A recent study published by Boston University has found out that lumbar spinal stenosis affects 4.71% of the general population, wihch seems like a very low number.  However, 47.2%   of individuals in the 60-69 age group have lumbar spinal stenosis on their MRI scan, which is a significant number.  The individuals  that actually  are diagnosed with severe stenosis will approach 20%.  These patients with significant spinal stenosis have a 3 times higher incidence of back pain than the general population.  As our population continues to live longer, spinal stenosis will certainly be  a significant health problem.

Spinal stenosis is the progression of arthritis in the spine occurring in the neck, as well as in the lower back.   As we age, the cartilage in the discs of our spine will lose their ability to hold water.  The water in the discs is what helps the disc move and remain flexible to bending and compression.  As the discs lose their water content, they become more fragile.  If the  fragile cartilage breaks, the condition is called degenerative disc disease.As discs degenerate, they will begin to expand and put pressure on the spinal canal and nerve roots.  This disc bulging will decrease the diameter of the spinal canal,a condition referred to as spinal stenosis.  This slows the information that flows between the brain and the extremities.  The arms will be affected by spinal stenosis in the neck and the legs will be affected by lower back (lumbar) spinal stenosis.

Patients with lumbar spinal stenosis will feel back pain, as well as leg pain or fatigue.  Because of the fatigue in the legs, patients will have to sit frequently during walks.Lumbar spinal stenosis will also cause patients to find benches in the mall and grab the cart at the grocery store, in order to make it through their errands due to the fatigue.  Some patients may attribute their fatigue to age and as they continue to remain active later in life, this may severely limit their ability to join in their families activities.The leg fatigue can cause significant pain and cramping during activity, but is lessened when the patient sits down.  The act of sitting  opens the spinal canal by decreasing the curve in the lower back,which also occurs while the patient is leaning on the grocery cart.

Spinal stenosis in the neck can cause more severe symptoms.  The cervical spine protects the spinal cord as it descends from the base of the brain.  Because spinal stenosis in the neck puts pressure on the spinal cord, the disc pressure will cause symptoms related to the spinal cord.  These include a decrease in the ability to walk as well as problems with the hands.Patients may find they tend to stumble, as it becomes harder to control the feet and legs as the disease progresses.  They may also find their handwriting getting severely worse and that they have difficulty differentiating the  size and feel of coins or shirt buttons. 

Spinal stenosis is usually treated with physical therapy and anti-inflammatory medications.  Physical therapy is intended to help position the spine and open the spinal canal.  With better posture and stronger core muscles, patients may find their leg symptoms and fatigue improve.  They may find they are able to walk farther or faster.  Oral anti-inflammatory medications are a first-line option for improving the inflammation related to the degenerating discs.  When physical therapy and oral medications no longer provide relief, injections of steroid around the discs and nerves may  decrease  the pain and symptoms related to the nerve pressure.Some patients are able to withstand their symptoms with a few injections per year. 

When all of these efforts fail, surgery  becomes an option for improving the patient’s pain.Surgery is aimed toward relieving the pressure from the arthritis on the spinal canal and nerves.  The mechanical pressure can only be relieved by physically removing the bone spurs or disc protrusions.  The surgical procedures involve removal of bone and disc, as well as protecting the nerve roots.  Fellowship-trained orthopaedic spine specialists have undergone the most intense training available in the treatment of the spine and are uniquely qualified to treat patients with spinal stenosis.

Dr. Jeffrey R. Carlson is a doctor at the Orthopaedic and Spine Center, a leading provider of Hampton Roads orthopedics services such as Hampton Roads spine surgery, Hampton Roads custom fit knee replacement, and many other services.  The Orthopaedic and Spine Center can be found online at:  OSC-Ortho.com

The spine is made up of muscles, bones, and nerves… The spine is held along by disks, connective tissues, tendons, and ligaments. The elements combine to allow us to square, however tension is applied.

The lower back makes up the larger structure of bones and joints with the joints at the hips. Hip joints connect with the pelvis, joining with the elements listed higher than and with the vertebral column and finally connect with the sacrum. Larger bones be a part of at the legs, that is where we have a tendency to get our support and strength to carry up the vertical column.

The bones thicken at the alternative facet of the vertebral column, or spinal cord and continue up to the neck. Thicker joints start at this area and continue to hitch with thicker bones, which start to shrink and thin at the joints.

The larger group of bones is at the lower area and joins with the spine. At the small baseline and near the prime structure these bones be part of and cause stress to the back. The legs are capable of moving, that additional stress is applied. The stress continues to the lumbar spinal disk. This disk is tormented by the stress as well. To allow you an example, if you were to choose up a 2000-pound object, you would have the same quantity of stress applied if you’d have sit down on the couch.

