Scott Webb (Host): Spinal stenosis is a condition where the spinal canal, the space within the spine that houses the spinal cord and nerve roots, becomes narrowed. And my guest is here to tell us more and share the latest in diagnosis and treatment of spinal stenosis. And I'm joined today by Dr. Wajeeh Bakhsh. He's a Board Certified Physician in both Spine and Orthopedic Surgery at Franciscan Health. 

This is the Franciscan Health Doc Pod. I'm Scott Webb.

Doctor, it's, nice to have you here today. I know you're Board Certified in Orthopedics and you have advanced training in Spine and Orthopedic Surgery. So, you're definitely the right expert to have on today. And I know we're going to talk in the future about scoliosis, but today we're talking spinal stenosis.

And all I really know about it is that it involves the back and my great aunt used to tell me that she suffered from it, but I don't really know what it is or what causes it, so it's great to have you here and let's start there. What is spinal stenosis?

Wajeeh Bakhsh, MD: Well, I appreciate you having me on. This is a chance to kind of reach out to folks and share some of my knowledge, which is always a great experience. To answer your question, you know, spinal stenosis, it's a condition where the spinal nerves, which are the nerves that go out to your arms and legs and make everything move, when they no longer have space within the canal that they travel through and they're being compressed.

That can be due to any number of reasons, whether it's arthritis or bone spurs, disc herniation, or other kind of factors.

Host: Yeah. And I'm sure, you know, like a lot of things in medicine and science, there's been a lot of advancements. So it's great to have you here, you know, from what I could tell from putting my notes together, you know, you're on the cutting edge, you know, so, we're all going to benefit from your expertise today.

I want to know, how do you diagnose spinal stenosis and is it predominantly diagnosed in children or adults?

Wajeeh Bakhsh, MD: So spinal stenosis, the official diagnosis really comes from imaging of the spine, the MRI, which allows us to look within the spine and see the canal and see if things are being compressed. The idea of the diagnosis is oftentimes based off of symptoms. So when someone is telling me that they have these specific symptoms, I can suspect spinal stenosis and then to diagnose it we can look at the spine in a kind of a 3D way with an MRI. And it's typically found in adults because the most common cause of it is degeneration and wear and tear over time.

So it's fairly uncommon in children. Although they can have a specific variant called congenital stenosis, where patients are born with a smaller spinal canal. But that typically doesn't really cause any symptoms, so we don't often see this in younger patients.

Host: Okay, yeah, I see what you mean. Yeah, I'm in my 50s, so a lot of wear and tear, arthritis, all the greatest hits, if you will. Are there different stages or degrees of spinal stenosis?

Wajeeh Bakhsh, MD: Absolutely. So, the canal, which is kind of the highway for the nerves to run down, can have any amount of stenosis. If you kind of compare it to driving down an expressway, there could be one lane closed, two lanes closed or three lanes closed, right? That can definitely affect the degree of symptoms and kind of change what our treatment options are.

Host: And I'm assuming there's a range of symptoms, and as you said, for diagnosis, it's patient history, imaging, what are the things, you know, what do we as sufferers of spinal stenosis, what do we usually experience?

Wajeeh Bakhsh, MD: So the symptoms of spinal stenosis will often include back pain, but there are a million reasons for back pain. So that alone doesn't tell us too much.

Host: Yeah.

Wajeeh Bakhsh, MD: But the telltale signs are aching pain in the legs, pain that can kind of travel down the backs of the thighs and go down into the legs or the feet.

And this pain is usually worse with standing or walking. Patients will notice they can't really stand or walk really far without having to either lean forward over something or take a seat and take a break for some relief. Something that we call the shopping cart sign means that folks can walk a lot further if they have something to lean over, such as a shopping cart. So you'll patients will often tell me hey I can't really walk more than a half a block but I can make it around the store as long as I have something to lean over. That's a telltale sign of spinal stenosis type picture.

Host: Okay. Yeah. And you mentioned the sort of rare form of it in children, more congenital, if you will. So I'm guessing family history and genetics, not a big part of this, maybe for adults, but just generally speaking, what are the causes of spinal stenosis?

Wajeeh Bakhsh, MD: So it's such a common diagnosis and a part of it, we do say it's multifactorial. I'm sure if you have a running family history of it, there's some part of this that we haven't necessarily directly mapped to a gene yet, but there is some kind of contribution from a family history. The most common cause is just degeneration over time. Arthritis and wear and tear throughout the spine leads to the walls kind of closing in. You have some what we call tissue hypertrophy. There's a ligament that helps support the spine and that gets thicker with age. And if that gets too thick, you can start crowding the nerves. The bone spurs from the vertebrae in the spine can start kind of creeping in from one side.

