Back Pain & Sciatica caused by Spinal Stenosis
R. H. in Glossop, UK, asks:
"The specialist has said that my mother's back pain is caused by spinal stenosis. She has had sciatica for some years now. What is the treatment - will she need an operation?"
Colin Natali, Consultant Spinal, Trauma and General Orthopaedic Surgeon at the back2normal back and neck clinic, London, replies:
"Most back pain is caused by disc degeneration and facet joint disease. As we get older the discs become 'de-hydrated' and as a consequence they lose their height. This closes down the spaces from which the nerve roots emerge from the spinal cord. This is known as spinal stenosis. Due to impingement on the nerve roots, spinal stenosis can cause pain and pins and needles in the buttocks and down the legs.
"You and your mother's surgeon need to be absolutely clear what the main problem is. If it is purely back pain, the source and site need to be established. A detailed examination and diagnostic investigations such as MRI scans can help to establish this. Once the definitive diagnosis has been established and if the pain is sufficiently severe, operative treatments should be considered ONLY if all non-operative treatments have been tried. These include physiotherapy (particularly core stability exercises), pain killers and injection therapy. The operations that might be considered include spinal fusion or total disc replacements.
"If the pain is in the legs and on exercise, a simple disc decompression may be the correct operation, although full non-operative treatment must have been tried first. With regard to operations, a simple disc decompression has good results; however if either the spine shows signs of instability or if back pain is an important feature, then a fusion might be required.
"As with all surgical treatments, these must be discussed with your surgeon and the risks and benefits discussed in detail.
Article published: 13th April 2004
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