Tag Archives: Spinal Stenosis

Back Pain: The Symptoms And Causes Of Sciatica

Most sciatica is caused by problems that affect the L4L5, or S1 nerve roots. The nerve may be compressed or irritated, usually because it’s being rubbed by a disc, bone, joint, or ligament. The resulting inflammation makes the tis­sues and the nerves more sensitive and the pain feel worse.

Damage to or pinching of the sciatic nerve, or the nerves that feed into it, can have several causes.

Herniated disc

One of the most common causes of sciatica is a herniated disc in the lower part of the spine. It’s also called a slipped disc, though there’s no slipping going on.

Spinal discs are tucked between the vertebrae, where they act as cushions to keep the bones from touching one another. The discs absorb all the forces placed on the spine from walking, running, sitting, twisting, lifting, and every other activ­ity we do. They also absorb forces from falls, collisions, and other accidents.

Spinal stenosis

The spinal canal protects the spinal cord and the nerves that run up and down the spine. Spinal stenosis is the narrowing of the spinal canal. When this occurs, nerves can be compressed, causing pain. Because the lumbar verte­brae undergo the most consistent stress and support the most weight, lumbar stenosis is the most common type of spinal stenosis.

Spondylolisthesis

The bones of the spine are stacked on top of one another, separated by discs. Spondylolisthesis occurs when one spinal bone slips forward in relation to the bone below it. When the L4 vertebra moves over the L5 vertebra, it can cause a kink in the spinal canal leading to pressure on a nerve root and sciatica.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #58: SPINAL STENOSIS

Spinal stenosis is a narrowing in the spinal canal. Constriction of the spinal nerves can produce pain that goes down one or both of the arms or legs, depending on the location of the stenosis. Malfunction of the nerves can cause numbness In the arms or legs, or weakness in muscles served by the affected spinal nerves.

Your doctor can confirm the diagnosis with imaging techniques such as MRI or CT scan.

The interesting part of this condition to me is the tremendous advances in surgical techniques that have taken place in the past decade. Many surgeries are now done through an endoscope, which limits the surgical disruption in the area. There is even a needle guided procedure to remove part of the ligament that is causing compression of the nerve.

Depending on the exact problem, small amounts of bone or other tissues can be removed, especially if the exact site of compression has been identified. If the extent of compression is more extensive, increasing amounts of bone is removed from the lamina (bony arches), facets , or nerve outlets (foramina) to give the nerves more room.

If there is slippage of the vertebra, a fusion is sometimes done. My understanding is that fusion is becoming less common. That being said, the Cloward procedure in the neck, with its approach from the front, is still sometimes used with neck pain.

Pain in the neck or back without any associated nerve malfunction is often best treated with physical therapy, steroid injections, or other conservative methods.

In my opinion spinal surgery is best done by trained neurosurgeons, who are familiar with minimally invasive surgery.

—Dr. C.

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