The Aging Spine and Spinal Stenosis
By Marge Dwyer
Beth Israel Deaconess Medical Center Correspondent
When Dr. Andrew P. White sees an older person in a store leaning on a shopping cart as they shop, he knows there's a good chance the shopper has spinal stenosis.
With America's aging population, Dr. White is seeing an increasing number of people with this condition in the spine surgery service in the Carl J. Shapiro Department of Orthopaedics at Beth Israel Deaconess Medical Center in Boston.
"Many people with spinal stenosis find it feels better to lean forward onto a shopping cart in a store or to sit down. Leaning forward stretches open the spine to relieve some of the stenosis. Leaning back or standing hurts because the spine is compressed," explains Dr. White.
What is spinal stenosis? It's when one or more parts of your spine narrow, compressing the spinal cord or the nerves within the spinal canal. The cause usually is problematic bone and ligament growth within the spinal canal triggered by osteoarthritis, the wear-and-tear form of arthritis that often accompanies aging. Other causes include disc problems, including herniated or slipped discs (when a disc protrudes into the spinal canal), lack of flexibility in the spine, tumors and injuries.
While some people have mild symptoms, others have debilitating symptoms that affect everyday life. Usually symptoms begin gradually and worsen with time. The main symptom is leg pain or cramping when you walk or stand for a period of time. Sometimes the discomfort is worse when walking uphill or standing. In other cases the pain is worse when you walk down a hill but improves when you sit. Symptoms also can include numbness in the feet, pain in the back, shoulders, neck or arms and incontinence. "It can be really disabling. People walk shorter and shorter distances until they can hardly walk at all," Dr. White says.
Most of Dr. White's patients with the condition are in their 60s and older, though it can occur at a younger age if you have a small spine, certain congenital abnormalities, or conditions like dwarfism.
"Getting aches and pains from wear and tear on the joints is like getting gray hair and wrinkles," Dr. White says. "The only way to rid oneself of osteoarthritis is to turn back the clock." You also can protect your spine by exercising regularly, maintaining good posture, picking up heavy items correctly, making sure your back is properly supported when you sleep, and watching your weight.
Baby Boomers represent a large number of his patients. "Baby Boomers want to do sports, hike, and take long, active vacations. The demand for spinal stenosis treatment is going up because the Boomers want to stay active," he says.
Spinal stenosis happens gradually. "It creeps up on you," Dr. White says.
That's what happened to David Ganz, 75, of Belmont, MA. The semi-retired tire company executive had back problems due to spinal stenosis for 40 years. Over the years he had undergone two unsuccessful disc operations and received several steroid injections in the spine to manage the pain.
More than a year ago, Ganz began experiencing severe ankle pain after getting out bed in the morning. Once he got moving, however, things seemed fine. Over time, the pain became worse and involved his other ankle and lower leg. This past April the pain was so severe that he could barely walk. "I had severe pain just standing up," he recalls. The grandfather of five made an appointment with Dr. White hoping he could help. Among the nonsurgical treatment methods Dr. White discussed were:
Nonsteroidal anti-inflammatory drugs (NSAIDs) and other pain medications: These can be helpful if symptoms are mild.
Physical therapy: Exercises and stretches strengthen muscles and ligaments to open the space for the nerves to go through the spinal canal.
Steroid injections: Epidural steroid injections help many patients for whom exercise is not enough. "These are especially helpful for patients whose symptoms come and go," Dr. White says.
Back braces: These can help support the spine.
Rest: Sometimes this will do the trick.
In Ganz's particular case, however, the choice was between physical therapy and surgery. Wanting to avoid surgery, he opted for physical therapy first. When that didn't produce results he wanted, he decided on surgery. "I made up my mind and called Dr. White and asked him to do the operation," he says. "I was so impressed with Dr. White. He was very comforting, reassuring, and even encouraged me to get a second opinion."
For patients like Ganz, who continue to get worse, surgery may be an option to decompress the spinal nerves and relieve the pressure. Fortunately there are a number of procedures, including newer, less invasive procedures. Less invasive surgeries can be done if the narrowing is in particular areas of the spine-not spread throughout. These newer options involve smaller incisions, sometimes working through a tube that is inserted into the spinal column. "These smaller procedure promise a quicker recovery but they are not for everyone," Dr. White says.
Surgical options include:
Decompressive laminectomy: This is one of the more common procedures, generally done as an open surgery. Bone covering the spinal canal is removed to create more space for the nerves and permit access for other spine repairs. Sometimes this is done through minimally invasive tubes and with a small incision.
Fusion: When the surgeon joins two or more vertebrae in the spine using pieces of bone usually from other bones in your body. Bone screws and rods may be used to restore stability and aid in the healing of the bone fusion.
Inter-spinous process implant: One of the newest methods uses an inter-spinous process device. This metal device fits between the spinous process bones in the lower back to give the nerves more space.
"These procedures help people get their lives back," Dr. White says.
This past August, Dr. White operated on Ganz. It had to be a traditional open spine surgery in his case. "After the surgery when I was in the recovery room, I said to my wife Judith, 'I feel great. Let's take a walk,'" says Ganz. "The next day I took a walk and had no pain. And I haven't had a twinge of pain since. It was a 100 percent successful. I'm feeling great."
While some patients have longer recovery times, Ganz hardly missed a beat since his operation. He's traveled to Virginia on business, regularly goes into work and does gardening. "I'm going to play golf. I'm going on an extended overseas trip and keep doing 100 push ups a day."
To schedule a consultation with the specialists at Beth Israel Deaconess Medical Center's Spine Center, call 617-667-8900.
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.