Spinal stenosis- by drdoc on-line
  Spinal stenosis is caused by Bony and disc material compressing the lumbar spinal roots in the spinal canal, where the nerve root bundles are found.
This is felt as a fatigue and vague ache in the low back and legs.
Frequently there is progressive weakness of the legs and neurological abnormality on examination.
There may be  feelings of numbness and electrical impulses in the lower limbs if the problem is in the lumbar spine.

The lumbar spine is most commonly involved. Sometimes we see it in other parts of the spine - i.e. the cervical spine, and here we see certain neurological changes in the arms and legs.

The condition is aggravated by walking with the back extended - i.e. walking downstairs or standing for long periods.

Exercise is best in the form of aqua therapy.
If the analgesic and conservative therapy doesn’t work and the patient is medically fit (as they are frequently elderly) then----there is a role for surgery.
If the symptoms of functional impairment are significant - i.e. pain despite analgesia that interferes with function or neurological defect - then surgery is unfortunately the main effective therapy (And that’s an opinion of someone who hates surgeons and spends his life getting people to avoid them - if possible). If the spinal stenosis is unequivocal on the MRI and the degree of root compression is DEFINITELY SIGNIFICANT, rather than "maybe" or "possible", then results are good.

I find epidurals are not always effective.....maximal help in approx 40 % and usually last only a few months at most. They are usually suggested where conservative medical therapy has failed and surgery is undesirable.


I usually suggest the patient get laminectomies rather than fusion - unless there is instability or multiple levels. Patients are in hospital 5-7 days. They get out of bed day 3 and are mobilized rapidly here. The recuperation period is 1 month - 6 weeks as many are elderly.

The incidence of failed surgery rises dramatically if the surgeon - "just has a look", "in case" or when there is no definite pathology-- to so to speak-- decompress or "cut out" and excise.


The DDD - disc degenerative disease is part of the whole - the legs and pain and coordination improve, but a significant percentage of those patients do get a episodic discomfort in the low back as the facet joints remain under some malalignment and pressure.

In the age of the COXIB drugs such as Vioxx and Celebrex, we are now able to offer lower side effect risk anti-inflammatory therapy for the patients.

 
  Back to disease index page
Back to drdoc on-line home page
Back to low back pain
Go to Osteoarthritis page