At the prime region of the rear, we have muscles moreover, that are shorter and helps us to maneuver the arms, likewise because the cranium. Currently, if you think about the weather spoken of in this text, you may wonder how it can cause back pain. The actual fact, when pulling up a decent combine of khakis, or trousers it can generate unusual tension. The stress affects the lower and upper back, so inflicting pain to arise. The explanation behind this is that the higher muscles cannot counterweigh for the pressure group going down at the lower region.

Back pain will emerge from the advantage we tend to receive from the spinal column still, like the control over the body. The spine has a prime focus and that’s to allow us such management or advantage to square, walk, run, and sit and thus on. Due to the current control we tend to have but, if we were to pick up twenty pounds, it’d be the identical as applying around two hundred pounds on the bones, muscles, and therefore the spine.

Currently, if you think regarding what I simply said, you’d see that as individuals we tend to often take the spine as a right, yet the granted we tend to take is gift in the tendons, muscles, ligaments, etc, and because the stress we have a tendency to apply is bigger than the spine will handle, injuries occur.

Certain, we have a tendency to all have to face, sit, walk, move, and perform daily activities, nevertheless as we tend to do that we have a tendency to are applying stress to the spine, more therefore than we realize. In brief, picking up one cup of low is additional weight than you realize.  

When one considers the spine, they have to additionally take into account weight, depth and the space finish to end. Since the spine is made from small and giant bones, also skinny and thick bones and joints, the vertebras in all areas exert its own degree of force and set limits on the lower and higher back. . As you can see, the pressure we apply daily to the spine gradually builds and causes lower and upper back pain. We still must take into account inappropriate bending however, since twice; the weight is applied when one lifts heavy objects and fails to bend properly.

Aching joints runing your life? Are you looking for joint pain relief? Visit our site: joint pain. Our joint pain site will help you to find the best natural supplements and lubrication for your joints. Get the most up-to-date joint health information, articles, and products at our site: joint pain.

Spinal fusion is one of the most misunderstood spinal surgical procedures. Everyone has heard some kind of frightening story about a distant family member who had back surgery and was never the same afterward. Many patients think a spinal fusion will cause their spine to become completely rigid, and they envision a future of robot-like stiffness with the inability to bend their backs or touch their toes, after surgery. Over the past decade, spinal fusion has also had a less than bright reputation as a treatment for pain. Given the overall perception that fusion of the spine is a delicate surgery with questionable outcomes, patients are quite concerned about proceeding with a fusion. This article will help to dispel many of the misconceptions that surround this treatment and why it is important to understand the procedure, when it should be performed and who might benefit from a spinal fusion.

What is Spinal Fusion?

Spinal fusion is a surgical procedure designed to provide stability to an area of the spine that has too much movement or movement that causes pain, tingling, numbness or weakness in the arm or leg. The object of a spinal fusion is to connect the bones (vertebrae) that were previously too mobile and form a connection of bone in the spine that is more rigid.

A History Lesson

Orthopaedic surgeons have long applied casts to broken bones to provide support to fractures and allow the bones to heal. The addition of this external support keeps the bones from moving. Why is this important? When there is too much movement between broken bones or bone fragments, the repair cells are prevented from being able to connect the bone fragments together, so their process of healing will stop.

As orthopaedic surgeons have progressed in the use of technology, plates and screws, called internal fixation devices, are now applied to fractured bones. These rigid internal fixation devices are stronger, and they add more support to the fractured bone. Plates and screws have been able to replace bulky external casting in a large group of fracture types.

The same treatment principles are used by the orthopaedic spine surgeon. There was a time when fusions were supported with external bracing. This external support, provided by casting or rigid bracing, has now been replaced with internal rods and screws. Using these internal supports provides stronger bone connections that decrease motion even more. As a result, the number of successful fusions has increased. The internal support of the spine is stronger, allowing patients to get up and out of bed and walk the day of surgery and to return to their usual activities in 6 weeks. This is a far cry from the days of original spinal fusions that were supported with a cumbersome hard plastic brace or cast, leaving patients with limited mobility or bed rest for many months.

Spine surgeons are now better able to determine which patients will benefit from a spinal fusion. Advanced imaging studies, including MRI and bone scans, as well as the use of diagnostic injections, help today’s spine specialist more accurately diagnose patients who would benefit from spinal fusion. Advances in surgical techniques and components, including the development of better screws and rods, also have greatly improved patient results. Improved diagnostic and surgical training, including advanced training in spine fellowship programs, has helped spine surgeons interpret and use these advances in technology to obtain better outcomes.

Who Can Benefit from Spinal Fusion?

As with all surgeries, there are proper uses that will result in good outcomes for patients with spinal fusion.

