Spinal Troubles are big troubles by Jane E. Brody

The New York Times

The spine can join the knees as an example of the limits of evolution.

We just were not meant to stand upright for more than 50 years. Still, most
of us now do, and we pay with progressive degeneration of these vital
support structures.

Arthritis - the wear-and-tear kind - is by far the most common cause of a
potentially debilitating disorder called spinal stenosis, a narrowing of the
passageways for spinal nerves. The problem is most common in people over 50,
though the young are sometimes affected through injury or a birth defect.

Not everyone with spinal stenosis has symptoms, but 250,000 to 500,000
Americans do, and with age as the leading risk factor, the number afflicted
is expected to grow significantly as the population ages.

The spine is an incredibly complex structure of bone and cartilage that must
provide both stability for an upright posture and flexibility to allow
bending in four directions. The spine also houses all the nerves that enable
the brain to tell the rest of the body what to do.

The spinal cord, a long bundle of nerves from the base of the brain to the
second lumbar vertebra, passes through a bony channel called the spinal
canal.

If the channel for the spinal cord and its many extensions becomes narrowed,
pressure on the nerves can cause pain, cramping, tingling or numbness in the
area served by the nerve.

When arthritis wears out the cartilage that cushions the ends of bones, the
body may produce bone spurs in an effort to repair the damage. If these
spurs form on the facet joints, they reduce the spaces through which the
spinal cord travels and the nerves exit.

Arthritis also is associated with deterioration of the spinal disks, which
flatten, become brittle and may develop tiny rips that allow the jellylike
substance to leak and press on the nerves. The ligaments, too, degenerate
with age, becoming stiff and thick, shortening the spine, narrowing the
canal and sometimes compressing nerves.

Other causes of spinal stenosis are tumors, trauma, Paget's disease of the
bone, and a genetic disorder called achondroplasia.

Common symptoms of spinal stenosis include pain or cramping in the legs,
especially when standing for long periods or when walking; radiating pain in
the back and hip (sciatica) that typically starts in the buttocks and gets
worse when sitting; shoulder and neck pain, headaches or loss of balance
resulting in frequent falls or clumsiness when the cervical nerves are
affected; and loss of bowel or bladder control when the cauda equina is
involved.

Spinal stenosis is a progressive disorder, so you can assume it will
gradually worsen. But even as it progresses, symptoms may come and go. Most
people with symptoms do not seek medical treatment, attributing their
discomfort to the inevitable consequences of age.

But experts say that any pain or stiffness that limits mobility (and is not
a result of overexertion or unusual exercise) is not normal and should be
medically evaluated.

Certain symptoms, like sudden difficulty controlling bowels or bladder,
warrant immediate attention. Likewise, if numbness develops in an extremity,
it is at greater risk of injury, muscle atrophy and permanent loss of
sensation.

Drug remedies include over-the-counter or prescription painkiller such as
acetaminophen (Tylenol and the like) and nonsteroidal anti-inflammatory
(Nsaids) such as aspirin, ibuprofen, Celebrex or Mobic. If symptoms are
severe enough to warrant it, the doctor may inject a corticosteroid into the
spinal fluid, to suppress inflammation and relieve sciatic pain.

For the very elderly or those with exceptionally weak abdominal muscles or
stenosis in more than one part of the spine, the doctor may recommend a back
brace or corset.

Physical therapy can help relieve symptoms and reduce recurrences. The
therapist can help patients increase strength, endurance and flexibility
(regular, proper stretching is a critical component of pain relief), teach
you how to relieve symptoms when they occur and improve the stability of
your spine.

Because nerve compression causes symptoms, learning how to open the spinal
spaces often brings temporary relief.

Increase flexion of your spine by bending forward a little when walking or
by lying on your back or side with your knees raised. Moderate, regular
exercise is also helpful; especially riding a bicycle with your back
slightly flexed.

Sometimes surgery is needed to decompress pinched nerves, although there is
no guarantee of complete or permanent relief.

Surgery can only correct existing problems, not prevent new ones. Various
operations are used, including laminectomy, to remove the back part of the
bone over the spinal canal and vertebral fusion.