PAIN MANAGEMENT
Dr. Stan Golovac
BACK PAIN is one of the most common complaints that I see and treat. Nearly four out of five people will experience back pain at some time in their life. One of the many causes of back pain is lumbar spinal stenosis.
What is lumbar spinal canal stenosis (LSCS)?
The lumbar spinal canal is the space in the lower spine that carries nerves to your legs. It is very narrow and gets even narrower if the bone and tissue around it grow over the course of many years. This narrowing is called “stenosis.”
THE LUMBAR SPINAL CANAL is the space in the lower spine that carries nerves to your legs. It is very narrow and gets even narrower if the bone and tissue around it grow over the course of many years. This narrowing is called “stenosis.” Lumbar stenosis is usually a disease of the middle-aged and the elderly.
What causes LSCS?
Narrowing of the lumbar canal has many potential causes, but for practical purposes, the causes of lumbar stenosis can be divided into congenital or acquired forms. Few causes of lumbar stenosis are truly congenital.
Narrowed or “shallow” lumbar canals may result from congenital anatomic changes, especially if additional elements such as herniated intervertebral discs or other space-occupying lesions further narrow the canal and contribute to the compression.
Arthritis, falls, accidents, and wear and tear on the spine’s bones and joints are all examples of acquired causes that may contribute to lumbar spinal canal stenosis.
What are the symptoms?
As the lumbar spinal canal narrows, the nerves that go through it are squeezed. This squeezing may cause back pain, leg pain, weakness and numbness.
Leg symptoms may also manifest as cramping and/or fatigue. Symptoms usually start with standing or walking, and may improve with sitting, crouching, or laying in the fetal position (on your side with your knees tucked up to your chest). It’s thought that these positions “open” the lumbar spinal canal and take the pressure off the nerves that go to the legs.
Disease onset is usually insidious, and symptom severity does not always correlate with the degree of lumbar canal narrowing. In severe cases, stenosis can also cause partial or complete bowel or bladder incontinence.
Who does it affect?
Men are affected with slightly higher frequency than women. Although symptomatic lumbar stenosis is usually a disease of the middle-aged and the elderly, younger patients may also be affected.
How is it diagnosed?
Although your doctor can probably determine if you have stenosis by asking about your symptoms and performing a physical examination, special tests and X-rays on the spine are sometimes necessary to make and confirm the diagnosis. These include plain films, computed tomographic (CT) scanning, and magnetic resonance imaging (MRI).
What can I do to relieve the pain and numbness?
If you have lumbar spinal canal stenosis, your treatment will depend on the extent of your symptoms. If your pain is mild and you haven’t had it long, you can try an exercise or physical therapy program. This can strengthen your back muscles and improve your posture. Your doctor may also prescribe medicine to help reduce inflammation (soreness and swelling) in your spine.
If you have more severe symptoms, you may need to see a spine surgeon. The surgeon may recommend surgery which takes the pressure off the nerves in your lower spine. Relieving the stenosis surgically is highly effective in most cases.
CONSERVATIVE TREATMENT for lumbar stenosis includes lumbar bracing, bed rest, physical therapy, and pain management.
Is it the same as a ruptured disk?
Lumbar spinal canal stenosis is not the same as a ruptured disk. A ruptured or “herniated” disk usually pinches one or two nerves at a time. Called sciatica, the pain caused by a ruptured disk in the lumbar spine is usually easy to diagnose. Sciatica generally causes back pain that shoots down one leg. This pain can happen any time, not just when you stand up or start walking as it does with stenosis.
Nonsurgical treatment
Conservative treatment for lumbar stenosis includes lumbar bracing, bed rest, physical therapy, and pain management. Pain management includes the use of epidural steroids that allow the canal to be relieved of the inflammation caused by the clinical condition.
Unless debilitating medical conditions prohibit surgery under general anesthesia, medical or nonsurgical management of lumbar stenosis is not a practical option if symptoms are incapacitating. Nonsurgical management of this condition may be attempted initially in patients with mild symptoms of short duration.
Morbidly obese patients with symptoms may improve following a weight loss program. Back strengthening exercises, strict physical therapy regimens, and symptomatic management with nonsteroidal analgesics also may benefit some patients initially but, in contrast to patients with herniated intervertebral discs (who often respond favorably to nonsurgical management), patients with lumbar stenosis often show no improvement on long-term follow-up.
Their symptoms rapidly return with the resumption of activity. Because many patients are severely limited by pain, early surgery is the best way to return them to full activity and independent living.
Surgical Treatment
Because most patients who develop lumbar stenosis are middle-aged or elderly, it is important to determine their relative surgical risks. Although decompressive lumbar laminectomy can be an extensive procedure, most patients, even the elderly, are medically capable of tolerating the procedure.
In general, these patients are severely disabled by their symptoms and usually willing to accept a small degree of risk to obtain relief. Anticoagulation therapy or severe cardiac or respiratory disease may be contraindications to surgery.
Stanley Golovac, MD is the co-director of Space Coast Pain Institutue. Dr. Golovac completed his education at UTESA University in 1985, where he received his Doctor of Medicine. Upon graduation, Dr. Golovac completed his postgraduate training in Family Practice Residency Program at St. Mary Hospital in New Jersey and in the Department of Anesthesiology at Jackson Memorial Hospital in Miami. Dr. Golovac gained extensive clinical experience in anesthesiology, emergency room medicine, and alternative services. He served as Assistant Clinical Professor of Anesthesia at the University of Miami Jackson Memorial Center for several years, and then as a practicing Pain Consultant in the Miami area. He currently utilizes his expertise at Cape Canaveral Hospital/Health First Pain Management and the Space Coast Surgery Center of Pain Management. For more information log on to YourPainInstitute.com
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