Transcription:
Lumbar Stenosis

Amanda Wilde (Host): Lumbar stenosis is a narrowing of the lower spine and it can cause all kinds of discomfort today. We'll talk about diagnosis and treatment of lumbar stenosis with Dr. Esteban Cuartas orthopedic spine surgeon at Montefiore St. Luke's Cornwall. Welcome to Doc Talk presented by Montefiore St. Luke's Cornwall. Great to have you here, Dr. Cuartas. Welcome.

Dr Esteban Cuartas: Thank you. Thank you for having me.

Amanda Wilde (Host): Can you give a quick sort of layman's anatomical explanation of what lumbar stenosis is?

Dr Esteban Cuartas: Sure. So the spine, does two basic things. One is hold up the whole structure of your, body and serve as an attachment for muscles, but it's also a conduit or basically like a pipe that carries the nerves, which are like the electrical wires, to your arms and to your legs. So when we're talking about stenosis, we're talking about the fact that that pipe or that, conduit is getting narrower over time. And then we start to present with symptoms, related to the narrowing, which would be, either nerve symptoms or claudication.

So claudication, comes from the Latin, for, having to stop walking. So it's a symptom where by, the person can't walk very far. And it sort of sounds more complicated than it is. So it's for example, when you, taking a walk with a grandmother or so, and they have to stop walking and take a seat. So in a way that symptom is called claudication.

Amanda Wilde (Host): I see. Now, when we're talking about symptoms, is there a range of symptoms someone may have, or are they fairly predictable?

Dr Esteban Cuartas: No, there's a very broad range of symptoms. Some people can have very bad stenosis on imaging, which is to say in, reality their Spinal canal could be very narrow and they could have very scanned symptoms or sometimes none at all. Or they can, oscillate and change over different days depending on the activity level. But the symptoms can vary from basically not much at all to a dull, low, level ache in the lower back, buttock area, to a more, distinct nerve pain, type of symptom. Where there is nerve, pain radi down a leg with, either tingling or numbness, associated with it as well.

Amanda Wilde (Host): So we know lumbar stenosis is caused by a narrowing, but what causes that to happen? That narrowing?

Dr Esteban Cuartas: So I would say there's two, broad categories that we see in the clinic. One, it's narrowing that happens through the degenerative processes, which is basically through getting older. So the process of getting older for the spine, involves all the multiple joints that we have. We have essentially three joints between each vertebral bone, we have a disc and we have the facet, joints, posteriorly. And all these joints, develop arthritis and wear and tear as we get older. And the main portion of the arthritis involves the smaller joints that tend to get bigger, or grow bone spurs, such as the knuckles in people's hands.

Some folks that tend to develop much bigger knuckles and the same process happens in the spine, specifically in the posterior aspect of the spine. Where we have a facet joints. And then the discs also, undergo a process of wear and tear. And the main thing that we see is that there's loss of height, which then also leads to sort of overcrowding of all the structures and of, impingement or narrowing of the spinal canal, related to all of these changes.

Amanda Wilde (Host): So what can we do about lumbar stenosis? What are their options for treatment?

Dr Esteban Cuartas: To some extent, some of these things are predetermined. Some folks are born with very small spinal canal dimensions, and we call that congenital spinal stenosis. Which when you're born and you're a young child or a young, adult knee feel totally fine despite having smaller, spinal canal that I mentioned. But then when you start to develop, wear and tear, then you can develop symptoms. So some of these things are, things that we're born with.

Some of them are genetically determined. Like for example, the rate at which we develop, wear and tear and arthritis is probably, very strongly genetically determined. We do see folks that, develop arthritis very rapidly at an earlier age in the spine. And some, folks that don't develop that much arthritis. So, those things are innate. What can we do to prevent these symptoms and this problem? I would say that for the most part, staying fit, staying active, trying to maintain good muscle tone, especially around the core. This all probably helps, stave off some of the wear and tear, and some of the symptoms.

