According to the Mayo clinic, spinal stenosis is a narrowing of the open spaces within your spine, which can put pressure on your spinal cord and the nerves that travel through the spine. Spinal stenosis occurs most often in the neck and lower back. Spinal stenosis can cause pain, numbness, muscle weakness, and problems with bladder or bowel function. Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to aging.
Flexing forward or sitting will open up the spinal canal and relieve the leg pain and other symptoms, but they recur if the patient gets back into an upright posture. Numbness and tingling can accompany the pain, but true weakness is a rare symptom of spinal stenosis. An older person leaning over the handle of their shopping cart while making short stumbling steps often has spinal stenosis.
When Should Surgery Be Considered and What Is Involved?
In many cases, the conditions causing spinal stenosis cannot be permanently altered by nonsurgical treatment, even though these measures may relieve pain for a period of time. To determine how much nonsurgical treatment will help, a doctor may recommend such treatment first. However, surgery might be considered immediately if a patient has numbness or weakness that interferes with walking, impaired bowel or bladder function, or other neurological involvement. The effectiveness of nonsurgical treatments, the extent of the patient’s pain, and the patient’s preferences may all factor into whether or not to have surgery.
The purpose of surgery is to relieve pressure on the spinal cord or nerves and restore and maintain alignment and strength of the spine. This can be done by removing, trimming, or adjusting diseased parts that are causing the pressure or loss of alignment. The most common surgery is called decompressive laminectomy: removal of the lamina (roof) of one or more vertebrae to create more space for the nerves. A surgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disk. Various devices may be used to enhance fusion and strengthen unstable segments of the spine following decompression surgery.
What Are the Major Risks of Surgery?
All surgery, particularly that involving general anesthesia and older patients, carries risks. The most common complications of surgery for spinal stenosis are a tear in the membrane covering the spinal cord at the site of the operation, infection, or a blood clot that forms in the veins. These conditions can be treated but may prolong recovery. The presence of other diseases and the physical condition of the patient are also significant factors to consider when making decisions about surgery.
What Are the Long-Term Outcomes of Surgical Treatment for Spinal Stenosis?
Removal of the obstruction that has caused the symptoms usually gives patients some relief; most patients have less leg pain and are able to walk better following surgery. However, if nerves were badly damaged before surgery, there may be some remaining pain or numbness or no improvement. Also, the degenerative process will likely continue, and pain or limitation of activity may reappear after surgery. NIAMS-supported researchers have published results from the Spine Patient Outcomes Research Trial (SPORT), the largest trial to date comparing surgical and non-surgical interventions for the treatment of low back and associated leg pain caused by spinal stenosis. The study found that for patients with spinal stenosis, surgical treatment was more effective than non-surgical treatment in relieving symptoms and improving function. However, the functional status of patients who received non-surgical therapies also improved somewhat during the study.
Chiropractic has been shown to be an effective alternative for spinal stenosis. In a land mark study in 2006, chiropractic low-velocity lumbar flexion-distraction to be a promising nonsurgical treatment option for patients suffering with stenosis. The flexion-distraction technique provides a direct manual decompression to the afflicted spinal motion segments while attempting to mobilize the segment and decompress the nerve root. This mechanism addresses’ both the nervous and compressive aspects of the pathology. Of note; the long term follow up shows clinically meaningful improvement in pain when compared to natural history.
The low-velocity lumbar flexion-distraction is a unique technique that not all chiropractors so make sure when seeking non-surgical treatments that you specifically ask for this technique because others could cause an increase in symptoms.
By: Dr. Arthur Langston
Board Certified Chiropractic Physician
Certified in low-velocity lumbar flexion-distraction
Integrity Spine and Joint Center
604 Edwardsville Road
Troy Illinois 62294