A healthy spine is essential to a healthy life.. Approximately 80% of the population experiences spinal pain at some point in their lives. People who are overweight or obese, people who smoke and/or lift heavy objects and people who have suffered injuries to their spine are more likely to experience back pain that requires medical attention.

Our spine specialists will help to keep your spine healthy. By following simple routines associated with posture, lifting, and maintaining a healthy lifestyle you can help keep yourself and your back in good shape.

Below are seven suggestions for protecting your spine when undertaking everyday tasks:

TIPS TO KEEP YOUR SPINE HEALTHY

As a part of normal aging, the spine can develop arthritis. The discs lose their water content and begin to collapse, bone spurs form, and the ligaments around the joints of the spine begin to thicken. After age 50, these slowly growing bone spurs and thickened ligaments may begin to narrow the spinal canal and compress nerves. The result is slowly worsening pain into the buttocks, hips, thighs, and legs. Walking and standing are often worse than sitting. Feet or legs can become numb or tingle. Walking distances becomes more difficult as the legs begin to "feel heavy." Often, patients find themselves standing or walking in a stooped forward position in order to ease the pain. This process of spinal nerve compression is called spinal stenosis. Back pain may or may not be present. Over time, if signs and symptoms of spinal stenosis are ignored, bowel and bladder control can be lost.

Nonoperative Treatment of Spinal Stenosis

Unfortunately, conservative care has not been very effective at providing lasting relief from pain caused by spinal stenosis or pinching of the spinal nerves. Early stenosis can be treated with arthritis medications with some success. Steroids pills or steroid injection into the spinal canal (epidural) can provide some improvement in symptoms if the nerves are not too badly pinched. However, the effect of the steroids usually wears off within several days, weeks, or months and the pain returns. Other treatment methods such as wearing a back brace, physical therapy, or spinal manipulation (Chiropractic) have not been shown to provide any lasting improvement when significant nerve compression is present.>

Spinal stenosis most often requires surgery to decompress nerve roots and alleviate the pressure caused by the overly narrowed spinal canal. The surgery is called Laminectomy and is commonly done by spine surgeons all over the country.

As with all surgery, a patient's decision to proceed is a very personal one. Surgery for this condition is usually elective in that it can wait until the patient decides it is time to get rid of the pain. A decision to avoid surgery is a decision to live with the symptoms a while longer. The only time surgery cannot wait is if significant leg weakness is present or if bowel or bladder control is lost.>

 The risk of infection is 1-2%. If the incision becomes infected, an additional trip to the operating room is usually required to wash out the infection. Antibiotics are required, sometimes through a vein.

If nerves have been compressed for an extended time, return of function and relief of pain may not be as complete as hoped for. There is also a risk (less than 5%) that new numbness or weakness could occur. If this happens, it usually improves on its own.

There is a risk that the fluid filled sack (dura), which surrounds the nerve roots, can adhere to the surrounding bone and ligaments being removed. If the dural sack is torn, it must be repaired during surgery. Rarely, an additional operation is required to repair a dural tear that hasn't healed.

In some patients, adequate decompression of the pinched nerve roots requires removing some of the bone that contributes to spine stability. Fusion of the unstable segment would then be required to restore spinal stability and relieve back pain. Other risks not listed here are even more rare and are not therefore listed. There are also medical risks as with any major surgical procedure.>

Surgical Procedure (Laminectomy) for correcting spinal stenosis

Patients enter the hospital the morning of surgery. The surgical procedure involves an incision along the spine and back muscles moved aside (not cut). Decompressing nerves involves removing arthritic bone spurs and thickened ligaments, which pinch nerve roots and cause pain. This can take 1-4 hours depending on the severity. If fusion is required to establish spinal stability, this may involve removing some of the thick bone on the back of the pelvis and placing it along the side of the spine. Spinal instrumentation (rods and screws) is usually required to promote successful fusion. The incision is closed with self-dissolvable sutures covered with steri-strip tape. There are no staples or stitches that need to be removed later.>

Usually patients are up walking a day after surgery. Most people are ready to go home after 1 - 2 days depending on how quickly they become independent. When additional physical therapy is needed, a therapist can visit patients at home. Sometimes a short-term stay at a rehabilitation facility is required in order to obtain additional therapy and nursing care.>

Pain: Relief of leg and buttock pain is often immediate and can continue to improve for several weeks to months. By 4-6 weeks, the incision pain is mostly gone. Patients may return back to work around that time. A back and abdominal strengthening program is started in physical therapy at 3 - 4 weeks.>

 Walking and swimming are excellent and can be resumed any time after week 3. Sitting is not usually a problem. Bending and lifting more than 10 pounds should be avoided until physical therapy can strengthen the back (starting week 4-6).>

 Before driving can safely be resumed (1 - 4 weeks), a practice session in a parking lot is needed to be certain that the patient can get from the accelerator pedal to the brake quickly enough for safe driving.>

 Intimate relations can be resumed after 6 weeks when the incision is well healed.>

With adequate surgical decompression of pinched nerves, about 80% of patients get good to excellent relief from buttock and leg pain. Numbness and leg weakness usually improve to some degree, if not completely. If significant back pain was present before surgery, it will likely be present after surgery. Patients with spinal instability, listhesis (slipped vertebrae) or scoliosis (curvature of the spine) do not usually do well with decompression alone. Instead, fusion of painful vertebrae along with nerve decompression is required to address the causes of back pain.

