Hi, my name is Bernie. Like most of you, I have suffered from low back pain on and off, but more recently I have developed pain down my legs whenever I walk or stand for longer than a few minutes. In fact the more I try to walk, the more my legs ache and I just have to sit down. Amazingly, within a few minutes my leg feel normal again and off I go. I tell you, having to live my life 5-10 minutes at a time is not how I envisioned my retirement!
If Bernie’s story sounds familiar, you or someone you know may be suffering from spinal stenosis (SS) of the low back. SS is caused by narrowing of the spinal canal (the area where our nerves pass through the spine on the way to the arms and legs) due to arthritis of the spine. As we age, everyone will develop spinal stenosis, however, as the degree of narrowing is variable from one person to the next, not everyone will get symptoms. For individuals with leg symptoms, when we are upright (standing or walking) the spinal canal partially closes and puts pressure on the nerves to one or both legs. When we sit or bend forward the canal opens and relieves the pressure on the nerves. The medical term for this is neurogenic claudication (NC). In addition to pain, other symptoms such numbness and or weakness of legs can occur.
The diagnosis of NC is typically made by the nature of the symptoms and is confirmed by imaging such as a CT or MRI scan. NC affects 1 in 5 of adults over the age of 65 and is the most frequent reason for spinal surgery in this population. NC is not immediately dangerous, but like arthritis elsewhere it can significantly impact your quality of life, and independence. Approximately half of individuals with NC can adequately manage their symptoms by simple exercises and activity modification.
Unfortunately, due to the structural nature of this problem, once symptoms become significant, it typically means the space for the nerve(s) has essentially run out and medication, exercises, injections or other available treatments that cannot permanently open the space for the nerves are ineffective. As such, the other half who don’t respond to these first line treatments, face a challenging decision, live with it (i.e. spend a lot of time sitting) or consider surgery.
The thought of spinal surgery is a frightening one, to say the least, however, there have been tremendous improvements in specialization and surgical techniques for the management of NC that are much less invasive and safer then traditional spine surgery. However, the general perception of the public and of a variety of health professionals seems to be that those over 65-70 are too old for spinal surgery. In short, this is not the case. Research has recently shown that spine surgery, for majority of individuals (most in their mid to late 70’s) with NC is as safe and effective as joint replacement for hip and knee arthritis.
If you suffer from NC, it may be worth your while to talk to a spine surgeon or at the least discuss this article with your family doctor. We will almost always recommend non-surgical treatment first and if it doesn’t work, the decision for surgery will always be yours to make, just make sure that it is an appropriately informed one!
For more information on NC / spinal stenosis visit www.backcarecanada.ca, a patient centered website that has been created by a multidisciplinary team of back experts to provide reliable information to Canadians suffer from spinal conditions.
Y. Raja Rampersaud MD, FRCSC
Divisions of Orthopaedic and Neurosurgery,
Spinal Program, Toronto Western Hospital,
University Health Network,
University of Toronto