Spinal Stenosis: What is Spinal Stenosis?
Guest: Dr. John Glaser – Orthopedic Surgery
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. John Glaser, who is Professor of Orthopedic Surgery and one of our spinal specialists here, at the Medical University of South Carolina. Dr. Glaser, a term that one hears, not infrequently, is spinal stenosis. What, exactly, is spinal stenosis?
Dr. John Glaser: Spinal stenosis, generally, means a narrowing of the area for the nerves in the spine. The spinal canal is where your spinal cord and your spinal nerves run. And the most common reason for spinal stenosis is wear and tear or aging. When a disc ages, it bulges. And after it bulges, it isn’t as mechanically sound as it used to be, so it allows for some stress transfer to the joints in the back of the spine and they become arthritic. The combination of those things will squeeze down on the nerves of the spine and give you spinal stenosis.
Dr. Linda Austin: What are the symptoms of spinal stenosis?
Dr. John Glaser: The classic symptom of spinal stenosis is someone is quite comfortable when they’re sitting down or lying, but when they walk, particularly in the upright position, they’ll get increasing pain in their back and often down their legs. If they lean forward, it often feels better. And if they sit down, it will improve rather quickly, within a few minutes.
Dr. Linda Austin: So, is this a sharp pain or an ache? How would you describe the feeling?
Dr. John Glaser: Most people describe it as an ache that gets progressively worse if they remain upright or doing what irritates it.
Dr. Linda Austin: What’s the treatment for spinal stenosis?
Dr. John Glaser: There are a lot of different things that people have recommended for spinal stenosis. One treatment is to modify your activities, because, for some reason, it seems the body can accommodate to the problem at times, and sometimes you just need to wait it out and things may improve. The stenosis, however, never really gets better. If you were to do an MRI, for instance, your stenosis wouldn’t look better, but some people feel better. So, time can be in favor of you, occasionally medication. Some people, with some simple ibuprofen or Tylenol can get some improvement.
We, often, will try some injections into the spine. This is one of the more common areas where we do injection treatments, generally some steroid. And that, in theory, will bathe the nerves in some steroid. When a nerve gets pinched, it also gets inflamed and swells up. I think of it like putting on a ring that’s a little too small; your finger will also swell. If you can get the swelling down, sometimes your nerves can tolerate the area. And, if all else fails, the final treatment is often a surgical procedure.
Dr. Linda Austin: And, what does that surgical procedure consist of?
Dr. John Glaser: Well, there are three things that are considered for spinal stenosis. The primary thing you want to do is give the nerve some more room, or decompress the nerves. The standard operation that is most commonly done is a decompression or a laminectomy. There are a number of names for it, but taking away enough bone and other tissue to give the nerves some room. And you do that at as many levels as you need to. You occasionally need to add a spine fusion to that if there is severe deformity or severe degeneration.
One of the newer things that have come out recently is what we call an interspinous spacer, which mimics the idea that if someone one bends forward, they often have enough room in their spine. So, and interspinous spacer is put in from the back. And it truly is just a little space between the spinous processes, or the bones in the back of the spine at that area where the problem is, to open up the area for the nerves.
Dr. Linda Austin: How successful is that surgery?
Dr. John Glaser: It gives many people some benefit. If you look very closely at the numbers, it is not 100 percent successful. It’s probably closer to 50/50 to 2 out of 3 in terms of success, but it is a much smaller procedure. It’s basically no blood loss and, occasionally, an outpatient or overnight in the hospital. So, at times, I think, it can be worth a try, because if you’re one of the people that benefits from it, you’ve gotten away with a much smaller operation.
Dr. Linda Austin: How about if it goes untreated, is this potentially serious?
Dr. John Glaser: Generally, most people who are not treated for this are still able to function and still able to get up and walk. It is very uncommon that someone ends up, for instance, in a wheelchair or unable to walk. But it is rather common for it to get worse over the years. So, if you follow people long enough, there’s a reasonable chance that they will be less functional than they were when you first saw them. But, it’s not something that you have to operate on right away. People don’t wake up paralyzed or anything like that.
Dr. Linda Austin: Dr. Glaser, thank you very much.
Dr. John Glaser: Thank you.
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