Surgery for Spinal Stenosis?
X-Ray indicated that my wife has what is called as spinal stenosis. Physical therapy have not helped much and now surgery seems to be the solitary option. I'm told that the success rate is about 70% and in attendance are other horor stories that make is wonder whether it's worth taking the risk. I would appreciate if you would share your experience or someone in your family who have gone through the surgery. Thanks
Answers: As a PT, and a spine specialist, and the daughter of someone with advanced spinal stenosis, I have a lot to proposition.
First, just because the stenosis shows up on an x-ray does not mean it is the source of her symptoms. Second, there are loving of two basic type of stenosis...ones caused by soft tissue obstructions, and those cause by boney obstructions. The soft tissue obstructions are often reversible...but I'll draw from into that for a moment. Since she's had an x-ray (no mention of MRI) we can assume some type of evidence of boney obstruction. .yet, again, lately because it's there does not mean it's the cause of her symptoms. Stenosis recurrently appear on x-rays...especially after the age of 50...even in those who have no back throbbing whatsoever.
True boney stenosis has a very predictable pattern. Back and leg throbbing (can be one leg or both, but usually both) upon rising and walking that happens EVERY time she walks and is relieved EVERYTIME she sits down or bends over. Sitting is usually never a problem and is often the position of greatest nouns. This is because of the position of the spinal canal in such maneuvers. For these folks, PT can only show one how to order the symptoms temporarily, but we know they will return. Advanced stenosis can lead to loss of sensation and position sense in the feet, loss of match, etc. For these folks, surgery for a decompressive laminectomy is usually the choice of surgery to open the spinal canal. Yet, multiple decompressions often head to a fusion.
Are your wife's symptoms more variable? Are there times she can walk lacking pain? Does beding backwards or sideways, etc make her feel better? Does sitting ever bring her symptoms? If so, we must consider that there is a more changable lesion present. Without getting into too much medical detail, there is a large group of patients whose symptoms can be swiftly reversed with a very specific approach to classification and treatment. I am not sure what your wifes PT entailed, but if her PT is not a certified MDT provider, I would suggest you check one out: http://www.mckenziemdt.org I've see many people who were told they own stenosis actually have complete relief of their symptoms contained by a few short visits...often times after they have "failed" "traditional PT" of grill, massage, ultrasound, and "stabilization" exercises.
Now, my father was a true boney stenosis type person...he could sit adjectives day long without pain, but couldn't waddle more than 50 feet...complete with inability to feel his foot when walking and loss of balance. He underwent spinal decompression...numerous times. It was successful within restoring his leg function and sense of balance, yet he continues to have significant rear pain...but only when standing and walking. He did finally opt for a fusion, but because of his advanced stage of disease, was fused from T-4-L-4...We know he will other have back pain...our goal are simple at this point...to be able to go to the store without a perambulator or shopping cart...to walk a few hundred feet unassisted. It's in a minute 3 months post operative and his ability to stand is better, but he has a long way to step. Granted, my dad represents some of the most advanced stages of the disease.
In the end, I would first see if your wifes PT is certified in MDT. That way, you can getting a better pedal on the presentation of her classification...is this a truely stenotic presentation? Or is there a possibility of reversal. Don't put all your eggs in one picnic basket based on an x-ray. There are still a lot more possibilities to explore. In my opinion, 50% of relatives who are given the diagnosis of "stenosis" based on an x-ray have symptoms that are absolutely not realted to their x-ray and are repeatedly reversible.
Good luck
You don't state whether the stenosis is in the neck or lower back. There is also no mention as to whether or not at hand is going to be any fusion or fusions done. I know that the process is painful and she has gone through therapy but how much work is she doing at home. The treatment can only go so far without her doing the movements asked of her. The program should include flexibility and strengthening plus big emphysis on posture. The stenosis cannot be reversed but it can be controlled through constant exercising. What is your wife's weight like. If she is overweight then bringing down the solidity will help significantly. Lastly if she is going to undergo the procedure check with as heaps neurosurgeons as possible. Do go with someone that you are comfortable with and who does greatly of this type of procedure. Ask about whether the procedure is going to include a fusion or not. Longterm fusions don't always workout as they place a lot of stress on the vertebrae above or below the fusion. Before the procedure manufacture sure that your wife is a strong as she can for the procedure will certainly decrease her strength levels. My father have spinal stenosis surgery March 1. He is definitely better but patience is necessary not so much for the surgery salvage but that it takes time for what I would call "remembered" pain to be in motion away. According to my father's surgeon what has happened is that the nerves have be sending pain signals to the brain and it takes time for them to "learn" that there isn't really spasm there anymore. Sort of like the nerves need to make well and forget the pain that used to be there. The surgeon said it would take 6 months for this to surface but for an older person (80ish) it can easily pilfer 12 months.
Be sure to ask around for a good back surgeon. We found one through our primary care physician whose father have this surgery done by a specific surgeon. That's a good enough referral for me especially when the father is brought to a local surgeon from out of state.
