Relieving the spinal column squeeze

Should I have surgery to end the pain?” a friend recently asked me.

For years, he had suffered from sporadic low back pain. These attacks were interspersed with episodes of sciatica, with pain in the buttocks that radiated down the back of his leg due to pressure on the sciatic nerve.

But in recent years, he had also noticed vague, unusual feelings in his legs, as if they had turned to rubber. At other times, there was the tingle of pins and needles, numbness and a burning sensation in the legs. By the time he questioned me about surgery, he had developed unrelenting pain in the legs, the classic symptom of spinal stenosis.

Years ago, spinal stenosis was called creeping paralysis. It was simply accepted that if you lived long enough, you would eventually get it and would have to learn to live with it. Slowing down or becoming an involuntary couch potato seemed inevitable.

Today, we know that spinal stenosis is due to a narrowing of the spinal canal (the cavity in the vertebral column through which the spinal cord runs). This can occur in the neck and chest regions of the spine, called the cervical and thoracic spine, but is more commonly seen in the lowack and the condition known as lumbar spinal stenosis (LSS). It’s estimated that more than 400,000 North Americans suffer from LSS, and it’s one of the most frequent reasons for back surgery in people over 60 years of age. In fact, it’s even been called a hidden epidemic.

The most common cause of spinal stenosis is osteoarthritis, the wear-and-tear type of arthritis. This causes a gradual narrowing of the spinal canal resulting in increased pressure on the spinal cord and the nerves that exit the spinal column. The result can be excruciating pain that, in effect, discourages a patient from remaining mobile and active.

The pain is usually present in both legs and is brought on by walking and sometimes just by standing. Patients with spinal stenosis usually find the pain is eased when bending forward or sitting. This creates a bigger gap between vertebrae, which temporarily decreases nerve compression. Standing erect, on the other hand, increases the pain because the vertebral space narrows.

Ordinary X-rays do not normally detect spinal stenosis. Rather, diagnosis requires the use of computerized tomography (CT) and magnetic resonance imaging (MRI), or a specialized X-ray called a myelogram, during which a liquid dye is injected into the spinal column. Pain can sometimes be eased by the use of non-steroidal anti-inflammatory drugs (NSAIDs), such as Aspirin, ibuprofen and naproxen sodium. Physical therapy and braces may be helpful for other patients.

Epidural steroid injections are occasionally used to provide short-term relief. In one study, 50 per cent of patients reported favourable results. Some patients have to resort to surgery. This is often referred to as “unroofing” the spinal canal, or decompression surgery. To carry out this operation, surgeons open the spinal column at specific points where the narrowing has occurred. They then remove the bone or fibrous tissue causing the obstruction. The opening through which the spinal nerves emerge may also be enlarged and often part of the disk removed.

I told my friend that since all other treatments had failed, he had little choice but to accept surgery. For others, the decision for or against surgery depends on the degree of disability. Since spinal stenosis is not life-threatening but requires a major operation, older adults should not rush into it without serious thought after a good discussion of the risks with a doctor.

Today, many people have heard of sciatica, lumbago, a slipped disk or chronic back strain. But few mention or have ever heard of spinal stenosis. That is bound to change. It’s a disease that we will hear more and more about in the future as our population ages.