Ask the Expert: Spinal Stenosis

by Dr. Andrew Sama
5.28 blog

In this week’s installment of Ask the Expert, Dr. Andrew Sama, Orthopedic Surgeon, answers questions on spinal stenosis.

Q1. What is spinal stenosis?

Spinal stenosis is a narrowing of the spinal canal which results in pressure on the nerves either in the central part of the canal, in the sides of the canal under the joints, or in the windows through which the nerves exit the canal. This can happen in the neck, mid or low back. The pressure on the nerves results in pain, numbness or weakness in the extremities. Cervical stenosis (in the neck) can affect the arms, legs and sometimes balance. Lumbar stenosis (in the low back) usually affects the buttocks and legs and can make standing or walking painful.

Q2. What are some of the causes of spinal stenosis?

Stenosis can be congenital or developmental from a young age. It can also be caused by arthritic changes of the facet joints and narrowing of the discs between the spine bones with overgrowth of the ligaments that help stabilize the vertebrae. It can also be caused by slippage of one vertebra on the next or by scoliosis or curvature of the spine.

Q3. What demographic is often at risk?

Patients in their 50’s and above are most commonly at risk for stenosis caused by arthritic changes to the spine. Developmental or congenital stenosis may affect patients in their late teens or twenties and above.

Q4. What can be done to treat spinal stenosis?

The early symptoms of stenosis can be treated with activity modification and anti-inflammatory medications. When symptoms become more significant, epidural steroid injections can be tried. If none of these give relief, then surgery to decompress the stenosis may be indicated. Depending on the cause of the stenosis and where it is located, fusion may also be required.

Q5. Is there any ongoing research regarding spinal stenosis?

Hospital for Special Surgery has been committed to the development of research and clinical expertise in this area of medicine.

http://www.hss.edu/conditions_lumbar-spinal-stenosis.asp

Dr. Andrew Sama specializes in the evaluation and surgical management of all traumatic, degenerative, and deformity-related conditions of the cervical, thoracic, and lumbosacral spine. Board certified in orthopedic surgery, he believes in a team approach to patient care. He is an active member of many spine societies, academic committees, and editorial review boards. He is a Fellow of the American Academy of Orthopedic Surgeons and a Diplomat of the American Board of Orthopedic Surgeons. 

Topics: Ask the Expert, Featured, Orthopedics, Rehabilitation and Fitness
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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

Duncan Ayr says:

I have spinal stenosis. 1998 L5, S1 discectomy. Now disc above it has failed. Minimal relief with epidural. Surgeon has told me major surgery. In through the back to start the “cage”, finish through the abdomin. 6-8 hour surgery and recovery up to a year with uncertain results.
I”m a 63 year old male who exercises daily on recumbent bike.

HSS on the Move says:

Hi Duncan, thanks for reaching out. For more information on spinal stenosis, click here: http://www.hss.edu/condition-list_spinal-stenosis.asp. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance. For more information, visit http://www.hss.edu/physician-referral-service.asp.

Sharon says:

I was also diagnosed with spinal stenosis at about age 55 and told I would need the lengthy major surgery with the “cage”. I had been in pain and with increasingly limited mobility for about 3 1/2 years. I then, separately, had the extremely good fortune to be diagnosed with Celiac Disease. I began the appropriate diet and within 5 days the pain was gone and I could walk. Presumably this is because the pain was caused solely by the inflammation caused by CD. I probably still have what an MRI would show as spinal stenosis, but that wasn”t the cause of the pain. I”d check out every possible cause of the pain before letting anyone do surgery, including food allergies which can all cause inflammation

HSS on the Move says:

Hi Sharon, thank you for sharing your input!

Randy says:

My discovery of severe Spinal Stenosis began with severe sciatic pain in my right leg. My spinal MRI has been reviewed by 2 Orthopedics. Both say I am eligible for a lifetime of Opiate’s. I have not taken any.

I had the x-ray guided steroid shots in the spine. No had no improvement. 1.They made me really hungry. 2. I read a recent study that showed this procedure has no medical benefit.

I had PRRT done by a physical therapist on inside of my right pelvic bone. I was told it has a 30% – 50% success rate. Immediate relief. I was one of the fortunate ones. It resulted in pain reduction and eventual pain elimination.

I am not saying this will work for everyone however it is well worth a couple of $20 co-payments.

Surgical intervention in my area is an option of last resort/treatment by the physicians and insurance companies. Probably because most studies show the 5 year result between having surgery and not having surgery is identical.

everybody I know that has had surgey say the same thing. “”Do NOT have spinal surgery. You will never be right again.”"

The other things I learned are; Compression from having my belt too tight on my pants caused symptoms. Wearing underwear when sleeping caused symptoms. Having the bed sheets to tight at my feet also caused symptoms. Laying in a recliner too long caused symptoms because of the way it rotated my hips.

All things worth checking into.

jeff says:

Duncan- Same problem same age. I think you are doing the wrong exercise. Upper body strength on an exercise machine as long as you don’t do ones that twist. I still need pain meds, but all in all it’s better than uncertain surgical results and dangers. Best luck.

Steve says:

How does one decide on surgery? I saw a orthopaedic surgeon at HSS and he was able to diagnose me while no other doctors did in the last 10 yrs. He offered surgery. I wound up having Bertolotti’s syndrome.

My problem is everywhere you read peoples experiences its always problem stories after surgery. How can I decide? Where do I look for success stories? Does anyone recover and get back to normal active life without having to have more surgery? Sorry for going off topic but I just have to ask.

HSS on the Move says:

Hi Steve, thanks for reaching out. To read success stories from HSS patients, visit http://www.hss.edu/stories.asp.

Ellie Damico says:

I had laminectomy due to a sports injury in 1993.
Once I recovered played tennis, biked and ran for over
12 years without. Singe doctors visit related o my spite.
In 2004 I was in a serious car accident and underwent several surgeries, I have fuiin from T10 thou S1. Fna surgery had very poor outcome: increased pain neuropathy in both legs and get, increasing leg weakness.I ave nations bulges and stenosis throughout ECG segment of my spite. Now it appears on recent cscans that the hardware. Crews, are loosening. Without going out on a limb is there hope that my condition cab be improved?

HSS on the Move says:

Hi Ellie, thank you for reaching out. Dr. Andrew Sama, Orthopedic Spine Surgeon, says: “This is difficult to answer as it sounds like you have a complex history and some issues that may or may not respond to any additional interventions.” It is best for you to consult with your treating physician who is familiar with your medical history for an in-person evaluation. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

pansycritter (@pansycritter) says:

My husband, Richard, has stenosis and has had surgery twice and is now in serious need of his third. He is frightened and concerned about this third surgery since the first lasted less than a year, the second was good for only a month. He now lives with debilitating pain and can walk for only moments at a time. He hasn”t been able to sleep lying down in a bed for over two years, using a recliner instead. The doctors are supposedly amongst the best in the area but he can find no relief. Will he ever be pain free? Will the third time be the charm? He is 60.

HSS on the Move says:

Hello, thank you for reaching out. Dr. Andrew Sama, Orthopedic Spine Surgeon, says: “It is difficult to answer this question without seeing your husband’s MRI and examining him in person. It is best for your husband to consult with his treating physician.” If he wishes to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

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