If you have back pain, you are in the majority. Estimates vary, but approximately 60 to 80 percent of us will get at least mild back pain at some time in our lives. In 2007 alone, about 27 million U.S. adults age 18 or older (11 percent of the total adult population) reported having back pain, according to the Agency for Healthcare Research and Quality. About 70 percent of these people, or 19.1 million, sought treatment by a doctor, the agency says. It also says that more women (10.9 million) received medical treatment for their back pain than did men (8.2 million).
Surgery for low back pain caused by spinal stenosis (a narrowing of the central spinal canal) varies depending on where in the United States you live, according to a 2014 report. In spinal stenosis, thickening of tissues such as ligaments, degeneration of intervertebral discs and arthritic growth or spurring around, near or in the spinal canal can compress the spinal nerve roots and/or the spinal cord, resulting in a variety of pain patterns.
Treatments for spinal stenosis can be separated into symptom relief, functional restoration and direct remedy. Medication, physical therapy, chiropractic, acupuncture, massage and steroid injections are considered symptom reducers. Their goal is to reduce pain, numbness or tingling. Physical therapy can also help improve function through strengthening the back and legs. Surgery is considered a direct remedy because it is directed at actually reducing the amount of structural narrowing and attempting to restore normal spinal canal diameter and volume.
The two most common types of surgery for spinal stenosis are spinal decompression and spinal fusion. Spinal decompression surgery will remove any tissue compressing the spinal nerves, such as thickened ligaments, tendons or bone growth from arthritic degeneration. Spinal fusion will join two or more vertebrae to stabilize the spine, typically in addition to the decompression. Spinal fusion is necessary when the spinal segments in question have become unstable and the instability is contributing to the patient’s symptom pattern.
Spinal fusion has a higher risk of infection and readmission to the hospital, and there is no evidence that it provides greater benefit to patients. Regardless, its use increased 67 percent among Medicare patients from 2001 to 2011, and it is now more common than spinal decompression, according to a recent study.
A recent analysis of Medicare data revealed that rates of spinal decompression varied eightfold across the United States, from about 25 procedures per 100,000 patients in the Bronx to nearly 217 procedures per 100,000 patients in Mason City, Iowa. Generally speaking, rates of spinal decompression were highest in the Pacific Northwest and northern mountain states.
Rates of spinal fusion varied more than 14-fold nationally, from about nine spinal fusions per 100,000 patients in Bangor, Maine, to approximately 127 fusions per 100,000 patients in Bradenton, Florida, according to the Dartmouth Atlas Project report.
Not everyone with evidence of spinal stenosis on advanced imaging tests such as an MRI or CT scan will have symptoms. When symptoms do occur, they often start gradually and progressively worsen over the course of time. Symptoms can vary depending on the location of the stenosis, how many levels have been affected, and which nerves have been compromised. Numbness or tingling can occur in the feet or legs. Over time, weakness can develop in the legs, creating balance difficulty. Pain or cramping in one or both legs may occur with standing for long periods of time or with walking. Most patients with longstanding degenerative spinal stenosis assume the classic posture of being flexed or bent forward. This is usually the most comfortable position for patients with degenerative spinal stenosis. Being in this position will typically ease any lower back pain or leg symptoms. It is commonly referred to as flexion antalgia.
Patients who display the symptom pattern described above will have signs of degenerative disc disease and degenerative joint disease on plain X-rays. Stenosis itself is not diagnosed on X-ray. If the patient does not respond to conservative (non-operative) treatment, then an MRI is usually performed. An MRI will allow your health care providers to visualize the diameter of the spinal canal and make a definitive diagnosis of spinal stenosis. If you have an MRI that reveals degenerative spinal stenosis and you have the corresponding symptom pattern, it is a good idea to speak to your current health care provider about a neurosurgical consultation.
As we age, our spines will degenerate and a large portion of the population will develop degenerative spinal stenosis. Maintaining a healthy weight, an anti-inflammatory diet such as a paleo diet, and exercising with a combination of resistance training and weight-bearing aerobic exercise is the best way to reduce the likelihood of developing degenerative spinal disease. Of course, the X-factor will be your genetic makeup and DNA structure given to you by your parents.
Dr. Dale Buchberger is a licensed chiropractor, physical therapist, certified strength and conditioning specialist, and a diplomate of the American Chiropractic Board of Sports Physicians, with 30 years of clinical sports injury experience. He can be contacted at (315) 515-3117 or activeptsolutions.com or shouldermadesimple.com.