Back pains , numbness can make life numb – Spinal Stenosis

Back pains may not be just pains, but can be life devastating pains. This 55 year old male, Ramkumar Shandilya, used to get small back pains and took a few medications to get him through the day. But this pain gradually started to increase more and more with time and the big toe on his left foot was going numb. He crawled to get around the house and could not walk more than 50 meters at a stretch and had to stop and rest before he could walk any further. This was affecting his professional life as he couldn’t concentrate on his job due to the pains. He started getting hopeless and used to think that he will never be able to live a pain free life like others. On seeing him in constant pain for more than a year, his colleague referred him to a neurosurgeon. He came to the clinic, where he was properly examined and advised an MRI. MRI showed severe Lumbar canal stenosis at two levels in spine and was advised surgery as it was too late for any non-surgical treatment.
Understanding the spinal Pain: Spinal stenosis is a disorder that is caused by narrowing of the spinal canal. This narrowing happens as a result of the degeneration of both the facet joints and the intervertebral discs. In this condition, bone spurs (also called osteophytes) grow into the spinal canal. The facet joints also enlarge as they become arthritic, which contributes to a decrease in the space available for the nerve roots. This condition is known as ‘facet arthropathy.’ Technically, spinal stenosis is condition of the narrowing of the spinal canal which causes pressure on the spinal cord and nerves. About 75 percent of cases of spinal stenosis occur in the low back (lumbar spine). In most cases, the narrowing of the spine causes pain, heaviness, tingling-numbness in the legs.
What causes lumbar pain? Spinal stenosis may be caused by a number of processes that decrease the amount of space in the spinal canal available for the nerves. Aging is one of the most common causes of spinal stenosis. Degenerative processes occur throughout the body as we age and stenosis can occur in individuals who were born with a spinal canal smaller than normal (congenital stenosis) or have rare conditions such as tumors and metabolic conditions. Tissues in the spine may start to thicken, and bones may get bigger, compressing the nerves. Conditions like osteoarthritis and rheumatoid arthritis may also contribute to spinal stenosis. The inflammation they cause can put pressure on the cord.
Other conditions that may cause spinal stenosis includes heredity, spinal defects present at birth, tumors of the spine, accidents and injuries that may dislocate the spine, etc.
The procedure of spinal fusion is done in a minimally invasive fashion using small key-holes (Minimally Invasive TLIF). After any type of back surgery, your doctor may recommend physical therapy for a short time. The right exercises can help you gain strength and flexibility.
How to identify Spinal Stenosis? Pain in the buttocks or leg, which is a common symptom of lumbar spinal stenosis, may be associated with the compression of the microvascular structures carrying blood flow to the nerve roots. At the same time, the symptoms of spinal stenosis may be the direct result of physical compression of the nerve roots. Each of these processes may interfere with the normal function of the nerve roots and decrease the effectiveness and endurance of the spinal nerves leading to –
Weakness in the legs or arms
Pain in the lower back while standing or walking
Legs or buttocks getting numb
Falling frequently and having balancing problems
Loss of urine and bowel control, in extremity.
Sitting in a chair usually helps relieve these symptoms which return with periods of standing or walking.
How does the doctor conclude? Usually, people who develop stenosis have no history of back problems or any recent injury. First simple treatments are provided for the suspected diagnosis. If postural changes or non steroidal anti-inflammatory drugs do not relieve the problem, then spinal imaging using X-ray, MRI or a CT scan will be helpful to confirm a suspected diagnosis.
Treatments and Surgeries for Spinal Stenosis: If diagnosed, depending on severity of spinal stenosis the treatment may include either or combination of options like postural changes which gives them relief of pain and discomfort, medications and surgery to relieve the pressure on affected nerves. There are several types of surgeries that can be performed to treat spinal stenosis. It could be:
1.) Laminectomy and foraminotomy are the most common types of surgeries. Part of the vertebrae is removed to provide more room for the nerves. Usually, this is done as an open procedure. The patient undergoes ‘Micro-endoscopic Decompression (MED)’, wherein, the entire procedure is performed through small key-holes. This has several benefits in terms of better cosmesis, less pain, limited days of admission, early discharge, cheaper costs, and more. This is a spinal surgery that has become a specialized revolutionary technique in which the routine spinal surgeries are performed using a key-hole. The most common spinal afflictions are disc herniations (slipped disc), lumbar canal stenosis and spinal instability. Generally, an open surgery is done to tackle the most of these conditions. However, with the micro-endoscopic techniques, the objectives of the surgical procedure are achieved without any significant collateral damage to the soft tissue (muscles and ligaments) or the bony skeleton. Tubular retractors are passed through the key-holes to perform the procedures based on the indication of surgery.
Advantages: Apart from the elegance and cosmetic appeal, this technique has several advantages. The scar is miniscule (1.5-2cm long) and appears like an ordinary scratch. No muscle or bony trauma, the contours of the back are well preserved.
Minimal pain killers required unlike an open.
No stress on the metabolic.
Swift and painless recovery as older patients may carry conditions of diabetes, hypertension, and heart problems.
Very small incision is made that heals(problem especially for the obese).
Minimal blood loss: The patients are made to walk within a few hours after surgery and can go home the very next day.
Post operation easiness – A water-proof dressing is applied such that the patient can take bath as early as he/she wishes to.
2.)Spinal fusion is typically performed in more severe cases where spinal stenosis is accompanied with spinal instability. Bone grafts or metal implants are used to attach the affected bones of the spine together.
The goal of this surgery is to stabilise, or lock two or more bones so they can’t move. This is done with metal hardware or bone graft from the pelvic bone. You may need to stay in the hospital for a few days following spinal fusion. The procedure of spinal fusion is done in a minimally invasive fashion using small key-holes (Minimally Invasive TLIF). After any type of back surgery, your doctor may recommend physical therapy for a short time. The right exercises can help you gain strength and flexibility.
Post operative Exercises: Your doctor or physical therapist can recommend exercises specifically designed to strengthen your back and abdominal muscles. They can also instruct you on how to do them safely. One might feel as though exercise would be too painful, but movement is crucial to your overall health. Try to perform some stretching exercises several times a day. If you haven’t exercised in a while, start slowly, even if it’s only a few minutes a day. Ideally, you should exercise for 30 minutes at least three times a week. If exercise is particularly difficult, try exercising in a pool. The buoyancy of the water makes it easier to move and get full range of motion. But before you take up any form up exercise consult your doctor.
(The author is Consultant Spine Surgeon at Mumbai Spine Scoliosis & Disc Replacement Centre Bombay Hospital, Mumbai. Views are his own)