IF SYMPTOMS PERSIST
Dr. Jose Pujalte, Jr.
“All the best days of life slip away from us poor mortals first;
illnesses and dreary old age and pain sneak up
and the fierceness of harsh death snatches away.”
Virgil (7-19 BC) Roman poet
Georgics No. 3, 1. 66 (36-29 B.C.)
You’ve taken your early morning (or evening) walk. Now your back hurts.
After the saunter, did you get leg pain, leg numbness, weakness or cramping? Sometimes the symptoms are also felt in the buttocks. If you are over 50, do you have back pain that was worsened by walking? Is the back pain eased by crouching or rolling into a fetal position?
You may have lumbar or lower back spinal stenosis.
What is spinal stenosis? Stenosis means narrowing. In this case, it is the narrowing of the spine. The lower back has relatively large blocks of bone called vertebrae that are stacked on top of each other. There are spaces on the sides of the bones where nerves that supply the lower extremity exit. Normally, there's just enough space for these sensitive nerve roots to slide through. If for some reason the space is compromised, the nerves are choked and this is manifested as: pain, numbness, weakness, or cramping.
Who gets it? Pressure on nerves can occur from trauma (bad spills and car accidents), tumors of the spine that eat bone, and if seen in children, from congenital deformities of the spine. However, the most common culprit is arthritis of the spine. This is the reason older people are more frequent sufferers. Degenerative arthritis attacks not only the large joints like the hips and knees but the miniature ones of the spine, as well. When arthritis occurs, extra bone grows obstructing the path of nerves. Ligaments and coverings also thicken, adding to the pressure.
Diagnosis. The doctors to visit are: family medicine practitioners, rehabilitation medicine specialists (physiatrists), rheumatologists, neurologists, neurosurgeons, and orthopedic surgeons. These doctors are trained to handle spinal stenosis cases from their own vantage points. A thorough physical examination includes recreating the movements that aggravate lower back symptoms. Longstanding conditions may manifest as loss of muscle tone and strength and a decrease in muscle reflexes. An X-ray will reveal injury, tumor, or arthritis. More sensitive imaging such as CT scans or MRIs are requested if pressure signs and symptoms are progressive.
Non-surgical treatment. Chafed nerves and sheaths react by swelling. NSAIDs (nonsteroidal anti-inflammatory drugs) such as diclofenac, mefenamic acid, and ibuprofen are taken for both pain and swelling. COX-2 inhibitors (etoricoxib, celecoxib) are now being used for both acute and chronic pain control as well as weak opioids like tramadol. Physical therapy and prescribed exercises may help stabilize the spine and restore good posture. Steroid injections with pinpoint accuracy help reduce inflammation of nerve coverings. Older patients may benefit from corsets and braces.
Surgery. The purpose of surgery is to re-create the space where the compressed nerve(s) once occupied freely. Now if this can be achieved without opening the back is the question answerable in three months. However, if bowel and bladder habits suddenly change (i.e. loss of urge to void), the dreaded cauda equina syndrome is suspect. This is a true orthopedic emergency. The nerves that supply the bowel and bladder must be decompressed.
Narrowing of the spine need never lead to narrowing of our lives.
Indicting spinal stenosis is one way to freedom.
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