Spinal stenosis is a narrowing of the bone channel occupied by the spinal nerves or the spinal cord. Spinal stenosis occurs in many patients in their 50's and 60's but is not limited to that age group. Symptoms of spinal stenosis depend on the location and severity of the diseased area of the spine, and can include pain, numbness, tingling, weakness, and loss of function.
Listen as Matthew L. Dashnaw, MD discusses spinal stenosis and treatment options available at Rochester Regional Health.
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Living With Spinal Stenosis
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Learn more about Matthew L. Dashnaw, MD
Matthew L. Dashnaw, MD
Matthew L. Dashnaw, MD specializes in degenerative spine conditions, brain and spinal tumors, traumatic brain injury, hydrocephalus, trigeminal neuralgia/cranial nerve compression, peripheral nerve disorder and spinal trauma. After earning his Pharm. D. degree and working for a year as a pharmacist, Dr. Dashnaw earned a full scholarship to pursue his Doctor of Medicine at Ross University in New Jersey. There, he specialized in neurosurgery, publishing research on treating cognitive deficits in patients with schizophrenia, malignant glioma metastatic brain tumors, and traumatic brain injury and CSF movement. He then completed his Neurological Surgery residency at the University of Rochester Medical Center.Learn more about Matthew L. Dashnaw, MD
Transcription:
Living With Spinal Stenosis
Bill Klaproth (Host): As we age, many of us will develop spinal stenosis causing pain and other symptoms in our legs, arms, or torso, so what do we need to know about this? Here to explain more is Dr. Matthew Dashnaw, a specialist in degenerative spine conditions at Rochester Regional Health. Dr. Dashnaw, thanks for your time. So what is spinal stenosis? Let’s start with that.
Dr. Matthew Dashnaw (Guest): First of all, thanks a lot for having me today. Spinal stenosis is a medical condition whereas the canal that the spinal cord and spinal nerves travel through, that canal now becomes narrow. One analogy that I like to use when I explain it to my patients is if you consider the nerves that run from the spinal cord through the spine, and if you imagine those as like a napkin ring, somebody – as a napkin, excuse me – and when somebody develops spinal stenosis, if you imagine a napkin ring that becomes tighter and tighter around the napkin, which is the narrowing of the spinal canal, which is progressively compressing that sac of nerves. This pressure on the nerves causes pain, often times most commonly in the lumbar spine when it’s in the low back, it causes pain across the low back that can radiate into the hips and sometimes down the legs. It’s most commonly brought on by walking or standing up straight. Patients often times get relief from these symptoms when they sit down or if they bend forward. Very commonly, patients will – one question I always like to ask my patients is when you go to the grocery store, are you able to make it around the whole grocery store? Patients who have lumbar spinal stenosis commonly say, “Well, if I’m able to lean over onto the shopping cart I can make it around, but if I have to walk by myself and I have to try to stand up straight, I get this pain across my low back, and my legs and I have to sit, and when I sit the pain improves. So that’ essentially what spinal stenosis is in a nutshell.
Bill: Dr. Dashnaw, are we all going to get this? How does – who is at risk for this?
Dr. Dashnaw: It’s really a condition that’s more common with aging. As we age and we put our spine through wear and tear every day, it can cause an advancement of arthritis, and it’s really arthritis that causes this narrowing of the spinal canal. There are not really any known specific risk factors other than, really, age and arthritis, so there really isn’t a great way to predict who is going to get this. I would say just in my practice, I commonly see it more often in people that have had many years of hard working jobs where they do a lot of mechanical lifting for many years and that does take its toll on the spine, but I’ve also seen it in elderly folks who have had mostly sedentary lifestyles, so it is pretty hard to predict.
Bill: Is this something that through lifestyle changes, can be avoided?
Dr. Dashnaw: The one thing that can sometimes slow the progression is, in patients that are obese trying to reduce body weight can sometimes decrease the wear and tear on the spine. The other thing that I would say is using healthy lifting techniques, lifting properly by bending at the knees and not bending at the waist, can sometimes help to prevent a precipitation of symptoms or a worsening of symptoms, but unfortunately, for much of the population, if you’re bound to develop spinal stenosis, there’s not a whole lot that you can do to prevent it.
