SPINE - SPINAL STENOSIS

Spinal Stenosis & Degenerative Spine Disease Degenerative Spine Problems occur as a consequence of age or degenerative processes such as arthritis. Everyone develops some degree of degenerative changes in the spine. Degenerative changes are only a problem if they cause pain, structural instability or compression of the spinal cord or nerve roots. Compression of the nerve roots causes a “radiculopathy.” Narrowing of the spinal canal that compresses the spinal cord causes “myelopathy.” Narrowing of the spinal canal in the low back causes “neurogenic claudication.”

Radiculopathy, irritation of a nerve root, may cause pain, tingling, sensory changes, or weakness in the arms or legs. Radiculopathy may be caused by degenerative changes in the spine, including herniated discs, bone spurs, degenerative joint disease and thickening of the ligaments. My surgical approach to radiculopathy from degenerative changes focuses on decompressing the nerves, while preserving the natural anatomy of the spine. Using microsurgical techniques, nerve roots are decompressed by removing only the mechanical impingement. Structurally important ligaments remain intact, often avoiding the need for a fusion.

Myelopathy is a very serious problem, indicating injury to the spinal cord. The surgical approach to myelopathy is the same as for other spine problems. At times, the treatment of myelopathy may require surgery at multiple levels of the spine.

Neurogenic claudication is due to a progressive narrowing of the spinal canal. Patients typically complain of weakness, pain, or cramping in one or both legs. Sometimes, patients experience a loss of coordination of the legs. Patients complain that the legs “feel heavy.” With typical claudication, symptoms are directly related to the distance walked. The tolerated distance becomes progressively shorter over time. Symptoms are often relieved temporarily with sitting or bending forward.

Neurogenic claudication is a mechanical problem. The round canal through which the nerves descend becomes smaller for several reasons. From the front, discs can bulge into the canal. From the sides, the joints slowly enlarge with age. From the back of the canal, the ligaments thicken. All of these changes conspire to squeeze the nerves, causing them to malfunction. The ligaments in the back of the canal (ligamentum flavum or yellow ligament) are built like shingles. When standing up straight or walking, the ligaments relax and can overlap or buckle into the canal, increasing the pressure on the nerve roots. Bending forward, the ligamentum is stretched tight, reducing the pressure on the nerves.

Neurogenic claudication is relieved by removing the bone, ligaments and sometimes discs which compress the nerve roots. Unfortunately, medicine and physical therapy have not been found to help. The operation for claudication is tailored for each patient. Surgery usually involves just one or two spinal levels but may extend over three or more levels. The operation includes an incision in the midline of the low back, separation of the fat and muscle behind the spine, and removal of the ligament, bones or disc material that is compressing the nerve.

Contact our New Patient Coordinator at 404-256-2633 to arrange for evaluation of your spinal stenosis and degenerative spine disease.