Spinal Stenosis

For people who have back pain, hope is not over. There is a way to make your back pain go away. The first step is to figure out what is causing it. When the discs are involved, a common surgical treatment of choice has been the laminectomy. This operation involves removing the structures that comprise the posterior or back of the spine. Typically the lamina is removed and sometimes a portion of the spinous processes, the bones that stick out from the back of the spine. The spinous processes are the bumps that one feels when they run their finger up and down the spine. Between the spinous processes runs a ligament that extends from the base of the skull to the bottom of the spine or the sacrum.

It is good to know that when leaning forward, this ligament is under significant tension. This allows for a person to lean forward without fatiguing the back muscles. The ligament acts in much the same way as the cable on a crane that runs down the back of the swing arm allowing it to extend out without falling over.

Spinal Stenosis literally means narrowing of the spinal canal. It is a condition that sometimes accompanies the natural degeneration of the spine.

Keep in mind that the narrowing or stenosis is caused by changes in several elements of the spine: the disc, the facet joint, and the ligamentum flavum. Together these three structures comprise the walls of the spinal canal. However, the two most common forms of stenosis are soft tissue and boney. Soft tissue stenosis means the narrowing is caused by herniated or bulging discs. Boney stenosis means the narrowing is caused by calcium build up on the vertebrae. The symptoms of spinal stenosis are very consistent. Simply, standing and walking become intolerable but sitting or driving a car is no problem.

A patient with spinal stenosis learns every bench and chair in the mall or doesn't venture there at all. The symptoms usually involve the legs more than the back and in fact may be misdiagnosed as a problem with the blood vessels in the legs. The legs become painful or cramped after a short period of standing or walking. They may become weak and numb or "feel like wood" due to the impingement of the nerves. Back pain may accompany the leg symptoms due to the facet arthritis or from muscle fatigue resulting from bending forward to keep the spinal canal open.

Over time, it becomes more comfortable to sit than stand and life becomes more sedentary. Rarely, a wheel chair becomes the only means of transportation. The disc is the shock absorber for the spine. As the disc undergoes the natural process of degeneration, it begins to desiccate or dry up. The result is loss of structural integrity whereby the disc can no longer support the weight of the spine.

As a consequence, the disc bulges much the same way as a tire bulges when it is low on air. The bulging of the front or anterior wall of the spinal canal results in narrowing of the canal. This is soft-tissue spinal stenosis. Boney stenosis is much more difficult to treat and usually requires surgery. Early treatment for spinal stenosis includes physical therapy to remain active and anti-inflammatory medication such as NSAIDs. Injections such as epidural steroid injections can be dramatic in relieving the symptoms.

There are two facet joints for each level of the spine; one on each side. The facet joints allow motion, mostly during flexion and extension of the spine. The lining of the facet joint is comprised of the same type of cartilage as hip or knee joints.

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