Spinal Stenosis FAQ’s

Spinal stenosis is usually present in older population and is caused due to degenerative changes in the spine. It presents with pain radiating down the legs after walking certain distance or prolonged standing. It is highly unlikely for a spinal stenosis to present with weakness or involvement of bowel or bladder. The treatment of spinal stenosis is conservative to start with and if the symptoms are not relieved, then these patients may need surgical intervention on an elective basis.

A symptomatic spinal stenosis if not treated will cause worsening of symptoms and decrease in time of standing or length of walk before the symptoms start. The patient may, in fewer, cases may be debilitated to walk even 10 steps. Rarely, a worsened spinal stenosis may cause weakness in the legs with involvement of bowel or bladder. Such patients will need to be treated on an emergency basis. There are many patients, many people who had spinal stenosis, but had no symptoms. Such patients usually do not require any active treatment.

Spinal stenosis of the lower back is a degenerative or ageing condition. As there is a no cure to ageing, there is no cure to spinal stenosis, but the compression on the nerve roots caused by the spinal stenosis can be removed surgically if the patient does not improve with conservative means.

A well-performed spinal stenosis surgery usually gives good results within a week or two. The patients are encouraged to be active and about out of bed immediately after the surgery. The patient may require to go to physical therapist for strengthening of muscles starting few weeks after surgery. The patient will usually have maximal improvement by two to three months after the surgery.

Spinal stenosis of the lower back is initially treated with medications to calm down the nerves along with Physical Therapy to strengthen the muscles. If the patient does not have improvement with these measures or have worsening, then they can be treated surgically by removing the bony elements so as to decrease the pressure over the nerve roots. Occasionally, the patient may also need fusion surgery performed by the use of screws and rods.

There are multiple medications which can be used in patient with spinal stenosis. These medications including gabapentin, pregabalin are usually used to decrease the sensitives of the nerve roots so as to calm them down and decrease the symptoms of pain caused due to the irritation from nerve roots.

Physical Therapy is helpful in patients with spinal stenosis by strengthening of the muscles and which help in offloading the bones and decreasing the compression and hence irritation of the nerve root. This may be helpful in decreasing the symptoms. Many patients may recover enough with the help of medication and physical therapy to not to undergo surgical intervention.

Spinal stenosis is usually a degenerative process which is worsened with ageing. Even after surgery, the ageing process of the spine does not stop and may lead to recurrence of spinal stenosis over many years. Despite progression of age related degenerative stenosis, occasionally a patient will need repeat surgery.

It is highly unlikely for a person to be paralyzed after a spinal stenosis of the lumbar spine or the lower back. These patients usually present with pain going down their legs especially after walking for certain distances. Spinal stenosis of the neck may present with paralysis especially if the patient has been involved in a fall or injury to the neck superimposed over this spinal stenosis.

Surgeries for spinal stenosis are usually very successful surgeries and the success rate is above 90% to 95% in relieving the pain going down the leg or arms depending on the location of the surgery.

The disc is present in the front of the spinal cord or nerve roots and the lamina are present behind the spinal cord of the nerve roots. Discectomy involves surgery usually from the front, though it can also be performed from the back especially in the lower back and involves removal of the disc to remove the pressure from the front of the neural elements.

Laminectomy on the other hand is performed from the back and involves removal of pressure from the neural elements from the back. Sometimes especially in the lower back area, both the surgeries can be combined and usually performed from the back.