Bill: And you said sharp pain when standing up is one of the symptoms and as I mentioned in the opening numbness and tingling in the legs, arms, or torso, what are some of the other tell-tale symptoms?
Dr. Dashnaw: The biggest complaint of patients who suffer from spinal stenosis is the inability to walk. When I ask people – often times when I come into my office I say, “Okay, pretend I’m a magician, and I can make one symptom you’re having disappear, but only one symptom,” and if they patient says, “I just want to be able to walk again because I can’t walk for a far distance without getting pain across the low back and numbness and tingling in the legs and its relief when sitting down,” that is the classic story. In addition, if there is a very, very severe case of spinal stenosis, patients can start to lose sensation in the groin area, or can have difficulty being able to tell when their bladder is full. They may even have some accidents with urine or fecal material. That is a sign that things have progressed very, very severely and that getting immediate medical attention would be important.
In addition to those symptoms, sometimes people may notice a weakness in one or both legs, or even in one specific muscle group in the leg depending on at what level the narrowing is occurring at. This can cause a focal weakness say in a calf muscle on one side or being able to lift the food upwards towards the ceiling when standing, or some other focal [CLEARS THROAT] muscle group, excuse me.
Bill: For someone who has this, is there a way to treat it?
Dr. Dashnaw: Absolutely. There are a whole list of both nonsurgical methods and surgical treatments for lumbar spinal stenosis. We generally start with physical therapy. There is some data to show that doing certain physical therapy exercises may help patients to open up that spinal canal and even just some small amount of opening may provide a good amount of relief for patients and it may help them manage very well with spinal stenosis. There are different therapies that a physical therapist could initiate. There are also a collection of medications that may help with the inflammation in the region and then getting a little bit more complex going up the scheme of treatments. There sometimes can be some benefit had from local injection of steroids, which a pain management doctor may be able to provide. Then, finally, when all of the nonsurgical options have been exhausted, we can consider a surgical decompression where there is an operation that I can do that takes about an hour or two of actual operating time in the OR and to remove the arthritic process that is pushing on the sac of nerves to relieve the pressure.
Bill: So through physical therapy or these other means, someone then can potentially manage this throughout their life to cut the pain that they may be having, at least so they can go on with a normal lifestyle.
Dr. Dashnaw: Yes, absolutely. Many patients – well, for example, in a given day I see a good number of patients, and on average, I may see seven or eight patients in my office, but only operate on one of them, and we’re able to usually provide good relief of symptoms with more conservative measures of therapy. I think that’s one misconception that patients often have when they come to see me is that, “Oh, well if I have spinal stenosis, the only way to treat it is with surgery,” and it’s really not the case. There are a lot of other good treatments to be had out there.
The other misconception that patients often have is what is the natural history of spinal stenosis, meaning if we did nothing, and we follow patient's for, say 10 years with spinal stenosis, are they all bound to get worse and eventually lose function in their bowel or bladder and not be able to walk at all and the answer is really, no. The natural history studies that have been done show that about 70% of patients without treatment will stay stable. They won’t progressively get worse. About 10 to 15% get better, and about another 15% may get progressively worse overtime, but it’s usually a gradual decline. I think patients have time to try conservative measures of therapy before considering a surgery if that’s what is ultimately necessary.
Bill: Well, there are a few bright spots, and that’s very good to hear that it basically stabilizes out and through physical therapy, you can learn to manage this and that surgery isn’t the only option and it makes me think, “Maybe one of the ways to avoid this is to stay active. If physical therapy can help alleviate the problems, maybe you can avoid the problems through being active throughout your older years, as well. That’s really good advice and good to know. Dr. Dashnaw, thank you again, for your time today. If you could wrap it up for us, why should someone choose Rochester Regional Health for their healthcare needs?
Dr. Dashnaw: I have been very fortunate to work all throughout Rochester during both my training and as an attending Neurosurgeon, and I would say – to answer that question, the thing that I find credible about Rochester Regional is that there are a group of doctors in every specialty here that really sit down and take the time to listen to patients. At the end of the day every patient just wants to get better, and at Rochester Regional we don’t treat an image, or we don’t treat a blood test, what we treat is our patients. I think Rochester Regional does a great job of listening to patients.
