Spinal Stenosis Might Require Surgery for Pain Relief

Q:  I am a 75-year-old woman in generally good health and have for the last several months been limited in how far I can walk due to significant leg pain. After a series of tests including an MRI of my lower back, I have been told that I have a condition called spinal stenosis and that I may need surgery to keep the problem from getting worse. I’m just a little bit shocked by all this and would like to know a more about what I am facing.

A:  The kind of pain you describe is classic for spinal stenosis due to pressure on the lower part of your spinal cord. To visualize this, imagine that your spine is a bit like a gooseneck lamp, with your spinal cord corresponding to the wire running through it. Due to conditions including arthritis and bone deposits, the spinal cord becomes squeezed, and as a consequence the nerves become swollen and irritated by movement. That pain is then transmitted along the backs of both legs and made worse by more activity and movement.

This disorder is most common in people over 50 years of age, although, it may occur in younger people who are born with a narrowing of the spinal canal or who suffer an injury to the spine. It most often results from a gradual, degenerative aging process that begins with either structural changes or inflammation. As people age, the ligaments of the spine may thicken and harden from calcium deposits. Bones and joints may also enlarge causing formation of bone spurs. When the health of one part of the spine fails, it usually places increased stress on other parts of the spine.

Treatment can begin with injections of a steroid into the area around the spinal cord to decrease the amount of swelling and pain, but this may only offer temporary assistance. Often, the only solution is a surgical procedure to decompress or take pressure off the spinal cord. This can destabilize the spine, requiring bone grafting and the addition of metal support structures to facilitate healing and return to less painful functioning and stability. This is a major operation that can take several hours and require several days in the hospital followed by a week in a rehabilitation facility.

This pain can sometimes be mistaken for the pain caused by poor circulation in one’s legs. Regardless, ignoring this pain will not make it go away and doing so can cause permanent damage that will not heal if the surgery is indicated and done too late. See your doctor soon if this is what you have, be specific about the pain and how it affects your functioning, and discuss the next steps you should take.

For more information on this topic, see the HealthLink article Chronic Pain Can Steal Sleep, Work and Pleasure.

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