Back pain, specifically low back pain, is the leading cause of disability in the country.i More than depression. More than diabetes. Low back pain is the number one contributor to years of life with disability.
Spinal stenosis is an abnormal narrowing of a space in the vertebra. Nerves, arteries and other non-bony tissues pass through these spaces. When this narrowing interferes with these tissues you can have pain, numbness and, if sever, poor muscle control. The disease typically occurs in the low back or neck, and is more common in older patients.
One of the hallmarks of spinal stenosis of the low – a.k.a. lumbar spinal stenosis – is shooting pain from the buttocks to down the leg that gets better when bending forward or sitting. A second hallmark is pain in the leg that worsens when walking. There may be numbness, and the pain remains even when you stop walking. It’s not until you sit or bend forward that you find relief.
There are a number of good treatment options available for spinal stenosis: activity, modification, epidural steroid injections, decompressive laminectomy, microdecompression and interspinous spacer.ii Activity modification includes things like using a cane and bending forward. Epidural steroid injections are one of the more familiar interventional pain management treatments applies anti-inflammatory medicine to the suspected source of pain. Decompression laminectomy and microdecompression are spine surgeries that have been performed primarily by spine surgeons, but can also be done using minimally invasive techniques. And finally, interspinous spaces are like drywall anchors that keep two vertebrae from narrowing the suspected spinal stenosis. It is not a new concept – spacers have been around since the 1950s – but the device took a hiatus from the therapeutic tool chest for the past 40 years to receive an engineering upgrade. They have recently seen an uptick in use as more spine pain physicians become trained in them.
All these treatment options have been shown to improve symptoms in some patients, but there is no resounding conclusion on which is the best for whom. We do know, however, that in patients’ with the hallmarks of spinal stenosis conservative therapies focusing solely on exercising and occasional over the counter pain-relievers do not relieve these symptoms. And so the practice is really to secure a specific diagnosis, identify the patient’s goals and functional health, and match a suitable treatment option.iii
i The stat of US health, 1990-2016: Burden of Diseases, injuries and risk factors among US States. The US burden of disease collaborators. JAMA. 2018;319(14):1444-1472.
ii Markman JD. Lumbar spinal stenosis: current therapy and future direction. Current therapy in pain. Saunders/Elsevier; 2009:316-322
iii Lurie J, Tomkins-Lan C; Management of lumbar spinal stenosis. BMJ 2016; 352 :h6234
Angelie Singh, MD, MPH, MS