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Spinal stenosis a painful arthritic condition

Jim Calhoun should be on the sidelines of a basketball court, coaching the University of Connecticut men's team. Instead, he's been on medical leave for a painful arthritic condition.

Calhoun's pain is caused by spinal stenosis, a medical condition that causes narrowing of the spinal column and crowding of the nerves and affects about 1 million people in the United States each year. Dr. Lee H. Riley III, chief of the spine division and associate professor of orthopedic surgery at the Johns Hopkins University School of Medicine, tells us about the symptoms of the disease, who typically gets it and how it is treated.


What is spinal stenosis?

Basically, it's a narrowing of the spinal canal that puts pressure on the spinal nerves. The ligamentum flavum and the facet joints form the roof and walls of the spinal canal and the disc forms the floor. Narrowing most frequently occurs from arthritis in the facet joints. The ligamentum flavum thickens and buckles as the facet joints enlarge like arthritic knuckles. The discs also bulge into the canal, compressing the nerves and causing pain and other symptoms in the lower back and legs.


What are the symptoms?

Even though spinal stenosis is caused by arthritis in the back, back pain is not the most common symptom. People with spinal stenosis most often notice pain in the buttocks, along with weakness, numbness or pain in their legs when they stand, walk or try to lie flat. The symptoms generally go away when they sit or bend over because those positions move the arthritic joints away from the nerves, increasing space in the canal.

Who gets it?

People in their 50s can begin to develop symptoms, and the numbers increase with age. A few individuals are born with small spinal canals and can develop symptoms at a younger age and with less severe arthritic changes.

How is it diagnosed?

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Spinal stenosis is most commonly diagnosed by its telltale symptoms and reports of less pain when sitting or bending forward. An MRI or CT scan can confirm the diagnosis by showing narrowing of the spinal canal.

Is surgery necessary?

Treatment with nonsteroidal anti-inflammatory medications like naproxen and ibuprofen to reduce pain and inflammation, and physical therapy, are the mainstays of nonoperative treatment. Physical therapy involves back exercises designed to strengthen the back and abdominal muscles and that can be done lying on the back, sitting in a chair or on a Swiss ball. Exercises in which the back is neutral or bending forward are best, because leaning backward often causes symptoms. Aerobic conditioning with a stationary bike followed by a gradual walking regimen is also useful. In some cases, steroids can be injected by a physician in the spinal canal in the epidural space, providing short- or long-term relief.


What is the surgical treatment?

Surgery for spinal stenosis involves making more space in the canal by removing the arthritis accumulation. This frequently involves an operation called a laminectomy, in which the roof over the canal and the underlying arthritis is removed. In some instances, a fusion, which entails growing adjacent vertebrae together with bone graft, is also performed. This is done when there is malalignment of the spine, excessive motion of the spine, or back pain originating from the area where the laminectomy is performed. Screws and rods may be used to help achieve a fusion. Surgery should be considered when standing, walking or lying flat and sleeping is so limited by spinal stenosis that it significantly interferes with a person's quality of life. The surgery stands an excellent chance of reducing the symptoms and improving a person's ability to stand, walk and sleep without pain or weakness. Rarely, bowel and bladder control can be affected by stenosis. In those cases, surgery is indicated to prevent further loss of function.