Many individuals with spinal stenosis have a similar story. At some point they began to have pain, numbness or tingling--usually in their legs and feet, but occasionally in their shoulders and arms. If they laid down or stretched their back, the symptoms would go away. They attributed it to aging or stress or bad genetics. But then the pain and numbness and tingling got worse. It hindered them from sleeping at night. It was difficult for them to sit for long periods. The feeling in their legs would disappear and they would collapse. At this point, they decided a visit to the doctor might be a good idea.
After the usual doctor's office spiel of medical history and physical exam, the doctor probably ordered some series of scans and pictures like an x-ray, MRI, CAT scan, myelogram and bone scan. Once the doctor could clearly see that the patient had both pain or discomfort and that there was a narrowing of spaces in the spine, putting pressure on the spinal cord or nerve roots, the diagnosis of spinal stenosis was given.
This diagnosis can be scary. It's not a well-known disease and a quick search on the internet will reveal blog posts from spinal stenosis sufferers. They share the pain they are in. It's not comforting to read. However, with the advancement of technology and medicine, spinal stenosis no longer has to cause such extreme suffering. There are a myriad of ways of addressing the pain and even curing the disease altogether. The key to getting to a place of no pain is understanding your choices. There are several options. Depending on the severity of the pain, a doctor can prescribe medication and activity/lifestyle alterations, physical therapy, or surgery.
Minimal Pain Relief
For those who have slight pain and don't have progressive nerve involvement, a doctor will likely decide to opt for a more conservative treatment plan. The individual may be directed to take non steroidal anti-inflammatory drugs (i.e. ibuprofen, aspirin, etc.) to relieve the pain and reduce the inflammation. Many times this will be all the patient needs. However, if these drugs are not affective at addressing the issue of pain, the doctor might suggest an analgesic, like acetaminophen. For older patients with weak abdominal muscles or degeneration in the spine, a lumbar brace or corset might be suggested to help regain mobility and provide support. Depending on the individual's condition these pain relievers, inflammation reducers and spinal support mechanisms might be taken or worn daily, or they may simply be used on as needed.
Moderate/Severe Pain Relief
For individuals whose pain is not addressed with NSAIDs or analgesics, doctors will often suggest pain relief in the form of corticosteroid injections and anesthetic injections. Since these only provide very temporary pain relief, it is likely that the patient will only resort to them in dire times. Patients with severe pain that only crops up occasionally should turn to these methods before traveling so as not to take any risks if sitting in a plane or a car for an extended period of time.
Physical therapy seems to be the standout treatment for spinal stenosis. The exercises provided through physical therapy help to stabilize the spine through endurance building, muscle strengthening and maintenance of spinal motion. Chiropractic treatment and acupuncture have also been heralded as useful methods for reducing pain, both in the short-term and in the long-term. However, there is very little scientific information in regards to these methods, only patient testimonies explaining the personal benefits felt.
Some typical physical therapy treatments include lumbar flexion exercises, general conditioning exercises, lower extremity strengthening exercises, lower extremity flexibility exercises (when deemed appropriate), and posture training. These treatments vary depending on the individual patient, the extremity of their pain, the extent of nerve involvement, and the type of spinal stenosis.
The goal of surgery is to relieve any pressure on the nerves or spinal cord and restore strength and alignment of the spine. This is achieved by adjusting, trimming or removing diseased parts that are leading to the loss of alignment or pressure. The most common type of surgery for spinal stenosis is called a decompressive laminectomy. During this surgery, at least one of the vertebrae is removed to create more space for nerves. Spinal fusion may also be needed if the narrowing in the spine is too extensive.
Unfortunately, the surgery has some risks. Along with blood clots and infections, there is the common complication of a tear in the spinal cord-covering membrane. These risks are likely to require an additional surgery or prolonged recovery time. These risks, though, are very minimal. Few patients end up having any complications and almost all surgeries help to reduce pain or even completely relieve pain.
Surgical Treatment Versus Nonsurgical Treatment
Surgery was previously the go-to option for individuals whose pain could not be treated with anti-inflammatory medicines and pain relievers. Recently, however, new information has come to light that suggests physical therapy is just as effective.
The Annals of Internal Medicine published a study in 2015 where over 150 participants with spinal stenosis participated. Half of the participants received surgery immediately, the other half participated in a physical therapy program. By 10 weeks, both groups were seeing benefits, and over the next four months pain decreased and physical function increased. At the two-year mark, the physical therapy group and the surgery group were seeing equal improvements in pain and physical function.
While there were great results for both groups, both also had their shortcomings. About 10% of the physical therapy group saw worsening symptoms and 25% of the surgery group either had a surgery-related infection or had to go in for repeat surgery. As for the 10% who saw worsening symptoms, this number can likely be explained by the fact that a third of the physical therapy group participants only attended half of their prescribed sessions. Another takeaway from the study is that some patients who had been in the physical therapy group chose to later get surgery. And some surgical patients chose to receive physical therapy. These individuals saw the best results.
While there's no hard and fast rule about surgery or physical therapy, many doctors are beginning to see the benefits of opting for physical therapy as a first resort and surgery as a last resort. Generally, surgery will only be required if strong medicine is unable to control pain, there is a loss of bladder and bowel function and control, or the muscles around the upper legs or pelvis become weak. Physical therapy, if started early enough and consistently attended, can prevent the extreme pain and strengthen the spine enough to avoid surgery down the road.
For individuals who lead active lives, a spinal stenosis diagnosis can feel overwhelming. But while there are plenty of factors to take into consideration, the diagnosis is very treatable and manageable. It doesn't have to be the end of your sport hobby or career, much less a hindrance to your daily routine. The best place to start is with your doctor. Ask questions and get answers. Understand how severe your spinal stenosis is and what treatment possibilities you have. After you've discussed these options with your doctor and decided on a treatment plan, feel free to contact us for a consultation. We'd be happy to walk you through the options for your situation.