Spinal Stenosis- The burden of the aging spine, survey results

In my last column “Spinal Stenosis: The burden of the aging spine!” I discussed a common spinal condition, termed spinal stenosis.  It typically causes pain, numbness and /or weakness (often associated with back pain) that occurs with standing or walking and improves with sitting or bending forward (know as neurogenic claudication). In this article, I discuss the key results of the associated survey on this topic. I would like to thank the 3651 of you who completed the survey. The overall results were as follows: Sixty-one percent of those who responded reported having some degree of back and / or leg symptoms. Of these individuals (i.e. those with spine related symptoms), 40% reported that these symptoms affected their quality of life (QoL) quite a bit or a great deal. Seventy two percent of those with symptoms saw a doctor about their symptoms. Interestingly, of the group that did not see a doctor, 37% reported that the symptoms significantly affected their QoL. This finding maybe due to a variety of reasons, such as poor access to a health care provider or a feeling from the individual that nothing can be done about it, so why bother (i.e. it is just a part of aging). Regardless of the cause, this finding is concerning given the potential number of individuals affected will only continue to rise as our population ages.

If we specifically focus on individuals with a probable diagnosis of symptomatic spinal stenosis (combination of those with back and leg symptoms or leg symptoms only), 37% of respondents met this criteria. A specific diagnosis of spinal stenosis would require confirmation by clinical assessment and spine imaging, therefore the number of individual with spinal stenosis from this survey is likely less than 37%.  However, this number supports previous research reporting that this condition may affect 1 in 5 individuals over the age of 65 and suggest that it may even be more common. Within this probable spinal stenosis group, 50% reported that their symptoms significantly affected their QoL. In this group (37% of respondents), 80% saw a physician and 20% were told that surgery was a possible option in their case, 25% were told that nothing could be done, and a minority (1%) were told that they were too old for surgery. Further, in this group 23% responded that they would not consider surgery, however, 89% of these individuals were told that surgery was not an option. As such their opinion towards surgical treatment may have been significantly influenced by the information provided by their physician. This finding is an important one to consider. As noted in the original spinal stenosis article, surgical intervention for appropriately chosen individuals (those failing a trial of conservative treatment and symptoms that are considered significant by the individual) is successful in restoring QoL for the majority.

The results of this survey are in keeping with what I have suspected for many years.  I regularly see individuals in my clinic suffering from symptoms of spinal stenosis who have been told that nothing can be done or nothing should be done.  However, in the era of easy access to information, I am surprised that the number (25%) from this survey is so high.  Given the significant impact that this condition has on the quality of life of approximately half of those who have it, I am also very concerned by this finding.  These results would suggest that significant educational opportunities exist at both the public and healthcare provider level.  As I noted in the initial article, surgery for this condition, like arthritis of the hip or knee, is the choice of the individual and obviously needs to be carefully considered.  However, like any major life decision, obtaining the right information at the right time, is critical to making the right decision. I would hate to think that a significant portion of you are suffering because you have been told or personally believe nothing can be done.

If you are an individual that suffers from spinal stenosis symptoms and believe nothing can be done, there is a high likelihood that you are suffering unnecessarily.  More then half of you are possible candidates for treatment that will make it easier to stand or walk, rather then looking for a place to sit down every 5 minutes.  Untreated, these symptoms can often cause a loss of independence and  reduction or elimination of your favourite actives,  please ensure you get the right information, it is easier then you think.  For more information on 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 suffering from spinal conditions.

Y. Raja Rampersaud MD, FRCSC
Associate Professor,
Divisions of Orthopaedic and Neurosurgery,
Spinal Program, Toronto Western Hospital,
University Health Network,
University of Toronto