The “Aging” Spine
The Body’s Aging Process
Your body goes through many changes as you get older. You may not see or hear as well as you did when you were younger. We recognize that this is a natural process, and we learn to accept it or make adjustments for it, such as getting glasses or a hearing aid.
As your spine ages, it also goes through some natural changes. In a condition often referred to as the Degenerative (or “Aging”) Spine, the gelatin-like centers of your discs begin to dry out, causing them to become compressed or “flattened” (Fig. 5). This, in turn, causes the vertebrae to”settle.” It’s one of the reasons most people actually become shorter as they grow older.
The Aging Spine
The Slowly Closing Window
As your discs begin to “compress” and your vertebrae begin to “settle”, the window-like openings of the foramen become smaller and smaller (Figs. 5, above & 6, below). Eventually, the opening can become so small that the nerve is “pinched” against a vertebra. It’s similar to laying your hand on a window sill. As long as the window is open, there is no problem. However, if someone slowly closes the window, there will be a point at which your hand begins to feel the pressure. The more the window is closed, the greater the pressure and the greater the pain you will feel.
The Loss of Your Spine’s “Shock Absorbers”
At the same time, your aging discs are drying out and losing their ability to act as effective “shock absorbers.” Your vertebrae begin to bounce against one another and this jarring action actually causes the bone matter of the vertebrae to grow. This results in the formation of bone spurs. The jagged edges of this new growth can cause both the spinal canal and the foramen to become even smaller. When this happens, the result is often the pinching of the cauda equina and/or a spinal nerve root.
When a spinal nerve is pinched by a narrowing of the foramen, the condition is referred to as lateral recess stenosis. Symptoms include intense pain, numbness and/or weakness in one leg. When the cauda equina becomes compressed by a narrowing of the spinal canal, the condition is referred to as lumbar canal stenosis and the pain, numbness and/or weakness appears in both legs.
If the aging of the spine is a natural process and happens to everyone, why does one person end up with lateral recess stenosis or lumbar canal stenosis while his/her neighbor is seemingly unaffected? The answer is that everyone’s spine is unique. Some people are born with discs which are naturally more”plump” than others. Some have wide foraminal or spinal canal openings, while others have narrow ones. These factors as well as your weight, posture and level of physical activity help to determine who will be adversely affected by the aging process.
Because the aging of the spinal discs is a natural and irreversible process, treatment options for lateral recess stenosis or lumbar canal stenosis are limited to the following:
- Taking Medication: For some, medication may help to ease the pain in the affected area and thereby provide relief.
- Using Physical Therapy: For those with only limited pinching of the spinal nerves, measures such as physical therapy or gentle exercise may provide relief
- Having Surgery: For those with severe compression of the cauda equina and/or spinal nerves, a decompressive lumbar laminectomy often is the recommended treatment.
When Surgery is NOT an Option:
The severity of your symptoms (pain, weakness, numbness) and your general health and physical condition will play an important part in determining when surgery is not an option for you. In general, surgery is not an option when:
- you do not have leg symptoms;
- your back and leg symptoms are not caused by a pinched nerve;
- there is a medical reason which prevents you from having surgery;
- medication which reduces swelling or relieves pain would provide you with adequate relief; or
- physical measures would improve your condition.
When Surgery IS an Option:
A decompressive lumbar laminectomy is usually recommended only when specific conditions are met. In general, surgery is recommended when a spinal nerve root(s) is pinched and you have:
- leg pain which limits your normal daily activities; or
- weakness in your leg(s) or feet; or
- numbness in your legs; or
- difficulty in walking or standing.
The Risks of Having Surgery
Some of the more common risks of having any surgery include excessive bleeding, infection, or a negative reaction to anesthesia. Certain unforeseen circumstances could even lead to death. Clinical experience and scientific calculation indicate that these risks are low, but surgery is still a human effort. You should feel free to ask any questions you have about your specific risk factors.
Since a decompressive lumbar laminectomy involves surgery in and around the spine, further nerve damage is a possibility. In some cases, the nerve is already so damaged that the surgical procedure required to simply take the pressure off the nerve could be the “straw that breaks the camel’s back.” The end result could be numbness, paralysis or a loss of bowel and bladder control.
The Risks of Not Having Surgery
Without surgery, simple everyday activities also could lead to further nerve damage. The consequences could be much the same as those associated with surgery, including numbness, paralysis or a loss of bowel and bladder control.
The Benefits of Having Surgery
You can think of surgery as the first step in the healing and recovery process. It can help relieve pressure on your spinal nerve(s) and, thereby, help relieve your leg symptoms. It also may help you begin the process of regaining more normal function in your legs.
Your Chances for Success
Your level of healing will be determined by your age, your general health and the severity of the damage to your spinal nerve(s). Your attitude and your willingness to work at recovery also will play an important part in your recovery process.
Making Your Decision
Making Your DecisionWhen you consider your options, keep in mind the impact your condition has on your way of life and carefully weigh the risks and benefits of having surgery against the risks and benefits of not having surgery. The decision is yours!
If You Decide to Have Surgery
Approach your surgery with a positive mental attitude and with full confidence that you have made the right decision. While the surgeon concentrates on finding and removing the cause of your pinched nerve, you must concentrate on the recovery process. Cooperate fully with your surgeon and focus on the improvements you will make in the future – not on the problems of the past.