Spinal Stenosis Can Now Be Treated Without Surgery

What is Spinal Stenosis?

Spinal stenosis is a narrowing (stenosis) of the spinal canal (the opening in each vertebra through which the spinal cord goes through), lateral recess (the tunnels where the nerve roots exit the central spinal chord), and/or intervertebral foramina (holes in the sides of the vertebrae where nerve roots exit). It can occur at any age and is typically due to the degeneration and enlargement of the facet joints (between the upper and lower vertebrae), the herniation of the intervertebral discs and/or ligamentum flavum enlargement (the ligament that connects the vertebrae together). This narrowing of the canals can put pressure on the spinal cord and nerve roots. The most common areas are cervical spinal stenosis, at the level of the neck, and lumbar spinal stenosis, at the level of the lower back. Thoracic spinal stenosis, at the level of the mid-back, is considerably less common.

Lumbar Spinal Stenosis

Approximately 1.2 million Americans have back and leg pain that can be attributed to lumbar spinal stenosis. It is the most common reason for adult lumbar spine surgery in the older than 65 age group. The most common place for spinal stenosis to occur in the lumbar spine is between the third and fourth lumbar vertebrae (L3-L4) or the fourth and fifth lumbar vertebrae (L4-L5).

What are the symptoms of Lumbar (Low Back) Spinal Stenosis?

• Low Back Pain – typically is present 95% of the time. Worse with walking, standing and/or arching the lower back The pain gets worse in an upright posture. Better by adopting a bending forward posture and many will frequently lean on a shopping cart, walls, or use a cane. Bending forward temporarily increases the spinal canal size and decreases compression of nerves. 
• Radiculopathy (leg pain) - a feeling of heaviness, cramping, burning, weakness, and/or pins and needles radiating down the back, buttocks, thighs, legs secondary to compression or irritation of the nerve roots. This pain is alleviated when the patient leans forward.  These symptoms are often bilateral (both sides) 40-50% of the time. but are not always symmetric. It typically is present 80% of the time.
• Neurogenic Claudication - pain, often cramp like, and weakness that occurs in the legs with walking. This pain is alleviated when leaning forward or sitting down. The distance required to cause symptoms or make symptoms worse is typically less than 100 meters (110 yards), but it can vary on a daily basis. It typically is present 91% of the time.
• Urinary Dysfunction - dysfunction in the urinary system occurs in 12% of patients with long-standing, chronic spinal stenosis. This dysfunction may manifest as recurrent urinary infections, frequency, and incontinence and more rarely, as urinary retention.                                                                                                                                                                   

 What are the symptoms of Cervical (Neck) Spinal Stenosis?

• Radiculopathy - usually caused by lateral recess or intervertebral foraminal stenosis. Symptoms include a sharp pain, tingling or burning sensation in the area supplied by the cervical nerves. Patients typically have severe neck and arm pain that precludes them from getting into a comfortable position. The most common symptoms and signs in patients with cervical radiculopathy are:
• Arm Pain (99%),
• Sensory Deficits (85%),
• Neck Pain (79%),
• Reflex Deficits (71%),
• Weakness (68%),
• Scapular Pain (52%),
• Headache (9%).
• Myelopathy - is a set of symptoms caused by compression of the spinal cord.  The symptoms of cervical myelopathy include:
• Deterioration of Fine Motor Skills 
• Shooting Pain into the Extremities (especially when the head is bent down),
• Inability to Walk Quickly
• Heavy Feeling in the Legs
• Arm Pain
• Loss of Balance
• Bowel and Bladder Dysfunction.

What are the testing procedures to diagnosis of Spinal Stenosis?

• History and Examination – this is often the most neglected, yet, by far the most important part of the diagnosis process. Quoting Sir William Osler MD, "Listen to your patients, they are telling you the diagnosis”. It is absolutely crucial to spend the time taking a detailed history.” You cannot find what you do not look for”. It is absolutely crucial to spend the time performing a detailed exam. Based upon the results, a determination will be made as to whether to begin treatment or to order further tests. 
• X-Rays – can provide a lot of information about the possible causes of spinal stenosis. Disc degeneration, facet enlargement, sliding of the vertebrae, and the development of bone spurs can all be seen. X-rays are also used to evaluate spinal alignment.  
• Cat Scan(CT) – used to see spinal stenosis, however CT without the combined use of myelography (contrast dye) is not recommended for the usual evaluation of stenosis. CT myelography also allows the neural structures to be visualized and provides a good view of the central spinal canal as well as the lateral recesses and foraminal tunnels. While less expensive than an MRI, it will expose the patient to high levels of radiation. Generally not the test of choice.  
• MRI  – this is the most common imaging study used to check for the presence of spinal stenosis. It will show both bone and soft tissue details and allows nerve root impingement to be well visualized. While this is an excellent test to help differentially diagnosis spinal stenosis, there are inherent problems as well. First is the cost, which can be as high $2000.  Second, is that the time to perform the test is about 30-45 minutes and you must lie still. This may be very difficult for many patients. Third and most importantly, is that most often, the MRI findings may have nothing to do with the presenting condition. Studies have shown that 30% of asymptomatic people, who have never had any pain, will have stenotic canal MRI findings. This does pose a diagnostic dilemma and is why you have to “marry the patient to the MRI, not the MRI to the patient”. Again, the history and examination will determine treatment going forward, in spite of the MRI findings.

What treatment can be done to help Spinal Stenosis?

While there are certainly many different types of treatment, that are effective for spinal stenosis, many of which we readily use in our office, namely spinal manipulation, electric muscle stimulation, ultrasound and spinal exercises, it is not the intent of this article to list all of them but simply to introduce you to a type of treatment that you may not be aware of. SDT is not meant to necessarily replace any of the above therapies. In fact, utilizing them can be very helpful and will often enhance recovery. As a stand alone therapy or as an adjunct to pre-existing therapies, STD can be extremely effective to help you get well. 

Spinal Decompression Therapy

Spinal Decompression Therapy is FDA approved and has a very high success rate for pain associated with herniated discs, degenerative disc disease and spinal stenosis.… even after failed surgery. It is a non-surgical, traction based therapy for the relief of back/ leg pain or neck/arm pain. During this procedure, we have the ability to cycle through distraction and relaxation phases and by proper positioning, a spinal disc can be isolated and placed under negative pressure, causing a vacuum effect within it, drawing it back from its herniated position and away from the nerve. If your condition is not discal and is secondary to arthritis, which can lead to spinal stenosis, we can change the parameters to focus on a more continuous shorter hold/relax phases, creating a “milking of the joints”. This will help to reduce inflammation and allow diffusion (absorption) of nutrients into the arthritic areas to lubricate and heal the irritated structures.