When Does Spinal Arthritis Become Spinal Stenosis?

We all know that the more miles you put on your car, the more likely it is to begin having wear and tear problems. Our spines work in the same way. Like a car, the spine has important relationships among its moving parts. The car can be traded for a new one but we must take care of our spine as best we can for many years.

Spinal stenosis, often an end stage of the spine degenerative process, is characterized by leg pain with walking. Pain will go away with rest but you may have to specifically sit down to ease the leg pain. Occasionally the symptoms of spinal stenosis will come on acutely, but most often it generally develops over several years. A person who stands for long periods or walks will worsen the leg pain. Bending forward or sitting will relieve the pain because these positions help to open up the spinal canal, but the symptoms recur if you stand straight again. Numbness and tingling can also affect you while weakness is less common.

Our lumbar spine (low back) and cervical spine (neck) are comprised of multiple bones separated from each other by cushions (discs) and connected to each other by small joints. Our anatomy allows our spine to protect neurologic structures, absorb stress and weight, and position our body in space. By its nature, as we age, we are more likely to have degenerative changes that eventually can cause symptoms. Spinal Stenosis refers to narrowing of the canal where the nerves travel to reach their ultimate destination (arms or legs).

Our spinal canal is bordered by three important anatomic structures: discs, joints (facet) and ligaments. With time, the discs dehydrate, lose their height and can bulge, which can cause infringement upon the anterior portion of the canal. At the same time, the small facet joints will begin to degenerate and form bone spurs which can narrow the canal from the sides. Lastly, the ligaments (ligamentum flava) that border the posterior portion of the canal can hypertrophy and contribute to overall narrowing of the canal. The overall degenerative process that contributes to spinal stenosis is slow and can take many years to cause enough narrowing to produce symptoms.

Typical patient complaints involve a loss of endurance and fatigue associated with their lower extremities. Back pain often is associated with the leg symptoms but is quickly alleviated when the patient sits. Common symptoms that identify stenosis are decreased ability to walk distances, preference for flexed positions (sitting and sleeping in a fetal position) or leaning over a shopping cart. The body prefers a flexed spinal position because the canal is at its widest dimension with bending rather than standing upright.

Tests to confirm a diagnosis of spinal stenosis includes a MRI scan or a CT scan with myelogram. These tests will confirm the suspected narrowing and compression of nerve(s). Since spinal stenosis at one or two levels of the spine can affect a single exiting nerve, a combination of imaging and a physical examination by a spinal physician can confirm the diagnosis.

Non-operative treatment refers to attempts to minimize the stenosis symptoms without altering anatomy (surgery). Physical therapy is a mainstay because increased strength & endurance of our trunk and neck muscles increases support of the bony architecture of the spine and minimizes irritation of degenerated anatomic parts. Non-steroidal anti-inflammatory drugs (NSAIDS) contribute to pain relief by decreasing irritation but they do not change the course of the disease process. Lastly, epidural steroid shots can decrease swelling and irritation of pinched nerves to achieve pain relief. Conservative measures work well because often significant relief can be obtained. In essence, these non-operative measures buy time by minimizing symptoms without altering the underlying issue of the aging spine. 

Activity modification can be helpful. For endurance exercise, try a stationary bicycle instead of walking since it is helpful to reduce pain by bending forward. Additionally, leaning over a shopping cart or a walker is effective and sitting in a recliner instead of a straight chair can be more comfortable.

The key to deciding whether or not to have surgery is the degree of disabling pain or disability from spinal stenosis. When you can no longer walk as you enjoyed before or care for yourself as you have previously, it may be time to consider what surgery can do for you.

After a minimum of 6-12 weeks of conservative measures, if no significant improvement has been obtained, surgery can be discussed. The Laminectomy procedure involves "decompressing the pinched nerves" by removing the posterior bony portion (lamina) of the narrowed canal. A laminectomy can take from 1 to 3 hours depending on how many levels of the spine are involved. There are minimal restrictions post-operatively. The majority of patients go home the next day with no restrictions.

A decompressive laminectomy quickly relieves leg symptoms. Barring any permanent nerve changes from chronic compression, patients quickly regain lost strength and walking distance with the help of physical therapy. In certain cases, stenosis is associated with spondylolisthesis, or slipped vertebra. This â€œslipâ€ can become worse after a laminectomy at the same level. In cases like this, a spinal fusion during the same operation is added to minimize potential back pain resulting from spine instability.

The risks associated with decompressive surgery are similar to most surgical procedures. The biggest risk is associated with the anesthesia. To reduce this risk, patients undergo a medical clearance by your primary care physician or cardiologist prior to undergoing surgery. Other risks include infection, dural tears (the nerve sack rips leaking spinal fluid, which is repaired during surgery) and developing stenosis at other levels.