In addition to that, there is excellent care across the spectrum in terms of physical therapy, pain management, knowing what are the best drugs to try. We really provide a comprehensive set of good, quality care across the board. That’s why I think Rochester Regional would be my system of choice.
Bill: Many benefits in that listening is so important because patients want to be heard and the physician is truly listening to them, and that’s so important that communication. Thank you again, Dr. Dashnaw, for your time. You're listening to Rock Your Health Radio at Rochester Regional Health. For more information, you can go to RochesterRegional.org. That’s RochesterRegional.org. I’m Bill Klaproth, thanks for listening.
Living With Spinal Stenosis
Bill Klaproth (Host): As we age, many of us will develop spinal stenosis causing pain and other symptoms in our legs, arms, or torso, so what do we need to know about this? Here to explain more is Dr. Matthew Dashnaw, a specialist in degenerative spine conditions at Rochester Regional Health. Dr. Dashnaw, thanks for your time. So what is spinal stenosis? Let’s start with that.
Dr. Matthew Dashnaw (Guest): First of all, thanks a lot for having me today. Spinal stenosis is a medical condition whereas the canal that the spinal cord and spinal nerves travel through, that canal now becomes narrow. One analogy that I like to use when I explain it to my patients is if you consider the nerves that run from the spinal cord through the spine, and if you imagine those as like a napkin ring, somebody – as a napkin, excuse me – and when somebody develops spinal stenosis, if you imagine a napkin ring that becomes tighter and tighter around the napkin, which is the narrowing of the spinal canal, which is progressively compressing that sac of nerves. This pressure on the nerves causes pain, often times most commonly in the lumbar spine when it’s in the low back, it causes pain across the low back that can radiate into the hips and sometimes down the legs. It’s most commonly brought on by walking or standing up straight. Patients often times get relief from these symptoms when they sit down or if they bend forward. Very commonly, patients will – one question I always like to ask my patients is when you go to the grocery store, are you able to make it around the whole grocery store? Patients who have lumbar spinal stenosis commonly say, “Well, if I’m able to lean over onto the shopping cart I can make it around, but if I have to walk by myself and I have to try to stand up straight, I get this pain across my low back, and my legs and I have to sit, and when I sit the pain improves. So that’ essentially what spinal stenosis is in a nutshell.
Bill: Dr. Dashnaw, are we all going to get this? How does – who is at risk for this?
Dr. Dashnaw: It’s really a condition that’s more common with aging. As we age and we put our spine through wear and tear every day, it can cause an advancement of arthritis, and it’s really arthritis that causes this narrowing of the spinal canal. There are not really any known specific risk factors other than, really, age and arthritis, so there really isn’t a great way to predict who is going to get this. I would say just in my practice, I commonly see it more often in people that have had many years of hard working jobs where they do a lot of mechanical lifting for many years and that does take its toll on the spine, but I’ve also seen it in elderly folks who have had mostly sedentary lifestyles, so it is pretty hard to predict.
Bill: Is this something that through lifestyle changes, can be avoided?
Dr. Dashnaw: The one thing that can sometimes slow the progression is, in patients that are obese trying to reduce body weight can sometimes decrease the wear and tear on the spine. The other thing that I would say is using healthy lifting techniques, lifting properly by bending at the knees and not bending at the waist, can sometimes help to prevent a precipitation of symptoms or a worsening of symptoms, but unfortunately, for much of the population, if you’re bound to develop spinal stenosis, there’s not a whole lot that you can do to prevent it.
Bill: And you said sharp pain when standing up is one of the symptoms and as I mentioned in the opening numbness and tingling in the legs, arms, or torso, what are some of the other tell-tale symptoms?
Dr. Dashnaw: The biggest complaint of patients who suffer from spinal stenosis is the inability to walk. When I ask people – often times when I come into my office I say, “Okay, pretend I’m a magician, and I can make one symptom you’re having disappear, but only one symptom,” and if they patient says, “I just want to be able to walk again because I can’t walk for a far distance without getting pain across the low back and numbness and tingling in the legs and its relief when sitting down,” that is the classic story. In addition, if there is a very, very severe case of spinal stenosis, patients can start to lose sensation in the groin area, or can have difficulty being able to tell when their bladder is full. They may even have some accidents with urine or fecal material. That is a sign that things have progressed very, very severely and that getting immediate medical attention would be important.
