Degenerative Lumbar Spinal Stenosis – What You Don’t Know Could Hurt

Anne Abate has learned to live with back pain, but she wasn’t ready for the burning pain that began three years ago, a searing discomfort travelling down her thigh and calf whenever she stood or tried to walk.

“It really impacted my life,” says Abate, a 66 year old Scarborough resident who loves to walk and travel. “I could stand for no more than five minutes and if I tried to walk I would need to find a place to sit down after only walking 10 minutes. The more I tried to walk or stand, the worse the pain became.” After seeing her family doctor who did some tests, she was told she had spinal stenosis and that her buttock and leg pain was coming from her lower back. She tried medication, spinal injections and different therapies but none improved her ability to walk.

Her doctor then referred her to Dr. Carlo Ammendolia at Mount Sinai Hospital who enrolled her into his Boot Camp Program for Spinal Stenosis.

At Mount Sinai, Dr Ammendolia is an Associate Scientist and chiropractor at the Rebecca MacDonald Centre for Arthritis and Autoimmune Diseases and is the Director of the Spinal Stenosis Program.

His research focuses on finding out which treatment is best to improve walking ability, quality of life and reducing the need for surgery for people with spinal stenosis.

Spinal stenosis is a leading cause of pain, disability and loss of independence in people over the age of 65. It is caused by a wear and tear type of arthritis that afflicts the spine. This wear and tear leads to narrowing or stenosis of the spinal canals. Narrowed canals lead to compression of the nerves traveling from the spine to the legs causing pain, numbness, tingling, weakness and limited walking ability. “The older we get the more likely we will suffer from spinal stenosis,” say Dr Ammendolia “and because of the aging population and because we are living longer, the number of people afflicted with spinal stenosis is growing very rapidly.” People with spinal stenosis maintain a more sedentary lifestyle because of limited walking ability and this leads to further weakness and decline in their overall health. Despite its high prevalence and impact on quality of life effective non-surgical treatments for spinal stenosis are unknown.

“There spinal stenosis cartare interesting opportunities to potentially improve walking ability due to the dynamic nature of spinal stenosis,” say Dr Ammendolia. “What this means is that patients’ symptoms change depending on the spinal position.”  People with stenosis usually stoop forward to reduce their pain or when they lean over a shopping cart or walker they tend to have little or no symptoms. This is because leaning forward increases the size of the spinal canals and reduces nerve pressure. There are treatments we can offer to help increase the size of the spinal canals. The boot camp programs developed by Dr. Ammendolia instructs patients on specific exercises aimed at building core strength and spinal flexibility allowing patients to control their symptoms by changing the spinal alignment when standing and walking. As part of the program patients are instructed on riding a stationary bike to build leg strength and endurance. Because patients are leaning forward over the handlebars when cycling they have no leg symptoms.

Ms. Abate rides her stationary bike 30 minutes every day and performs daily exercise routine knowing that her program is for life. “It is a small sacrifice for the ability to keep walking. The Boot Camp program changed my life,” sasy Abate. “I can now walk for more than one hour and I just got back from an amazing vacation in Italy where I walked and walked everywhere”.

Even though Ms Abate experienced relief from this program, we still don’t know which non-surgical treatments are best for patients with stenosis.

Dr Ammendolia has recently received a grant from The Arthritis Society to develop and test other non-operative treatments for spinal stenosis and further refine and test his Boot Camp Programs.

For more information contact his research coordinator Dr. Danielle Southerst at 416 586-4800 ext. 6449.

Guest contributor: Carlo Ammendolia D.C., Ph.D is Assistant Professor, Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto  Associate Scientist/Chiropractor, Rebecca MacDonald Centre for Arthritis & Autoimmune Diseases, Division of Rheumatology, Mount Sinai Hospital Associate Scientist, Institute for Work & Health, Toronto, Canada CCRF Professorship in Spine, Department of Surgery, University of Toronto.