Spinal Stenosis is a debilitating disease affecting many elderly Americans. The primary cause is osteoarthritis of the spine, which is common with aging. Spinal stenosis may also be seen in patients having had prior spinal surgery. Spinal stenosis may occur in the cervical, thoracic, or lumbar spine.
The vertebra of the spine interact in the so called "triple joint complex" which consists of the disc and two facet joints. Osteoarthritis causes the facet joints to degenerate and the surface lining these joints to enlarge and become inflamed. This is a reaction to constant friction and destructive wear and tear. These joints eventually become eroded and cause back or neck pain. At the same time, the disc may herniate or degenerate. All this leads to a narrowing of the canal in which the spinal cord and nerve roots lie. As the canal narrows, there is pressure on these nerves and this leads to back and leg pain.
Spinal Stenosis causes pain on walking or prolonged standing. There is significant back and leg pain. The leg pain is often described as burning, shooting, stabbing and is relieved with rest. Patients often find leaning forward on a shopping cart or walking uphill alleviates the pain. Spinal stenosis can be so severe as to cause profound weakness and inability to walk, thus requiring back surgery.
Treatment usually consists of physical therapy, medical therapy and spinal nerve blocks. Epidural in jections are an effective treatment for spinal stenosis. This involves placing a small amount of steroid into the epidural space which bathes the nerves and disc. Steroids are the most potent anti-inflammatory agents known and they act by reducing the pressure on these nerves, thus relieving pain. The facet joints may also be injected with steroids for the same purpose