Back pain is common with eight out of ten people complaining of back pain at some time in their life. It can develop slowly as we age, or suddenly due to injury. There are many conditions that are related to back pain, including the common findings of spinal stenosis, disk herniation, and muscle strain.
What is spinal stenosis?
Spinal stenosis is a narrowing of the spinal canal that compresses the spinal cord and nerves. It can occur anywhere in the spine, but is most common in the lumbar spine.
Cervical stenosis (neck) is rare and more dangerous because it can pinch the spinal cord and nerve roots in the neck compromising function of the arms, and neck. In cervical spinal stenosis there are no symptoms until the cord or nerves become compressed. Then symptoms include stiffness, pain, numbness in the neck, shoulders, arms and hands, and can include the legs. Decompression surgery may be recommended when symptoms are severe.
Lumbar stenosis (low back) causes neurological symptoms that may include limb weakness, movement disorders, radiating pain, numbness, tingling, prickling and burning. All of these are symptoms of nerve compression. When the nerve roots in the lower back are compressed the result is often sciatica pain that radiates into the buttocks and legs.
Symptoms commonly develop over time and include:
- Claudication- leg pain while walking.
Stenosis is usually due to degenerative arthritis, and aging. Arthritis causes degeneration of the vertebrae, discs, muscles and ligaments, and overgrowth of bone (bone spurs). People over age 50 are commonly affected, but younger people with inherited narrowing of the canal or spinal injury can also be affected.
Stenosis can affect the spinal column and the peripheral nervous system. Facet joints are small stabilizing joints that connect the vertebrae to each other and permit backward motion. Arthritic changes enlarge the facet joints causing degeneration, compression and damage to spinal nerve roots (part of the central nervous system that extends from the base of the brain down to the lower back, where the nerve roots leave the spine).
The peripheral nerves, the branches from the spinal cord, enervate the muscles telling them when and how to move. Herniated discs can compress nerve roots. In the worst cases, nerve root compression can cause radiating pain in the leg, weakness, sensory loss, and loss of bowel and bladder function. When this occurs it is called cauda equine syndrome and requires urgent treatment, primarily surgery.
When treatment is postponed, it can lead to permanent loss of function and sensation, including the potential to lose the ability to walk.
This condition can be inherited due to a smaller than normal spinal canal, or scoliosis (curvature of the spine) that produces pressure on nerves and soft tissues, and stretches ligaments.
Nonsurgical treatments include activity modification and exercise including physical therapy, NSAIDS and epidural steroid injections for temporary pain relief. When conservative treatments fail to relieve symptoms and improve the ability to actively participate in daily life activities, surgery is usually recommended.
Surgery is usually recommended for patients suffering with poor quality of life. Surgery is intended to allow the patient to return to a pain-free active life. Studies report a success rate of about 80%.
The goal is to relieve pressure on the spinal cord and nerves. The surgery is called decompression laminectomy.
When the patient has numbness and weakens that impairs walking, and bowel and bladder function, surgery should be considered immediately.
Lumbar laminectomy may be conducted as an outpatient procedure using minimally invasive techniques to reduce soft tissue trauma. This technique, guided by fluoroscope, can remove bone and bone spurs, and enlarged ligaments that are causing compressions, without disturbing other structures in the spine. If arthritis causes spinal instability, a spinal fusion may be recommended. A laminectomy can also be performed as an open surgery.
At South County Orthopedic Specialists (SCOS), spine surgeons Dr. Bryce Johnson and Dr. Stephen Huo offer advanced surgical techniques and are skilled and experienced in both open and minimally invasive spine surgery. Dr. Johnson received his Fellowship training at UCSD under Dr. Steven Garfin, a world renowned spine surgeon, while Dr. Huo did his fellowship training at Brown University.
In Orange County, California, SCOS offers patients the most comprehensive orthopedic care available. Our state-of-the-art facilities and dedicated doctors and therapists are here to serve our community with offices in Irvine, Laguna Woods, and Fountain Valley.