Dr. W.L. Lippert on Spinal Stenosis – LIVING WELL Magazine

The Problem is…Spinal Stenosis

What is the solution?

By W.L. Lippert, M.D., Colorado Springs LIVING WELL Magazine

Spinal stenosis is a common cause of low back and leg pain. Unfortunately, it is responsible for pain in the senior population far too often. It is estimated that over 20% of elderly residents of retirement communities have spinal stenosis pain. You can often recognize those with stenotic  pain as the people sitting at gatherings when everyone else is standing. Sadly, stenosis makes “sitters” out of people who were always active in their past. Trips to the shopping mall are focused more on a search for the next bench to sit on, rather than a shopping item. Grocery shopping begins with finding your friend the shopping cart to reduce the pain of the trip. Venturing out on a nice day for a walk may become a thing of the past…

So what is this spinal stenosis?  Stenosis refers to narrowing of the spinal canal. Narrowing of the spine results from several factors: disc deterioration, degeneration of joints of the back of the spine (“facet joints”), and thickening of a spinal ligament called the ligamentum flavum.  With sufficient narrowing, there can be limitation of blood flow to the spinal nerves or squeezing of the nerves themselves with resultant nerve pain in the back or legs.

The most common means of reducing the pain of spinal stenosis is to modify your activities. Simply staying off your feet a bit more will reduce pain. Pain usually resolves nicely when sitting down or for that matter, lying down. Planning shorter episodes of standing and walking or using an assist such as a cane or walker, will often reduce mild to moderate stenosis pain such that no other treatment is necessary. Typically bending forward will decrease pain as well, because the canal is more spacious in this position. Medications may reduce the pain of mild to moderate stenosis, some of which would include anti-inflammatories, anti-convulsants, and narcotic therapy. Physical therapy, while often recommended, actually offers limited help, though improved core strength and range of motion may offer some symptomatic relief. There is no good evidence that traction or manual “spinal decompression” has any long-term efficacy with this condition.

As stenosis becomes more severe, the ability to stand and walk becomes much more restricted and quality of life diminishes. To modify activity and reduce pain, a patient would now have to sit most of the time…When activity level is significantly reduced, patients will seek more aggressive therapies. Many pain specialists will offer epidural steroid injections to reduce inflammation at the narrowed area of the spine. Decreasing inflammation will reduce pain directly. Steroids will also reduce swelling in the canal, which contributes to canal narrowing. If necessary, these injections can be repeated if extended relief is realized and quality of life clearly improves.

For those who remain frustrated with sustained pain after the above efforts are made, the next step can be much more aggressive by seeking out a spine surgeon and considering open surgery with laminectomy and possibly fusion; often an appropriate step, but a big step. What we have sought for some time is a surgical procedure that would reduce the stenosis with a less traumatic means.  We have hoped for a decompression procedure that would be milder for the patient. That “MILD” procedure is here today.

The MILD (minimally invasive lumbar decompression) is a safe and effective means to reduce spinal stenosis by removing some of the excess bone and ligamentum flavum in the spinal canal. These tissues are removed through a small tube about the diameter of a pencil, which is introduced by way of a tiny nick in the skin in the low back. It is through this tube that special instruments are used to remove a portion of the offending tissues. Most patients return home the day of surgery and may return to work in most cases the following day. Data from MILD surgeries extends beyond one year now with 74% of the patients indicating they were pleased with the procedure and the response. For the few who fail to improve with the MILD, all options remain available for their treatment.

Spinal stenosis is a killer of an active lifestyle, there is no need to be a victim. Most stenosis symptoms can be improved with conservative treatment. Talk to your physician about treatment options and, if indicated, seek out a qualified pain specialist.

W. L. Lippert, MD, Pain & Spine at St. Francis, may be reached at 719-380-7246.