I recently had spinal stenosis surgery done. What can I do to prevent more damage from spinal stenosis?

Question

I recently had spinal stenosis surgery done. What can I do to prevent more damage from spinal stenosis?

Answer

Spinal stenosis usually occurs in the lower part of the spine, called the "lumbar" spine. The "stenosis" is a narrowing of the canal that is formed by the bones of the spine (vertebrae). There is also narrowing of the openings between the vertebrae, through which nerves travel to get from the spinal cord to the different parts of the body. When the narrowing becomes severe enough, the spinal cord and nerve roots become compressed, which results in pain, and potentially, weakness and loss of sensation.

The symptoms of spinal stenosis include lower back pain and pain that radiates below the level of the buttocks into the thighs and knees. About half the patients will experience pain below their knees. The pain is generally made worse with walking, bending backward, and bending forward. Some patients may have both stenosis and disc herniation, but X-rays can often help sort out the nature of the back pain.

There are three causes of spinal stenosis. The most common is degeneration of the disc material between the vertebrae, followed by disc herniation. This then leads to vertebral bone degeneration and inflammation. These changes occur with age and, as a result, symptoms typically begin when patients are in their 60s and 70s.

Less common causes of spinal stenosis include abnormalities of the spine that are present at birth, in which case symptoms often begin in the 30s and 40s, and recurrence can occur after surgical correction of spinal stenosis.

Initial treatment does not usually require surgery. First, your doctor will probably prescribe back and leg exercises and a mild painkiller like acetaminophen (Tylenol). It is when these conservative treatments fail that your doctor may suggest surgery.

The goal of surgery is to correct the narrowing of the spinal canal and relieve compression. This is accomplished by "laminectomy," which means removing the part of the vertebral bone and disc material that is causing the compression.

The best way to avoid recurrence of back pain is to examine your lifestyle and eliminate the risk factors and activities that can place stress on your back. These steps can help you avoid back pain or prevent recurring episodes:

Exercise regularly. By exercising 20 to 30 minutes at least three times a week, you can strengthen the muscles around the spine. This in turn takes some of the stress off of your bones, ligaments, and disks. Stretching exercises such as yoga can help increase flexibility. Aerobic exercise (walking or swimming) and weight exercise (lifting weights or pulling on elastic bands) help improve strength and coordination. Exercise also increases blood flow to spinal tissues and speeds up the healing process. Spinal extension exercises improve muscle tone and help reduce back pain.

Lose excess body weight. Extra weight increases your risk of back pain, as well as prevents rapid healing should you become injured.

Reduce emotional or mental stress. Doctors have found that it is sometimes more helpful to treat the source of stress than the back pain itself. Stress can affect your brain's perception of pain, making slight problems seem worse.

Stop smoking. Research shows that nicotine can increase the risk of disk degeneration and back pain. Nicotine can also slow or prevent recovery because it reduces the amount of blood flow to the tissues that are trying to heal. For patients who may require an operation to treat back pain, smoking reduces the rate of bone healing after surgery and increases the risk of complications from anesthesia.

Sleep properly. You can protect your back by sleeping on a firm, supportive mattress and supporting your back with pillows.

Practice proper body mechanics. This includes walking and sitting with good posture and bending your knees, not your waist, when lifting objects.

Links

• Oh, My Aching Back!
• Smoking May Stunt Bones