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Spinal Stenosis

Spinal Stenosis

The spine at the lower back (lumbar spine) provides a foundation to carry the weight of the upper body and also contains the nerves that control the lower body. The building blocks of the spine are the "vertebrae" which are held together by the discs which also act as fluid filled "shock absorbers" between these vertebrae. With age, the discs dry out and loose height. The joints in the back of the spine become overloaded and overgrown due to arthritis. Due to the height loss ligaments around these joints become slack and the slackness may cause the ligament to onfold onto the nerves. These degenerative changes are the result of the normal "wear-and-tear" associated with aging. Over time these changes lead to narrowing, or stenosis, of the spinal canal. Stenosis often becomes symptomatic in the seventh and eighth decades of life.

Typically patients with spinal stenosis of the lumbar spine complain of pain in the back, buttocks or legs that gradually becomes worse. Symptoms are worsened by standing upright or walking and this results in pain, tightness, heaviness and a sense of weakness in the buttocks and legs. The patient often chooses to rest and the symptoms improve only to come back again when walking is resumed. Gradually the distance and time to get the severe pain decreases. Symptoms can also be relieved by leaning forward say on a supermarket trolley or bicycle.

As you can see the pattern can be very typical and the diagnosis is often straightforward but the exact location and extent of the disease needs to be evaluated by means of an MRI scan.

Treatment

Non surgical treatment options for spinal stenosis include lifestyle changes such as walking aids and activity modification which are often not acceptable to patients. Epidural injections involve injecting a steroid and anaesthetic into the spinal canal in an attempt to decrease the inflammation. About 66% of patients will experience good relief after an epidural injection, although the results can to be temporary. If the injection is helpful it can be done up to three times annually. The injection is very safe and the worse possible outcome is that it will not work.

Spinal surgery is the best 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 being pinched when the patient stands up. This is called "decompression" or " laminotomy/laminectomy." Some patients require only a decompression but, patients with slippage of the spine or a curvature of the spine may require a stabilization procedure called fusion. In this procedure, two or more vertebrae are fused together using screw, rods and bone graft or bone substitute. Surgery is effective in approximately 80% of cases, although over a 5-year period the results tend to deteriorate - due to the progressive nature of spine osteoarthritis and also to the overall aging process.

Some patients may benefit from a newer, relatively smaller procedure where an "intraspinous spacer device" is implanted between the spinous processes of the vertebrae. This separated adjacent vertebrae and stretches out any infolded ligament thus lifting it off the nerves. This "bends the spine forwards from the inside" giving the patient the relief the patient gets when he/she leans forward.