In patients where the spinal bones have begun to slip and cause pressure on the spinal nerves (spondylolisthesis), this excessive movement may need to be stopped to prevent worsening of the nerve pressure. During surgery, these patients will have the bone spurs and disc protrusions removed from around the nerve roots and spinal cord, which may destabilize the bones of the spine and cause the bones to slip. Inserting screws and rods in these bones will prevent the bones from slipping any further after surgery and also may be used for correction of the original slippage.

Use of screws and rods can also provide stability and correction for patients with scoliosis. Scoliosis is the bending of the spine in an abnormal direction. The curve of the spine may increase with time or may be painful as the curvature of the spine increases. If the patient has a large curve or the curve is continuing to get worse, screws and rods are used to correct the position of the spine and prevent the curve from worsening.

In patients with obvious bone destruction from fracture, tumor or infection, stabilizing the bones with screws and rods will provide the support needed so the underlying disease can be addressed. The structure of the spine can be improved while the patient receives chemotherapy or radiation. By removing the tumor in the spine, the back pain related to an expanding tumor can be relieved and the patient can remain mobile, which helps to prevent pneumonia and blood clots. Being ambulatory, while receiving chemotherapy and radiation, also improves the patient’s mood and outlook.

Who is Not a Candidate for Spinal Fusion?

Most patients with disc herniations or pinched nerves will not need a spinal fusion. These conditions can be treated with simpler procedures that allow the removal of pieces of discs or bone spurs that do not increase the movement in the bones.

The more difficult indication for spinal fusion is in the patient with severe pain in the back. Degenerative disc disease is the leading cause of back pain in the United States, but back pain can have many underlying causes. One of the reasons that spinal fusion developed a bad reputation is that they were performed as a remedy for back pain that did not respond to other forms of treatment. Older fusion methods and inadequate diagnostic approaches left surgeons with few options for treating these patients, so some patients were given fusions as a last attempt to improve their pain . Most patients with lower back pain and degenerative disc disease will not need a spinal fusion.

What To Expect From Spinal Fusion?

Most patients will be back to their usual state of health and activity at approximately 6-8 weeks after their fusion surgery. Most patients will be pain-free after their spinal fusion. It is important to choose a well-trained surgeon to make educated decisions about your diagnosis and treatment. With the combination of the proper diagnosis and properly applied spinal fusion most patients will have very good outcomes.

In adolescents, back pain may start as the bones start to shift and become irritated due to the abnormal connection in the spine. As children become more active in sports and use their backs for athletic activities, the instability related to the lack of connection in the back bones will start to become painful. X-rays, taken at this time, may show a break in the bones; however, there are a significant number of these kids with back pain who will have normal looking x-rays. These children may need to have a further evaluation with a CT scan to help visualize the bones of the spine more specifically. There a large portion of these individuals that may live their entire lives with a break in their vertebrae and not experience back pain until their discs start to degenerate.

The largest group of patients with spondylolisthesis have degeneration in the discs that leads to back pain and doctor visits is the middle age population. As the discs degenerate, they are not able to support the weight of the spine, which allows the bones to shift. Because the position of the bones changes, the discs will have to bear the brunt of the patient's body weight and movement, which applies more stress to the discs and forces them to degenerate faster.

Most patients with a mild slippage of the bones will not have any worse back or leg pain than most people their age. There are no particular restrictions in activities that need to be considered in mild spondylolisthesis. However, as patients get older, the discs that are between the slipped bones will continue to degenerate. Disc cartilage degeneration can be painful and can lead to an increase in the slippage of the bones. As the spine continues to degenerate and slip, the nerves that are protected by the bones will begin to receive pressure from the discs and bones. Pinching the nerves in the back will cause pain in the distribution of the nerve roots. This pain is felt in the back of the legs and down to the foot, called sciatica. The nerve pain is usually the most painful and many patients will wonder why the doctor is checking their back when it is the leg that is hurting.

The initial treatment for low back and leg pain related to spondylolisthesis is a physical therapy program and anti-inflammatory medications. Exercise, stretching, traction, as well as manual therapies, can be very helpful in relieving the pain. The goal is to relieve the pressure on the nerve and mobilize the bones and discs - this will allow for a fluid motion of the back without irritating muscle, tendon, or nerve. Most patients respond favorably to this treatment and can maintain their spines with exercise at home. If this treatment is not successful, injections of steroids around the nerves and joints may be helpful in relieving some of the acute pains. After pain reduction, the exercise program may be more effective. If all of these treatments don’t work, surgery should be considered to relieve the back and leg pain. Although, most patients are reluctant to have back surgery, with the improved techniques used by the fellowship-trained orthopaedic spine surgeon, spondylolisthesis is one of the conditions of the spine that responds very successfully to surgery.