 And all of that kind of contributes to narrowing the canal in a degenerative picture. Other causes, like if you have a, like a frank disc herniation from a spine injury, whether it's like a lifting injury, a twisting injury, a car accident, any number of back injuries, and that can result in a disc herniation.

What a disc herniation is, is disc material that's supposed to be within the spine, the bony spine, that can kind of squish out into the canal. And then you have something taking up quite a bit of space in the canal. So similar to how we described it with the expressway, now you've got two, three lanes closed because of this disc herniation. So you've got a lot of traffic and that can contribute to spinal stenosis.

Host: Yeah. And those of us in Indiana and Illinois, we're familiar with roads being closed and how frustrating that could be. And in this case with our backs, how painful. What are some of the risk factors? You said wear and tear. So is it folks that use their backs a lot, injure their backs a lot. Like, how do we end up getting this?

Wajeeh Bakhsh, MD: Sure, so risk factors, they can include previous spinal injury, that can contribute to it. Something that we always have to kind of keep in mind is the heavier you are, the more stress your back sees, and that can lead to a little bit more rapid thickening of the ligaments and wear and tear throughout the spine.

 And then also, when you get really into clinical obesity, you can have a prominence of fat within the spinal canal, that can contribute to taking up space there and then as always smoking is a factor for just about everything that causes pain. So those are the things to kind of keep in mind and try to avoid if you want to avoid having these symptoms.

Host: Yeah, and you mentioned earlier that it, you know, it sort of originates in the spine, in our backs, but then it kind of can spread out for folks to the arms, the legs. So, what are some of the other physical complications that folks might experience?

Wajeeh Bakhsh, MD: So when you've got pressure on the spinal nerves, everywhere that the nerves go can suffer, and primarily that's in the legs because this is more a problem in the lower spine than anywhere else. And that can lead to significant leg weakness, and if this goes on for long enough, and the nerves aren't talking to the muscles anymore, you can lead to permanent weakness and atrophy of the muscles.

Most commonly, it'll present with kind of pain and fatigue. And if you let this go unchecked, and it starts really crowding all the nerves, and putting a lot of pressure on them, it can give you some trouble with going to the bathroom. And that's when things get really kind of urgent, where you need to have something done.

Host: Yeah. Urgent, literally, figuratively, of course, and I teased a little bit at the beginning that, you know, you're on the cutting edge of treatment for this. So let's talk about some of the latest advancements in care for spinal stenosis.

Wajeeh Bakhsh, MD: So there are minimally invasive ways to what we call decompress or to open up the spinal canal to take the pressure off the nerves and get some relief. The asterisk is, you know, with all latest and greatest technologies, not all of them are tested or reliable. So the short answer is you've got to consult with a surgeon that you trust to kind of walk you through what your options are.

 You can go as far as to the old school way of just big and like bigger incision, take the pressure off the nerves. And sometimes you need that. And then sometimes you can do like a minimally invasive, what we call it microdiscectomy or what, it depends on what the pathology is, that kind of guides what the options are.

The end goal is to do what you need to do to get symptom relief and take the pressure off the nerves. And a quick chat with a surgeon will help you sort that out.

Host: Yeah, for sure. Yeah. And it would be difficult to really get into the nitty gritty of surgeries since we don't have the benefit of pictures and things like that. So at least you give us a sense there, that there are options and we as patients, of course, doctors are patients too. We like to know there's options.

Just want to, as we get close to wrapping up here, find out about, you know, you mentioned smoking is always bad for everything, of course, but in terms of managing a healthy lifestyle, you know, once we've been diagnosed or trying to avoid diagnosis, what's your best advice?

Wajeeh Bakhsh, MD: So even though spinal stenosis can slow you down and you know, you can lead a healthy life and still develop arthritis because nothing can stop Father Time. It is important to stay active. You know, we always say use it or lose it, and that really does kind of play a role here. Don't let it slow you down too much.

Stay active. Stay loose. Keep moving around. Even if it hurts a little bit, kind of, the the whole goal is to stay active and live the best life that you can. And when it gets to the point that you need help, we're always here.

Host: Yeah, that's perfect. There's just things we can't outrun. Family history, genetics, Father Time. There's just certain races we're going to lose. But as you say, keep active, keep moving, push through. Sometimes we all benefit from having the shopping cart. I'm not going to lie. I don't think I have spinal stenosis, but I don't mind, you know, when I get to push the cart around. So I, as I mentioned, we're going to talk again soon about scoliosis. Thanks so much.

Wajeeh Bakhsh, MD: Of course.

Host: And to learn more, visit franciscanhealth.org and search spinal stenosis.

And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.