Lower back pain - Spinal Stenosis
What is spinal stenosis?
Spinal stenosis is a very common problem that can occur as we age. As we get older, joints between the bones in our spine accumulate wear and tear, also known as osteoarthritis. This erosion can slowly cause compression of nerves in the lower back through thickening of ligaments and overgrowth of joints. Occasionally, this degeneration may lead to slippage of one vertebra onto another. This is called a spondylolisthesis.
What problems can this cause?
Many people have no symptoms from spinal stenosis! When symptoms start, they usually progress with time.
Symptoms can vary enormously but can include:
• Problems with walking and balance
• Pain or cramping in the legs. This is often improved by bending forward or sitting down. The pain may be as severe as sciatica.
• Back pain and buttock pain
Symptoms are usually mild at first but may become debilitating.
Are there simple things I can do that may help?
Yes! It is important to be physically active. I suggest to all my patients that low impact exercise is crucial for our spine health (and our health in general).
Physiotherapy-led core strengthening programs and Pilates can be very helpful in improving our spine’s flexibility and support. Walking, swimming, and simple over-the-counter pain medication are straight-forward measures that will improve the discomfort and symptoms that spinal stenosis can cause.
When should I consider surgery?
Surgery can be very effective in the treatment of spinal stenosis, but it should be considered only if the above suggestions haven’t shown a clear benefit and your quality of life is not what you would wish.
Surgery can significantly improve quality of life and mobility in the right circumstances!
What happens with surgery?
As the problems can vary so significantly, it is vital that surgery is tailored to the individual problem. This means that different types of surgery may apply to different patients. We aim to perform the most effective surgery possible in the least intrusive fashion.
In general, surgery is performed through a 3 cm cut. Microsurgical instruments are used to protect important structures and to allow access to the overgrown structures causing the spinal canal narrowing. Using a microscope, the degenerative tissues are removed, freeing up the spinal sac and spinal nerves.
Surgery is done in a minimally-invasive fashion and we are fortunate to have the most technologically sophisticated equipment at St Vincent’s Private Hospital so that each operation is performed in the safest and most beneficial way.
If you have a slippage, or spondylolisthesis, a fusion may be suggested. This is a technique to cause two vertebrae to knit together so that no movement can occur. The spine can be re-aligned, and no further slippage occurs. If performed for the right reasons, surgery for spinal stenosis can be effective in 80-90% of situations. It is crucially important to get advice from a surgeon that you trust and in whom you have confidence. If in doubt, a second opinion is always valuable.
What can I expect after surgery?
We aim to get people walking the same day as surgery. The evidence is clear that early movement is advantageous to recovery and with modern neurosurgery and anaesthesia techniques, most patients can walk independently the same day as their surgery.
Most people are admitted at St Vincent’s Private Hospital for between 1 to 4 days. If the spinal stenosis is severe and patients haven’t been walking confidently for some time, rehabilitation may be suggested.
Dr Jacob Fairhall
MBBS(Hons) BSc(Med) FRACS
Suite 704 St Vincent's Clinic
438 Victoria Street
Darlinghurst NSW 2010
P: (02) 9650 4132
F: (02) 9650 4820