Spinal Stenosis
Background
Over 90% of the population over the age of 50 has degenerative changes in the spinal column. As we age the intervertebral discs degenerate and lose their fluid content. This causes them to collapse, bulging backwards into the spinal canal. Compression of the nerve roots can occur due to a combination of a disc bulging from the front and / or spurs of bone which arise from the facet joints at the back of the spine. This can result in the spinal canal becoming narrowed causing compression of the nerve roots. The symptoms the patient experiences depend on the level in the spinal column at which narrowing occurs.
Clinical Evaluation
Patients with spinal stenosis may present with a range of symptoms including:
- Back pain: this can arise from degenerative changes in the fact joints or discs in the spine. In addition increased strain on the soft tissues (muscles, ligaments and tendons) can give rise to injury and pain.
- Leg Pain: Patients with spinal stenosis are often pain free at rest but note the onset of leg or calf pain with exercise which can limit their walking distance. They can however occasionally use a bicycle or exercise bike without difficulty. Other “tricks” to minimise symptoms can be leaning on a shopping trolley whilst grocery shopping
- Changed sensation such as numbness, burning, or tingling in buttocks, legs or feet
- Weakness in legs or dropfoot.
Examination assesses the patients spinal column, neurological system and circulation.
MRI is the initial investigation of choice.
Treatment options include:
Nonsurgical Treatments
Nonsurgical treatment options focus on spinal rehabilitation and pain management. The underlying narrowing of the spinal canal is unchanged by non-operative methods . However many people report that these treatments do help relieve symptoms.
Physiotherapy. This may comprise strengthening and stretching of lumbar and abdominal muscles, and massage.
Acupuncture. Acupuncture can help reduce muscle spasms and back pai that can accompany spinal stenosis but there is no evidence to demonstrate that it reduces the synmptoms of spinal stenosis.
Laser: there is evidence to support the use of laser therapy to address back pain
Anti-inflammatory medications may help reduce swelling around a nerve and reduce pain over a 7 – 10 day course. These medications include Nurofen, Voltarol, and Difene.
Long term use can cause complications including gastritis or stomach ulcers, kidney and cardiac problems. You should check with your doctor if you have a history of cardiac problems, asthma, or gastric problems before starting these medications and stop them immediately if you develop any abdominal pain
Steroid injections. Injections of cortisone around an inflamed nerve root can help dexcrease swelling and pain in the nerve. This is typically undertakne in ttheatre under sedation as a day case procedure.
Surgical Treatment
Patients who have not made progress with non operative management and continue to experience day to day difficulty in terms of leg weakness or difficulty walking due to leg pain may be candidates for surgery. The mainprinciple behind surgery is to increase the space available for the nerves and there are a rage of surgical procedures that can achieve this.
Laminectomy (Spinal Decompression). This is a long standing procedure procedure that involves “de-roofing” the spinal canal by removing the lamina. The lamina is removed along with ligaments and osteophytes (bone spurs) that together compress the nerves. This is typically an open surgery and take about an hour to complete.
Spinal fusion. If the spine is unstable prior to surgery or after surgery where extensive bine has had to be removed to decompress the nerves a spinal fusion may be required. This involves inserting screws and rods into the spine to hold the bones in a stable positon until they fuse together.
Minimally Invasive Decompression
This technique uses less invasive techniques where a smaller incision is made resulting in less trauma to the tissues and more rapid recovery. The typical hospital stayis two days and patients commence walking n the day of surgery. Magnification is used including the use of microscopes to see the area for surgery.
Interspinous Stabilisation
This technique involves placing a small spacer device between the spinous processes in the back of the spine. These devices hold the vertebrae apart and increase the size of the spinal canal, making more room for the nerves. This procedure is minimally invasive and is often combined with a minimally invasive decompression. In select patient groups success rates are greater than 80%.
Rehabilitation.
Following surgery, you may be in the hospital for a number of days depending on your overall health and the procedure you underwent. Walkig id the main activity following spinal decompressive surgery with physiotherapy commencing 4 – 6 weeks after surgery.
This is focussed on developing strength and flexibility in the muscles of the back and abdomen.
Mr Morris was appointed as a Consultant Orthopaedic Surgeon to the Adelaide and Meath Hospital, Tallaght in 2007 before taking up his current post at the Mater Misericordiae University Hospital in 2013. His higher orthopaedic training was on the Irish …Read more