Relieving the Pain of Spinal Stenosis
By Maureen Sangiorgio
When William Stowell started getting excruciating pain down his leg last March, he thought his active lifestyle was over. “I used to run marathons,” recalls Stowell, 53, a Service Electric repairman. “But then all of a sudden, I was in agony. I couldn’t take a step without the pain feeling like a lightning bolt shooting down my leg.” Doctors diagnosed him with a synovial cyst in his lower back, and spinal stenosis, a narrowing of spaces in the spine that results in pressure on the spinal cord and/or nerve roots. Chiropractic treatment and steroid injections only brought partial relief. Then his doctor recommended Christopher Wagener, M.D., Minimally-Invasive Spine Surgeon at the Center for Advanced Spinal Solutions at Coordinated Health, the leading center for the new spine procedure in the Lehigh Valley. “I was able to relieve his pain with just two tiny, one-inch incisions.” As soon as William woke up from anesthesia, his pain was gone. “Before my spine surgery, I was in so much pain, I had lost all hope. I thought I was in for a lifetime of suffering. Dr. Wagener gave me my life back.”
Causes of Spinal Stenosis
The spine is a column of 26 bones, and 24 of them are vertebrae. The vertebrae link to each other and are cushioned by shock-absorbing disks that lie between them. Picture a stack of jelly doughnuts with a thin hockey puck in between each one. The normal vertebral canal has enough room for the spinal cord, but with spinal stenosis, that canal becomes narrow. Spinal stenosis most often results from a gradual, degenerative aging process. Degenerative changes of the spine are seen in up to 95% of people by the age of 50, according to the American Academy of Orthopaedic Surgeons (AAOS). As people age, the ligaments of the spine thicken and calcify. Bones and joints can also enlarge, all growing to fill in that tiny space in the vertebral canal. That puts pressure on nerves and soft tissue, compressing and/or stretching ligaments. Bottom line? Pressure on nerves means PAIN.
Why suffer with all that pain when you have a chance at enjoying life again?
The location of spinal pressure dictates where on your body you will feel pain. Pressure on the lower (lumbar) region of the spinal cord or on nerve roots branching out from that area can cause pain or numbness in the legs. Pressure on the upper part of the spinal cord (the neck or cervical area) often produces pain in the shoulders, and can sometimes cause pain in the legs.
Spinal stenosis is most common in men and women over 50 years of age. However, it can occur in younger people who are born with narrowing of the spinal canal, or who suffer an injury to the spine. William’s doctors suspect his back trouble started when he was in a serious car accident three years earlier.
Tell-Tale Signs and Symptoms
The space within the spinal canal can narrow without producing any symptoms. However, if narrowing places pressure on the spinal cord and/or nerve roots, there may be a slow onset and progression of symptoms such as neck or back pain. Patients often feel a burning pain radiating down the leg (sciatica). As it progresses, it can result in pain in the foot. Other common symptoms include numbness, tingling, weakness, cramping, or general pain in the arms or legs.
Another sign you might have spinal stenosis is if you have weakness in the legs or “foot drop,” which is a feeling that your foot slaps on the ground while walking. Pain is usually made better by sitting and made worse by standing up straight and walking.
Spinal Stenosis Diagnosis
According to Dr. Wagener, if you feel any of these symptoms, it’s critical to contact your doctor right away. “Spinal stenosis is a progressive disease that won’t resolve on its own, so the pain will only worsen. In extreme cases, long-term pressure on the spinal nerves can lead to bladder and bowel problems.” Your doctor can use a variety of approaches to diagnose spinal stenosis, and rule out other conditions. During the physical exam, the doctor will determine your limitation of movement, check for pain or symptoms when you bend forward and bend backwards, and check for nerve sensation, muscle strength, and reflexes in your arms and legs. Following the physical exam, your doctor may or may not order an X-ray, MRI, CAT scan, myelogram or a bone scan.
The Pathway to Relief
If the nerve involvement is not too severe, your doctor may prescribe NSAIDS such as aspirin, naproxen, or ibuprofen, steroid and/or anesthetic injections (nerve blocks), physical therapy, or a lumbar brace. Alternative treatments include chiropractic manipulation and acupuncture.
If these conservative measures are not relieving pain for an extended period of time, surgery might be the next step. Surgery might be considered immediately if you have numbness or weakness that interferes with walking, impaired bowel or bladder function, or other neurological involvement. 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, which is 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.
A new surgical option available right here in the Lehigh Valley is minimally invasive decompression. While this procedure is available at various local hospitals, Dr. Wagener has performed the highest number of this cutting-edge technique in the Allentown area. The Center for Advanced Spinal Solutions is the only one of its kind in the Lehigh Valley. “Through tiny incisions we are able to accomplish the same results once only accomplished through traditional ‘open’ surgery,” notes Dr. Wagener, who also instructs other surgeons around the world on how to perform the new procedure. “In William’s case, I performed a minimally invasive decompression and fusion to go in and take the pressure off the spinal nerves,” says Dr. Wagener. “In traditional therapy, the surgeon makes a six-inch incision. With this new procedure, I make two one-inch incisions. The advantages include less pain, less soft tissue trauma and scarring, less bleeding, shorter hospitalizations, fewer complications, and a much earlier return to everyday life. Having done many traditional procedures, I have observed that the minimally-invasive patients do far better, and return to their normal lifestyle quicker.”
It’s important to note that this procedure is not for everyone. “Not every spine problem can be treated in a minimally invasive fashion,” notes Dr. Wagener. “In some cases, the spinal stenosis has invaded a very large area of the spine, so we must use the traditional, open technique with the larger incision in order to reach the entire affected area.”
All the more reason to seek help as soon as possible. “I strongly encourage anyone who was diagnosed with spinal stenosis to get evaluated for the new minimally invasive procedure,” says William. “Why suffer with all that pain when you have a chance at enjoying life again?”