More than 80 percent of Americans will experience low back pain at some
point in their lives. Most low back pain is acute, or short term, and
lasts a few days to a few weeks. However, about 20 percent of people affected
by acute low back pain develop chronic low back pain.
“One of the most common culprits for this type of pain is spinal
stenosis, a condition caused by degeneration, or wear and tear, of the
back joints. In some cases, this degeneration can lead to pain down one
or both of the legs,” spine surgeon
Dr. Benjamin Bjerke with BoulderCentre for Orthopedics told a crowd of more than 200 people
during a free health lecture held in Boulder.
“Men and women over 50 years old are the most likely to suffer from
spinal stenosis, but it can happen when you’re younger, too. The
good news is there are ways to manage spinal stenosis, and for many patients
that treatment is nonsurgical,” Dr. Bjerke stressed.
What is it?
Spinal stenosis is the narrowing of the spine. “This narrowing puts
abnormal pressure on the spinal cord and nerves traveling through the
spine, causing pain, decreased sensation, and in some cases weakness in
the legs” explained Dr. Bjerke.
Spinal stenosis can affect your neck (cervical stenosis) or lower back
(lumbar stenosis). Lumbar stenosis is the most common form of spinal stenosis.
Lumbar Stenosis Symptoms
According to Dr. Bjerke, the diagnosis of spinal stenosis should be made
by a physician or surgeon.
“If we have an MRI, almost all of us will have abnormalities show
up, including stenosis. It’s your doctor or surgeon’s job
to listen to your symptoms, examine you and determine if your symptoms
are coming from spinal stenosis seen on an MRI,” he said. “When
symptoms do occur, they often start gradually and worsen over time along
with the aging process that caused them.”
Dr. Bjerke said symptoms of lumbar stenosis can include:
- Weakness or numbness in the feet or legs
- Low back pain that is relieved when lying down
- Pain or cramping in one or both legs that worsens with standing for long
periods of time or walking
Symptoms are often relieved with sitting or leaning forward. “We
call it the ‘shopping cart sign.’ Pain is relieved by leaning
forward, as if you were pushing a shopping cart, because the nerves become
unpinched in this position,” Dr. Bjerke remarked.
Other symptoms include:
- Difficulty lifting the front part of the foot (foot drop)
- In severe cases, problems with bowel or bladder incontinence may occur
Conservative Treatment Options Exist
Dr. Bjerke stated that conservative treatment options include:
Time, activity modification - “Give it time to rest and heal on its own. Or, modify activities
temporarily such as walking shorter distances when in pain.”
Maintaining a healthy weight - “Our body weight compresses back joints together, leading to pinching
of nerves. Keeping the weight off will do wonders for your back.”
Physical Therapy - “Physical therapy may include strengthening, balance training
and instruction on proper posture.”
Medications - “They include gabapentin, steroids, and NSAIDs to treat inflammation."
- Epidural spinal injections
Minimally Invasive Surgery
When conservative treatments don’t help or stop working, surgery
can often provide relief.
“There are two general types of surgical techniques for spinal stenosis:
decompression and fusion. All surgery for spinal stenosis involves ‘decompression,’
or removing bone spurs and arthritic portions from around the nerves,”
Dr. Bjerke explained. “In some cases, the spine is unstable, or
may become unstable after the decompression. For these patients, a spinal
fusion is needed to link together two or more vertebrae so that they heal
into a single, solid bone, helping to stabilize the spine.”
Dr. Bjerke often uses minimally invasive techniques for these surgeries,
offering patients smaller incisions, less muscle damage, decreased blood
loss and shorter hospital stays. Dr. Bjerke says that “for many
of my patients, we can perform a decompression through a 22-millimeter
tube in an incision less than an inch.”
He went on to explain laminotomy, a type of minimally invasive decompression
surgery: “The procedure involves carving a small hole in the lamina
– the back part of the affected vertebra – just large enough
to relieve the pressure in a particular spot.”
If you suffer from chronic back and leg pain, schedule a consultation with
Dr. Benjamin Bjerke by calling (303) 449-2730.
Click here to view PowerPoint slides from Dr. Bjerke’s lecture on “New
treatments for low back and leg pain.”
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