Amanda Wilde (Host): Is lumbar stenosis progressive then once you are feeling symptoms, is that going to get worse? Is it curable or do you have to live with it?

Dr Esteban Cuartas: Yes, I would say that, it is something that is progressive. What we don't know is how fast is it going to progress. So typically patients that we're seeing, in clinic for spinal stenosis. we will follow them for some time and, try to get a feel for what their symptoms are really doing over time. Are they oscillating? Are they, going away for long periods of time or are they really progressively, impairing their quality of life, and their function? So everybody's different.

Amanda Wilde (Host): How do you diagnose the lumbar stenosis? Does that require x-ray or CT, or what tools do you use?

Dr Esteban Cuartas: We go initially by history, which is, very important in the clinical evaluation of the spine patient. For example, we definitely have to pay attention to what kind of symptoms the patient is having, how long they've had them, what makes them worse? Are they being able to walk enough to meet their needs? Or, sometimes it's the spouse or the significant other that lets us know, oh, he doesn't, or she doesn't want to walk anymore and, or they can't really take care of the basic activities of daily living.

And so the first step is really, the history. And that almost gives us a pretty good idea of what we're looking for. And obviously then we also depend, on imaging and MRI imaging has been really the workhorse of, evaluation of the spine patient.

Amanda Wilde (Host): Can lumbar stenosis get better?

Dr Esteban Cuartas: I would say yes and no. I think that the imaging, may not really get much better over time, in general. But the symptoms can get better. Some patients respond rather well to physical therapy into conditioning. I think probably that has to do with the more fit you are the better you can compensate and adjust your position, and really push through some of these symptoms. So I think physical therapy can definitely help.

Amanda Wilde (Host): But the best thing we can do, it sounds like is to try to prevent spinal stenosis in the first place, or at least prevent it from worsening, even if we don't know yet that we have it. By doing core work and exercise and building those bones. Is there anything else we can do to prevent spinal stenosis?

Dr Esteban Cuartas: I don't think there's that much that we know for certain about this. I think leading a healthy lifestyle and inactive lifestyle is important. It's also important, to try to prevent injury to the spine. I think that, some of the changes that we see in the spine can be accelerated or initially trace back to an injury, either lifting something very heavy and damaging a disc. That disc later on can turn into what we commonly call a bulging disc And so on, so forth and that can lead to some stenosis.

So I think that injury prevention is key by really realizing what types of, activities such as heavy lifting or lifting while leaning forward or bent forward, are the most stressful to the spine. And then I think the activity level is probably not much that has been studied about that. But I do think that, progressive inactivity in a poor lifestyle, can trigger the genetic processes that lead to faster, development of arthritis .

Amanda Wilde (Host): So wear and tear is gonna happen, but there are wayss to deal with prevention such as injury prevention and just being aware of the way we use our bodies. When we do lift, when we do carry, even when we walk or sit.

Dr Esteban Cuartas: And I think just the activity level helps. The body responses like the age old maxima of use it or lose it. I think if we remain active that keeps the body and the genetic environment and the body from triggering some of these changes that, we see in the elderly folks, sometimes happen in younger patients.

Sometimes it's genetic, but I would say, Some folks start to develop calcification of ligaments very early on or stiffening of the spine very early on. and others don't. So I think that there's gonna be more to come about what are really triggers that we can modify or, prevent, but I think that just a common sense, at this time would be stay active, and prevent injuries.

Amanda Wilde (Host): Yep. Those are the keys. This is great information that sheds light on what we can do to address that lower back pain that so many of us suffer from. Thank you so much for your time and expertise, Dr. Cuartas.

Dr Esteban Cuartas: Thank you.

Amanda Wilde (Host): Thank you for listening to Doc Talk presented by Montefiore St. Luke's Cornwall. For more information, please visit Montefioreslc.org. That's Montefioreslc.org. And please remember to subscribe, rate and review this podcast and all other Montefiore St. Luke's Cornwall podcasts. I'm Amanda Wilde. Be well.