In addition to those symptoms, sometimes people may notice a weakness in one or both legs, or even in one specific muscle group in the leg depending on at what level the narrowing is occurring at. This can cause a focal weakness say in a calf muscle on one side or being able to lift the food upwards towards the ceiling when standing, or some other focal [CLEARS THROAT] muscle group, excuse me.
Bill: For someone who has this, is there a way to treat it?
Dr. Dashnaw: Absolutely. There are a whole list of both nonsurgical methods and surgical treatments for lumbar spinal stenosis. We generally start with physical therapy. There is some data to show that doing certain physical therapy exercises may help patients to open up that spinal canal and even just some small amount of opening may provide a good amount of relief for patients and it may help them manage very well with spinal stenosis. There are different therapies that a physical therapist could initiate. There are also a collection of medications that may help with the inflammation in the region and then getting a little bit more complex going up the scheme of treatments. There sometimes can be some benefit had from local injection of steroids, which a pain management doctor may be able to provide. Then, finally, when all of the nonsurgical options have been exhausted, we can consider a surgical decompression where there is an operation that I can do that takes about an hour or two of actual operating time in the OR and to remove the arthritic process that is pushing on the sac of nerves to relieve the pressure.
Bill: So through physical therapy or these other means, someone then can potentially manage this throughout their life to cut the pain that they may be having, at least so they can go on with a normal lifestyle.
Dr. Dashnaw: Yes, absolutely. Many patients – well, for example, in a given day I see a good number of patients, and on average, I may see seven or eight patients in my office, but only operate on one of them, and we’re able to usually provide good relief of symptoms with more conservative measures of therapy. I think that’s one misconception that patients often have when they come to see me is that, “Oh, well if I have spinal stenosis, the only way to treat it is with surgery,” and it’s really not the case. There are a lot of other good treatments to be had out there.
The other misconception that patients often have is what is the natural history of spinal stenosis, meaning if we did nothing, and we follow patient's for, say 10 years with spinal stenosis, are they all bound to get worse and eventually lose function in their bowel or bladder and not be able to walk at all and the answer is really, no. The natural history studies that have been done show that about 70% of patients without treatment will stay stable. They won’t progressively get worse. About 10 to 15% get better, and about another 15% may get progressively worse overtime, but it’s usually a gradual decline. I think patients have time to try conservative measures of therapy before considering a surgery if that’s what is ultimately necessary.
Bill: Well, there are a few bright spots, and that’s very good to hear that it basically stabilizes out and through physical therapy, you can learn to manage this and that surgery isn’t the only option and it makes me think, “Maybe one of the ways to avoid this is to stay active. If physical therapy can help alleviate the problems, maybe you can avoid the problems through being active throughout your older years, as well. That’s really good advice and good to know. Dr. Dashnaw, thank you again, for your time today. If you could wrap it up for us, why should someone choose Rochester Regional Health for their healthcare needs?
Dr. Dashnaw: I have been very fortunate to work all throughout Rochester during both my training and as an attending Neurosurgeon, and I would say – to answer that question, the thing that I find credible about Rochester Regional is that there are a group of doctors in every specialty here that really sit down and take the time to listen to patients. At the end of the day every patient just wants to get better, and at Rochester Regional we don’t treat an image, or we don’t treat a blood test, what we treat is our patients. I think Rochester Regional does a great job of listening to patients.
In addition to that, there is excellent care across the spectrum in terms of physical therapy, pain management, knowing what are the best drugs to try. We really provide a comprehensive set of good, quality care across the board. That’s why I think Rochester Regional would be my system of choice.
Bill: Many benefits in that listening is so important because patients want to be heard and the physician is truly listening to them, and that’s so important that communication. Thank you again, Dr. Dashnaw, for your time. You're listening to Rock Your Health Radio at Rochester Regional Health. For more information, you can go to RochesterRegional.org. That’s RochesterRegional.org. I’m Bill Klaproth, thanks for listening.