Surgery is worth the risk if there aren't any other vigour issues with surgery. The pain from spinal stenosis will NOT go away over time.
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Answers: As a PT, and a spine specialist, and the daughter of someone with advanced spinal stenosis, I have a lot to proposition.
First, just because the stenosis shows up on an x-ray does not mean it is the source of her symptoms. Second, there are loving of two basic type of stenosis...ones caused by soft tissue obstructions, and those cause by boney obstructions. The soft tissue obstructions are often reversible...but I'll draw from into that for a moment. Since she's had an x-ray (no mention of MRI) we can assume some type of evidence of boney obstruction. .yet, again, lately because it's there does not mean it's the cause of her symptoms. Stenosis recurrently appear on x-rays...especially after the age of 50...even in those who have no back throbbing whatsoever.
True boney stenosis has a very predictable pattern. Back and leg throbbing (can be one leg or both, but usually both) upon rising and walking that happens EVERY time she walks and is relieved EVERYTIME she sits down or bends over. Sitting is usually never a problem and is often the position of greatest nouns. This is because of the position of the spinal canal in such maneuvers. For these folks, PT can only show one how to order the symptoms temporarily, but we know they will return. Advanced stenosis can lead to loss of sensation and position sense in the feet, loss of match, etc. For these folks, surgery for a decompressive laminectomy is usually the choice of surgery to open the spinal canal. Yet, multiple decompressions often head to a fusion.
Are your wife's symptoms more variable? Are there times she can walk lacking pain? Does beding backwards or sideways, etc make her feel better? Does sitting ever bring her symptoms? If so, we must consider that there is a more changable lesion present. Without getting into too much medical detail, there is a large group of patients whose symptoms can be swiftly reversed with a very specific approach to classification and treatment. I am not sure what your wifes PT entailed, but if her PT is not a certified MDT provider, I would suggest you check one out: http://www.mckenziemdt.org I've see many people who were told they own stenosis actually have complete relief of their symptoms contained by a few short visits...often times after they have "failed" "traditional PT" of grill, massage, ultrasound, and "stabilization" exercises.
Now, my father was a true boney stenosis type person...he could sit adjectives day long without pain, but couldn't waddle more than 50 feet...complete with inability to feel his foot when walking and loss of balance. He underwent spinal decompression...numerous times. It was successful within restoring his leg function and sense of balance, yet he continues to have significant rear pain...but only when standing and walking. He did finally opt for a fusion, but because of his advanced stage of disease, was fused from T-4-L-4...We know he will other have back pain...our goal are simple at this point...to be able to go to the store without a perambulator or shopping cart...to walk a few hundred feet unassisted. It's in a minute 3 months post operative and his ability to stand is better, but he has a long way to step. Granted, my dad represents some of the most advanced stages of the disease.
In the end, I would first see if your wifes PT is certified in MDT. That way, you can getting a better pedal on the presentation of her classification...is this a truely stenotic presentation? Or is there a possibility of reversal. Don't put all your eggs in one picnic basket based on an x-ray. There are still a lot more possibilities to explore. In my opinion, 50% of relatives who are given the diagnosis of "stenosis" based on an x-ray have symptoms that are absolutely not realted to their x-ray and are repeatedly reversible.
Good luck
You don't state whether the stenosis is in the neck or lower back. There is also no mention as to whether or not at hand is going to be any fusion or fusions done. I know that the process is painful and she has gone through therapy but how much work is she doing at home. The treatment can only go so far without her doing the movements asked of her. The program should include flexibility and strengthening plus big emphysis on posture. The stenosis cannot be reversed but it can be controlled through constant exercising. What is your wife's weight like. If she is overweight then bringing down the solidity will help significantly. Lastly if she is going to undergo the procedure check with as heaps neurosurgeons as possible. Do go with someone that you are comfortable with and who does greatly of this type of procedure. Ask about whether the procedure is going to include a fusion or not. Longterm fusions don't always workout as they place a lot of stress on the vertebrae above or below the fusion. Before the procedure manufacture sure that your wife is a strong as she can for the procedure will certainly decrease her strength levels. My father have spinal stenosis surgery March 1. He is definitely better but patience is necessary not so much for the surgery salvage but that it takes time for what I would call "remembered" pain to be in motion away. According to my father's surgeon what has happened is that the nerves have be sending pain signals to the brain and it takes time for them to "learn" that there isn't really spasm there anymore. Sort of like the nerves need to make well and forget the pain that used to be there. The surgeon said it would take 6 months for this to surface but for an older person (80ish) it can easily pilfer 12 months.
Be sure to ask around for a good back surgeon. We found one through our primary care physician whose father have this surgery done by a specific surgeon. That's a good enough referral for me especially when the father is brought to a local surgeon from out of state.
Surgery is worth the risk if there aren't any other vigour issues with surgery. The pain from spinal stenosis will NOT go away over time.
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