WHAT IS STENOSIS?
The word, "stenosis" automatically implies that you are dealing with a tube or canal.   Stenosis simply means that this tube or canal, for whatever reason, is getting smaller.  Thus, Spinal Stenosis is the name given to the condition of calcium deposition involving the spinal bones and ligaments that affect (shrink / compress) the Spinal Canal. 

The picture on the left is from the legendary anatomy textbook, Gray's Anatomy.  The other is a simple drawing.  Note that in these pictures, the spinous processes are opposite each other.  They are both top views of a Spinal Vertebrae.  In both pictures, you can see the rings (ligament layers) that make up the outer disc's Anulus Fibrosus.  The Annulus is what holds the jelly center of the disc (the Nucleus Pulposus) in place.  Notice how the Central Canal in the picture below is smaller (stenotic).

Now, look at the big hole in the middle ---- just (behind) the disc?  This is the Spinal Canal (sometimes called the Central Canal).  When you stack the 24 spinal vertebrae on top of each other, all of these large "holes" line up with each other to create a long tube.  This tube (the Spinal Canal) is where the Spinal Cord is housed.  

___ HOW COMMON IS SPINAL STENOSIS:
Believe it or not, in the United States, one of the most common reasons for Spinal Surgeries in the over-60 crowd is Spinal Stenosis of the lumbar spine (low back). Current estimates by the American Association of Neurological Surgeons (AANS) put the number of elderly suffering with Spinal Stenosis at almost half a million people and growing rapidly.  Right now nearly one in five Americans is over 60 ---- so the number of people struggling with Spinal Stenosis will continue to grow as our population ages and gets increasingly heavier.

SPINAL STENOSIS DEFINITION:
According to the most common definition, published in a 1976 issue of the medical journal Clinical Orthopedics, Spinal Stenosis of the low back is caused by narrowing of the Central Canal. This causes nerves to be pinched, which leads to unrelenting buttock pain pain, limping, lack of sensation in the legs, altered sensation in the legs, numbness, tingling, diminished strength, and decreased physical activity. Although there are several types of Spinal Stenosis, there is only one that we will deal with here, as it is the one that responds to Spinal Decompression Therapy.

DEGENERATIVE SPINAL STENOSIS:
By far, the most common type of Spinal Stenosis is Degenerative Stenosis. The truth is, if you live long enough, you will probably end up with at least a small degree of Degenerative Spinal Stenosis.  It is a degenerative narrowing of the Spinal Canal (Central Canal) and nerve root canals (Intervertebral Foramen).   And in similar fashion to DEGENERATIVE DISCS, is characterized by bone and ligament calcification / thickening in the spine. This calcification results thickening of supporting ligaments, which cause a subsequent narrowing of the Central Canal.  As you might imagine, this causes compression of spinal nerves and nerve roots ----- and sometimes, even the Spinal Cord itself.  All of this creates the "Perfect Storm" that can cause the myriad of symptoms that we discussed in the previous paragraph.

WHAT CAUSES DEGENERATIVE SPINAL STENOSIS?
Degenerative changes in the vertebrae and surrounding spinal structures (ligaments, discs, tendons, bones, cartilage, etc) is affected by age.  However, if you read the piece on DISC DEGENERATION, you are already aware that age is often times an all too convenient scape goat.  The biggest reason people get Spinal Stenosis is mechanical dysfunction over time.

As the body weakens and dehydrates with age and / or injury, bones and ligaments hypertrophy (they "thicken" or get slightly bigger).  This is due to a buildup of calcium deposits as the body tries to stabilize itself.  However, despite this hypertrophy, the bones themselves become less dense (osteoporosis) and the discs of the spine can lose their height as well as their fluid.

The discs compress, causing tilting, slippage and rotation of vertebral bodies (SUBLUXATION). This results in compression of the pain-sensitive thecal sac that surrounds the Spinal Cord.  It can also cause compression of the Spinal Nerves as well.  In some cases, bone spurs form in the Intervertebral Foramen (Foraminal Stenosis).  This can cause compression of Spinal Nerve Roots as they exit through the Intervertebral Foramen and travel through the lower back, buttock, and  down the legs.  This typically leads to chronic low back pain and intermittent numbness and weakness in the legs (SCIATICA SYMPTOMS).

CALCIFICATION OF LIGAMENTUM FLAVUM:
If you have ever had a chance to look at a spine taken from a cadaver, you will notice a huge difference from the model spines seen in doctor's offices or science classrooms.  Model skeletons or model spines show you the bones only.  While this is great for learning anatomy, it does not give one a very lifelike picture of what the spine actually looks like or how it really functions. 

To say that the spine is held together with ligaments is a gross understatement.  The spine is literally "mummified" in ligaments ---- inside and out!  Yes, interestingly enough, some of these ligaments are on the inside of the Spinal Canal.  The ligament that runs the entire length of the back part of the Spinal Canal is called Ligamentum Flavum, while the ligament that runs the entire length of the front of the Spinal Canal (against the vertebrate and discs) is called the Posterior Longitudinal Ligament.  Simply understand that the Spinal Cord sits in the Spinal Canal, but never touches the bones or discs.  It touches these and other ligaments.

