A Closer Look at Lumbar Stenosis – Symptoms and TreatmentsJuly 27, 2018
We see many patients who come in with a diagnosis of spinal stenosis. Their doctors have told them that they have a narrowing of the spinal column and that is causing pressure on the spinal cord, and/or a narrowing of the openings where spinal nerves leave the spinal column through the vertebrae.
Surgery is intended to give those nerves more room and reduce pressure and pain by drilling bigger holes. In recent research published in the journal Osteoarthritis Cartilage, doctors found that while stenosis was common on MRI, its cause as the pain source was described as “relatively uncommon.”1 You may be operating on people who have no pain and no symptoms other than a MRI reading.
If stenosis was not causing the pain, why were patients being sent to surgery to correct it?
Alarming research conducted by Dr. Nancy E. Epstein of Department of Winthrop University Hospital, Mineola, New York and published in the medical journal Surgical neurology international says:
“The incidence of nerve root injuries following any of the multiple minimally invasive (fusion) surgical techniques resulted in more nerve root injuries when compared with open conventional lumbar surgical techniques.
Considering many of these procedures are unnecessarily being performed for degenerative disc disease alone, spine surgeons should be increasingly asked why they are offering these operations to their patients?”2
A paper from the University of South Carolina further questioned the decision to go to surgery by suggesting conservative or non-surgical treatments could be utilized with equal hopes of success or non-success. Here is what the research says:
“the benefits of surgical treatment versus nonsurgical treatment is ultimately inconclusive because of the nature of data collection, inconsistencies with the clinical definition of lumbar spinal stenosis, and a lack of standardized treatment guidelines.”3
A study in the European Journal of Orthopaedic Surgery & Traumatology from Italian doctors concluded: “We cannot conclude on the basis of this review whether surgical or nonsurgical treatment is better for individuals with lumbar spinal stenosis. We can however report on the high rate of side effects reported in three of five surgical groups and that no side effects were reported for any of the conservative treatment options.”4
Spinal stenosis usually occurs as a person ages and the discs become drier and start to shrink. At the same time, the bones and ligaments of the spine swell or grow larger due to arthritis or long-term swelling (inflammation).
Spinal stenosis may also be caused by:
- Arthritis of the spine, usually in middle-aged or elderly people
- Bone diseases
- Defect or growth in the spine that was present from birth (congenital defect)
- Herniated or slipped disc
- Injury that causes pressure on the nerve roots or the spinal cord
- Tumors in the spine
Recently researchers made an obvious connection between obesity and stenosis. The more significant the risk factors, the more the worsening of symptoms. 5
Often, symptoms will get worse slowly over time. Most often, symptoms will be on one side of the body or the other. These symptoms include:
- Numbness, cramping, or pain in the back, buttocks, thighs, or calves
- Tightness and pain in the neck, shoulders, or arms
- Weakness of part of a leg or arm
Symptoms are more likely to be present or get worse when a person stands or walks. They will often lessen or disappear when a person sits down or leans forward. Most people with spinal stenosis cannot walk for a long period of time.
SPINAL STENOSIS TREATMENT The non-surgical approach.
Using prolotherapy, Prolozone®, platelet rich plasma (PRP) and stem cell therapy, we accelerate and enhance the body’s natural healing process. Our regenerative approaches rebuild the connective tissue of the spine including the ligaments and tendons. Structures designed to hold our spine stable and prevent the vertebrae from rotating out of place and causing pressure on the discs and nerves.
We see many patients who have already been through the gamut of traditional medicine and have not found relief. Many people who have had no success with treatments such as surgery, nerve block, epidurals and steroid injections, trigger point injections, chiropractic therapy, acupuncture and more, find relief for the first time after receiving treatment at the Magaziner Center. With no side effects, downtime or surgery, we have gotten patients off of medication, helped them to avoid surgery and gotten them back to their lives.
This article was written by Dr. Scott Greenberg, MD.
1. Ishimoto Y, et al. Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: The Wakayama Spine Study. Osteoarthritis Cartilage. 2013 Mar 5. pii: S1063-4584(13)00706-1. doi: 10.1016/j.joca.2013.02.656. [Epub ahead of print]
2. Epstein NE. More nerve root injuries occur with minimally invasive lumbar surgery: Let’s tell someone. Surg Neurol Int. 2016 Jan 25;7(Suppl 3):S96-S101. doi: 10.4103/2152-7806.174896. eCollection 2016.
3. Patel J, Osburn I, Wanaselja A, Nobles R. Optimal treatment for lumbar spinal stenosis: an update. Current Opinion in Anesthesiology. 2017 Jul 10.
4. Inoue G, Miyagi M, Takaso M. Surgical and nonsurgical treatments for lumbar spinal stenosis. Eur J Orthop Surg Traumatol. 2016 Oct;26(7):695-704. doi: 10.1007/s00590-016-1818-3. Epub 2016 Jul 25.
5. Knutsson B, Sandén B, Sjödén G, Järvholm B, Michaëlsson K. Body mass index and risk for clinical lumbar spinal stenosis: A cohort study. Spine (Phila Pa 1976). 2015 Jul 10. 4 Inoue G, Miyagi M, Takaso M. Surgical and nonsurgical treatments for lumbar spinal stenosis. Eur J Orthop Surg Traumatol. 2016 Oct;26(7):695-704. doi: 10.1007/s00590-016-1818-3. Epub 2016 Jul 25.