Generally, the more and the longer, the better, - if painful, stop.
Loss of body weight and stopping tobacco use, once again, are among the doctors recommendations.
Steroid injections
- Nerve roots may be irritated and swollen at the spots where they are being pinched. Injecting a corticosteroid into the space around that constriction can help reduce the inflammation and relieve some of the pressure. However, repeated steroid injections can weaken nearby bones and connective tissue, so only a few injections a year are allowed. The benefits of this treatment is somewhat controversial based on (few) controlled trials.
For cervical stenosis- Apply heat or cold. Some symptoms of cervical spinal stenosis may be relieved by applying heat or cold packs to your neck.
- Avoid injuries. Take great care to avoid injuries to your head and neck, which could rapidly worsen your symptoms.
For lumbar stenosis- Use canes or walkers. In addition to providing stability, these assistive devices can help relieve pain by allowing you to bend forward while walking.
- Lose excess weight. Extra weight puts additional stress on your joints and bones, particularly those in your lower back.
Surgery???
A new approach to back surgery is being used by many neurosurgeons and spinal surgeons. Stenosis decompression procedures and other spine surgeries can be done through minimally invasive techniques. By using endoscopic equipment and microsurgical techniques to perform surgeries through very small incisions, many stenosis patients can go home from the hospital within 24 hours -- and without heavy pain medication.
Using an endoscope allows the surgeon to have an illuminated and magnified view of the operating field without having to make a large incision. With the assistance of the endoscope, surgeons can utilize several small incisions to perform the same procedure they would otherwise perform using a single large incision. Results and rates o complications appear similar for the 60 and 80 year old patients, if otherwise healthy.
Nevertheless, surgery is rarely an option until all conservative measures have been exhausted for the particular person.