Hypertrophy, thickening, and calcification of these spinal ligaments (particularly the Ligamentum Flavum) can reduce the space available to the Spinal Cord and Spinal Nerves.  Ligaments tend to stiffen with age and injury, and can "buckle" into the Central Canal.  This creates additional areas of compression and pain.  Degenerative Arthritis (sometimes referred to as Degenerative Disc Disease (DDD), Degenerative Joint Disease (DJD) or DISC DEGENERATION) will often compound the problem by increasing the stiffness and inflexibility of the ligaments and joints.  In addition, Spinal Discs tend to dehydrate with age.  None of this is a good thing.

_I could not resist putting up this video.  All I can say is Amazing!  It is a video interview of Encino California's Dr. Bruce Shannahoff (a true expert in Non-Surgical Spinal Decompression Therapy), being interviewed by one of his patient's families.  The gentleman that Dr. Shannahoff is treating (Al Podrid) looks to be between 85-90 years old --- maybe older.  At the 3:00 minute mark of the video, Dr. S will show you one of the worst Lumbar MRI's I have ever seen in my life!  It is an amazing example of Lumbar Spinal Stenosis.  If someone with problem's like Al's can get better with non-surgical Spinal Decompression Therapy, there is hope for just about anyone!  Thank you Podrid family for this awesome video!

_In the April 2010 issue of JAMA (Journal of the American Medical Association), several doctors from Portland Oregon's Health and Science University published a study called Trends, Major Medical Complications, and Charges Associated with Surgery for Lumbar Spinal Stenosis in Older Adults.

The truth is, when it comes to back surgeries, even a significant number of doctors and surgeons admit that there is a serious lack of evidence-based support for more complicated and risky Spinal Fusion Surgeries that are commonly done for elderly stenosis patients. There is, however, a significant financial incentive to both hospitals and surgeons to perform lots of these low back fusions.

SPINAL STENOSIS (the typically age-related narrowing of the spinal canal --- usually due to to enlarging thickening of the ligaments inside the spinal canal --- usually Ligamentum Flavum) is the most frequent cause for spinal surgery in the elderly.  Although there was a slight overall decrease in spinal surgeries between 2002 and 2007, there was an utterly shocking 1,500% increase in spinal fusions.   Could this massive increase in a dangerous and typically-ineffective spinal surgery be just about the money?  Many doctors believe it is.

The Journal of the American Medical Association concluded that,"It is unclear why more complex operations are increasing. It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just 6 years. The introduction and marketing of new surgical devices and the influence of key opinion leaders may stimulate more invasive surgery, even in the absence of new indications…   financial incentives to hospitals and surgeons for more complex procedures may play a role…”

There is a significant difference in average hospital costs for simple decompression spinal surgery versus complex surgical fusion. The cost of the less invasive surgery is $23,724 compared to an average of $80,888 for a spinal fusion.  Despite the much higher cost, there is no scientific evidence of superior outcomes.  And while there are significant risks associated with the cheaper surgery, there are much greater risks of adverse events associated with the spinal fusion.  So why perform these surgeries?  Can anyone say "MONEY"?  The surgeon is typically reimbursed $600 to $800 for the less invasive back surgeries and approximately ten times more ($6,000 to $8,000) for the complex fusions.

In an accompanying JAMA editorial written by Dr. Carragee of Stanford University School of Medicine, the following comment was made. “In 2007, the final year of data reported in the study, Consumer Reports [the magazine] rated spinal surgery as number 1 on its list of overused tests and treatments. This was a harsh rebuke.....   The findings from the study should not only remind patients, surgeons, and payors that the efficacy of basic spinal techniques must be assessed carefully against the plethora of unproven but financially attractive alternatives, but also should serve as an important reminder that as currently configured, financial incentives and market forces do not favor this careful assessment before technologies are widely adopted. When applied broadly across medical care in the United States, the result is a formidable economic and social problem.”  Thanks Dr. C.  But why don't we just call a spade a spade and admit to the general population (in plain English) that it is becoming increasingly difficult to trust anyone in the medical field?  There is just too much money as stake (HERE)!


MY SUGGESTION:
Spinal surgeries, even the less invasive and cheaper ones that the article above mentions, are frequently a bust --- a bust that frequently leaves people worse off than they were before the surgery!  Even John-Q Citizen on the street knows that they rarely work like they're supposed to!  Just read the related medical studies!  Or better yet, find 10 people that you know who have had spinal surgery and ask them how they feel about their results.  I promise you that you will be lucky if 30% have good things to say.  Many people will tell you it made no difference.  Many others, like we mentioned above, will tell you they are worse because of it! 

If you are one of those folks who is struggling with chronic and debilitating spinal pain, pick up the phone and call (417) 934 -6337 to see if Spinal Decompression Therapy MIGHT BE A GOOD OPTION FOR YOU.  Dr. Schierling will sit down with you, go over your history, and review your tests.  If he thinks that Spinal Decompression Therapy will help you, he will tell you.  Unfortunately, NOT EVERYONE IS A GOOD CANDIDATE.  But if you are, the results could be life changing!