Low back pain is a common problem that plagues most of us. Fortunately, most get relief within a couple of months. For those who continue to have chronic back pain, there are multiple causes. For those over 60, a common cause is spinal stenosis. It affects men more than women at a 9 to 1 ratio. Spinal stenosis is tightness in the spinal canal that causes pressure to be placed upon the nerves or spinal cord. Since the spine is actually a bony tube that contains the spinal cord and nerves, any inflammation or swelling within that space causes a significant increase in pressure.
The causes of spinal stenosis are numerous consisting of arthritis of the spinal joints, degeneration of the disc, and an enlargement of the connective tissue within the spine. These are the most common causes, however, certain patients are born with smaller canals than others. This predisposes them to early development of the stenosis or tightness. This can occur at any level in the spine. My emphasis today is the lumbar area.
The symptoms and pain associated with lumbar spinal stenosis is a heavy, tired feeling or pain in the low back, hips and legs. It can be a deep, aching pain or weakness that makes one feel they have to sit for relief. Some will have numbness and tingling with walking and standing. Unlike the pain associated with poor blood flow, it does not improve with just stopping. It requires sitting or leaning forward to relieve the pain. As the disease progresses, they may find themselves walking leaned forward or leaning on a shopping cart for relief. Depending on the area of tightness, a specific nerve may be involved giving symptoms similar to a ruptured disc.
Treatments range from conservative measures to surgery. Conservative measures include activity modification, physical therapy, muscle relaxers, antidepressants, anti-inflammatory, anti-seizure and pain medications, as well as epidural steroids for specific nerve pain. These treatments will generally decrease the pain to a reasonable level until the disease progresses to a level requiring surgical evaluation.
Surgical intervention is a major undertaking, especially for the elderly. It may require extensive surgery to relieve the stenosis and most surgeons want patients to wait as long as possible before the operations. The operation is successful in a majority of patients, but occasionally may require repeat surgery 5-10 years down the road. Surgery is generally only considered for those not responding to more conservative therapy or those with major nerve dysfunction.
Should you or your loved ones have such symptoms and discomfort, please discuss them with your physician or contact Comprehensive Pain Specialists. Conservative therapies may be able to significantly improve your quality of life.
Frank E. Jordan, M.D.
Dr. Jordan graduated from the University of Tennessee School of Medicine in Memphis. He completed residency training in both Internal Medicine and Anesthesiology at the University of Tennessee. Dr. Jordan obtained Board Certification in both Internal Medicine and Anesthesiology and was appointed a clinical staff position at the University of Tennessee School of Medicine. Dr. Jordan went into private practice in Anesthesiology, but became interested in pain and pursued additional training through a pain fellowship at Baylor School of Medicine, Center for Pain in Houston. Dr. Jordan then obtained Board Certification in Pain Medicine. Dr. Jordan returned to Tennessee and established the first full time pain practice in rural West Tennessee. Dr Jordan has helped patients with chronic pain in Jackson for the past 25 years.