Surgery results are generally 70-80% successful at 5 years. This means you will be able to walk increased distances, have improved functionality, less leg pain and less medication use. The main cause for another surgery is if stenosis develops at levels above or below the primary surgical site.

To conclude, spinal stenosis is a chronic degenerative process that develops over many years. Conservative measures are available to control symptoms until one feels his or her quality of life is severely inhibited. At that point, surgery can be considered. Results from decompression are often very rewarding, allowing the person affected by spinal stenosis to return to their favorite activities.

Spinal Stenosis: Symptoms, Diagnosis and Treatment

In between the vertebrae of the neck are cervical discs. The cervical disc serves to cushion the weight of the head while allowing the vertebrae to move. When a piece of the disc escapes through a tear in its thick containment ligaments called the annulus, this is called a cervical disc herniation. Herniations occur into the spinal canal and can compress the spinal nerves or even the spinal cord.

Most often, patients do not remember a specific event or injury that caused their disc herniation. It most often seems to start without any apparent reason. Occasionally, an automobile accident, work injury, or sports injury is the cause. The thick containment structure for the disc, the annulus, becomes thin starting around age 30 - 40. This leads to disc bulging and herniation. The annulus can also be torn from an injury. When the annulus tears, the disc material is no longer contained and can extrude or herniate through the tear in the annulus and enter the spinal canal.

The most common symptom of a disc herniation is pain that radiates across the shoulder and into the arm, through the forearm and often into the hand. The area of arm pain depends on which disc in the neck is herniated. A herniated disc may also cause pain across to the shoulder only and not down the arm. It may cause pain only into certain fingers. Numbness over parts of the arm or hand is common. Weakness in muscle groups associated with the nerve is also not uncommon. An injured cervical disc can also cause referred pain around the shoulder blade or scapula. Headaches and neck pain are also common. If the disc herniation is large enough to compress the spinal cord, numbness, tingling or weakness in the legs might develop.

Most cervical disc herniations that cause radiating arm pain will improve over the first six to eight weeks after symptoms occur. The majority of patients who have arm pain will notice that the pain slowly improves over this two month time frame and numbness and weakness may also improve. The initial treatment approach should include anti-inflammatory medications such as aspirin, Advil or Aleve. Physical therapy including general traction can also play a roll and provide some relief. In some cases, epidural steroid injections may be appropriate. It is very important that patients with a cervical disc herniation not have passive manipulation of the cervical spine such as chiropractic treatments. Such forceful movement on the cervical spine can cause more of the disc to herniate, increasing the arm pain, numbness, weakness, with potentially catastrophic results. Such manipulation of the neck should be avoided completely.

If radiating arm pain, numbness, tingling or weakness persists beyond six to eight weeks, surgery may be indicated. Surgery is also indicated if profound weakness exists, if there is progressive numbness or weakness, or if symptoms in the legs develop. If none of these are present, the decision to proceed with surgery is made on the basis of the patients desire to obtain relief from the radiating arm pain. Surgery for a cervical disc herniation is not recommended for patients who only have neck pain.

The procedure to remove the disc from the neck is very commonly performed in the United States with excellent results. A 1 1/2 inch incision is made in the left front of the neck. The trachea and esophagus are retracted toward the patient's right while the pulse and neck vessels are retracted leftward. The cervical spine is very close and accessible in the front part of the neck. The cervical disc is then removed and in its place, a piece of bone graft from the bone bank is positioned to maintain the height of the vertebrae and prevent neck pain from developing after the surgery. Often, a titanium plate is placed across the disc to make it more stable. Surgery takes 1 to 1 1/2 hours and the patient awakens with a cervical collar in place. The collar is worn for six weeks while the bone heals. Following this, the collar is removed and the patient can resume most activities.

The results from cervical diskectomy have shown approximately a 95% chance at good or excellent relief from the radiating arm pain. Numbness generally improves. Weakness in the effected arm may require some physical therapy to fully recover. Improvement and strength in the arm is expected over time. After three to four months from surgery, the patient can resume full-unrestricted activities. About 7% of neck motion is lost when a disc is removed. Most people do not notice a difference in their neck motion after surgery.

The complications from this surgery are very rare. The most common of these is the failure of the bone fusion. This happens in 5 to 8% of patients. When it occurs, half of the patients have no symptoms from it and nothing further is required. For the patients who do develop neck pain as a result of the failure of fusion, additional surgery may be required to obtain a solid fusion of the disc and alleviate the neck pain. The risk of paralysis with this surgery is one in several thousand. Infection rate is less than one in a hundred. Other complications are even more rare.

The long-term outlook for patients who have undergone cervical disc herniation is excellent. Patients are able to resume full activity, in some cases even including full contact sports. For patients who have several herniated discs removed, collision sports such as football should be avoided. Even for those patients involved with heavy labor jobs such as construction, the expectation is that these patients will be returned to work without restriction.

pinched nerves & spinal stenosis

TIPS TO KEEP YOUR SPINE HEALTHY

When Does Spinal Arthritis Become Spinal Stenosis?

Spinal Stenosis: Symptoms, Diagnosis and Treatment

Cervical Disc Herniation (Neck)