Physical Therapy in Brooklyn for Lower Back

Q: Six of my friends turned 65 this year and all ended up having surgery to fuse their spine because of spinal stenosis. Is this a fad or just something to expect with aging like having your wisdom teeth pulled and the appendix removed?

A: Spinal stenosis is defined as a narrowing of the spinal canal where the spinal cord travels down the spine. The effects of aging (e.g., bone spur formation, thickening of spinal ligaments inside the canal, disc degeneration) shrink the amount of space for the spinal cord.

Spinal nerve roots that leave the spinal cord can also be affected. The resulting pressure or irritation of nerve tissue can cause low back pain, leg pain, and other symptoms such as numbness, tingling, weakness, or foot drop.

The government reports that 1.65 billion dollars is spent in one year just in hospital costs for the surgical treatment of this problem. So, it's not exactly a "fad" as much as it is a major trend in how the effects of aging catch up with the over 65 set.

When surgery is done for lumbar spinal stenosis, there are two main choices: decompression (remove the disc and/or remove bone from around the disc) and fusion. Younger, healthier, and less frail patients are more likely to be treated with decompression and fusion (compared with older adults with more comorbidities).

In fact, data collected from hospital records show that two-thirds of the patients having decompression and fusion are younger (less than 65 years old). The remaining one-third of the procedures are for just decompression and in the older group with more health problems.

Advancing age often comes with a whole host of other problems we call comorbidities. Additional health problems like high blood pressure, diabetes, heart disease, cancer, and so on add to the complexity of patient treatment.

So, it's not a given that when you turn 65, lumbar spinal stenosis will require surgery. But the chances of developing age-related spinal stenosis, of course, increase with age. Many older adults with this condition never experience any symptoms and the problem goes undiagnosed. It isn't until X-rays are taken for some other problem that the presence of stenosis is noted.

Why some people develop painful symptoms associated with lumbar stenosis and others do not remains a mystery. Likewise, the best way to treat this problem remains a puzzling challenge. Some people seem to respond to conservative care (physical therapy, exercise, medications) while others only find relief from the pain only after surgery.

Reference: Richard A. Deyo, MD, MPH. Treatment of Lumbar Spinal Stenosis: A Balancing Act. [Commentary]. In The Spine Journal. July 2010. Vol. 10. No. 7. Pp. 625-627.