The term spinal stenosis simply means narrowing of the spinal canal or Spinal Motorway. As discussed earlier, the spine is the superhighway, and any blockage of this channel will cause problems further down the carriageway. If the blockage is in the upper or middle spine, it causes myelopathy; whereas, in the lower lumbar spine it causes claudication leg pain.
The most common cause is thought to be age-related changes. Wear and tear related disc bulge along with arthritis of the facet joint (Roof Tiles) narrows the motorway for the traffic to pass through causing neurogenic claudication.
Lumbar stenosis illustrated on MRI ; The normal appearance of the motorway (outlined in blue) along with the travelling cars / nerve (outlined in yellow) is compared stenotic or occluded motorway (outlined in red).
The classical symptoms are of lower leg pain on walking or prolonged standing, and relieved by sitting or bending forward, such as leaning on a shopping trolley. You may experience tingling, heaviness, tiredness and numbness or weakness of the legs.
These symptoms may affect both your quality of life as well as limit your activity of daily living. Simple day-to-day activities such as walking and taking dogs for a walk get difficult as time goes on. It is important to be assessed, as other non-spinal conditions such as blood supply to the leg, peripheral nerve cause (“B” Roads)(Read Spinal Motorways) and referred pain can also present similarly.
I am often asked “What will happen if nothing is done?”
I think it is a very valid and important question, and both doctors and patients need to understand the natural course of any condition before embarking on treating it. It is believed that half of patients will remain the same and a quarter will get worse. Interestingly, the rest do improve and will not need any major intervention. The decision for a patient getting worse is simple, as they cannot carry on and something needs to be done.However, the quandary lies in the status quo patients, and how we manage their symptoms. I strongly believe in patient-oriented care and a very clear discussion regarding their needs, expectation and goal has to be carried out.
Once an informed decision has been made, a further management plan can be drawn up to achieve the desired goal. The options can be broadly divided into non-operative and operative. The non-operative approaches consist of physiotherapy, yoga, appropriate painkillers and alternative medicine, like acupuncture. The operative measures include epidural injections and decompression surgery.
Secondly, you may ask “Is fusion surgery needed?”
It is thought that about one in five will need further surgery, including fusion, which is a more complex operation compared to simple decompression. A decision of going along the lines of fusion surgery needs to be weighed against its potential risk and complications. However, at times it is not as simple as it sounds, and we have to take multiple factors in account to make these decisions. These discussions are part of the pre-operative planning and must be understood prior to going through any surgical intervention.