The spine is important as it provides support and structure to the body, enables movement, and protects the spinal cord, nerves, and many important organs. The bones (vertebrae) in the spine are separated by shock absorbers known as discs. Much like a tire, discs are subject to wear and tear. Discs often degenerate with age causing vertebrae to sit closer together. This is part of the reason we shrink with age. Degenerative discs can lead to pain via multiple pathways.
Spinal stenosis is another condition of the spine where the central canal diameter is reduced much like a pipe that becomes clogged. When this occurs the nerves are compressed causing pain not only in the back but often in the legs as well. Patients with spinal stenosis can have leg pain with walking and better at rest known as neurogenic claudication. Additionally, spinal stenosis patients often get pain relief by bending forward when they walk. This position is the one we assume when pushing a shopping cart. In fact, when a patient with spinal stenosis gets relief by resting on a shopping cart we call that the “shopping cart sign”.
Discs are like jelly donuts. The crust is the outer layer known as the annulus and the inside is the jelly known as the nucleus pulposus. The annulus contains all the nerve fibers. So when the crust bulges or tears this can result in back pain. When the crust compresses the central canal this can contribute to spinal stenosis. If the jelly breaks through the crust this is known as a disc herniation or extrusion. Discs don’t have a robust blood supply so when damage occurs it is difficult for a disc to heal on its own.
Disc degeneration can occur due to a variety of reasons including:
Degenerative disc disease can lead to arthritis of the joints of the spine which is called facet arthropathy. Sufferers might experience pain that is worse when sitting, bending, lifting, or twisting. This pain might feel better while walking, standing, changing positions, or lying down. These episodes of pain might come and go, lasting anywhere from a few days to several months before getting better. Sometimes the pain does not improve. The severity of the pain varies as well and can be excruciating or simply irritating. You might also experience numbness and tingling in the extremities.
There are several treatment options available for pain associated with degenerative disc disease that your doctor might recommend. These include:
Facet joint intervention such as radiofrequency (RF) ablation/rhizotomies
Spinal stenosis is a narrowing of the central canal of the spine. Spinal stenosis most often occurs in the lower back and in the neck. Spinal stenosis symptoms include back pain and pain, numbness, and tingling in the extremities, and even the sensation of muscle weakness. Over time, symptoms usually worsen without treatment. In severe cases, sufferers may experience bowel or bladder dysfunction.
There are a few different causes of spinal stenosis including:
Degenerative changes in discs can cause spinal stenosis, but there are treatments available. Depending on the severity, your doctor may recommend:
If you suffer from back or neck pain, talk to your doctor about the best treatment options custom-tailored to your underlying diagnosis. Spinal stenosis and degenerative disc disease often coexist. You don’t need to live in pain. Great treatment options are available.
