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One of the more common low back diagnoses in older adults is spinal stenosis. It results from degenerative changes in the spine, typically the neck or low back. It is frequently due to a combination of disc degeneration and resultant bulging, ligament buckling and facet joint arthritis, all of which can narrow the opening for the spinal nerves as they exit the spine. Sometimes congenital (from birth) narrowing of spinal structures is a factor, often asymptomatic early in life, but contributing to narrowing as the spine ages.
Although the conditions causing stenosis may contribute to neck and or low back pain, typically there is pain, weakness and or numbness to the arm or leg. Usually symptoms are on one side, but they can occur bilaterally, depending on where the nerve compression is. In the low back, one of the hallmark signs is that of leg pain on walking or standing, relieved by sitting or bending forward. Often walking downhill is worse than uphill.
In the past, surgery was considered the ultimate treatment for stenosis, however it has become clear that surgical outcomes are somewhat unpredictable, and is unlikely to give complete relief of symptoms. Several studies have shown that conservative care, designed to decompress the nerve have shown equal or greater benefit, without the exposure to surgical risks and complications. Over the past decade or so, epidural injections have become a popular conservative option, however there is a high failure rate for long-term improvement, as well as a higher rate of complications if subsequent surgery was performed.
A recent clinical trial published in the Journal of the American Medical Association compared the effectiveness of three non-surgical options in 259 lumbar spine stenosis patients:
- Medical care consisted of medications and/or epidural injections.
- Group exercise classes
- Manual therapy/individualized exercise consisted of spinal mobilization, stretches, and strength training provided by chiropractors and physical therapists.
The results: “manual therapy/individualized exercise had greater improvement of symptoms and physical function compared with medical care or group exercise.”
One of the best-researched chiropractic approaches is Cox Technic. This provides stenosis relief in four ways:
1. Increase of the intervertebral disc space height
2. Increase of the intervertebral foraminal area by up to 28% by:
a. Decrease of posterior disc bulge
b. Tauten the ligamentum flavum to reduce the “buckling” phenomenon of the ligament that results in narrowing of the vertebral canal.
3. Decrease of intervertebral nucleus pulposus pressure. This is termed decompression. A centripetal or suction is instituted inside the nucleus to pull back disc protrusion.
4. Return physiological range of motion to the motion segments of the spine.
Can spinal stenosis be cured?
There is no 100% effective treatment. While surgery can provide space for affected nerves, 50% relief of symptoms is considered a good outcome….pretty much the same as Cox Technic. Improvement that allows taking a walk, participate in daily activities and family life is welcomed. As this is a chronic condition, it may be necessary to continue to treat periodically once maximum improvement is attained, to prevent return of symptoms.
Finally, what I've been promising myself for too long. Stay tuned for information on chiropractic, nutrition, wellness, and the occasional rant. Please comment, give feedback, and feel free to suggest topics.