If you are 50 or older and have pain, numbness and tingling in your legs when walking or standing—but it improves when you sit—you may have spinal stenosis, a degenerative disease that causes the spinal canal to narrow. Spinal stenosis is the most common reason for spinal surgery, according to Joe Duncan, MD, an orthopedic surgeon practicing at IU Health Ball Memorial Hospital.
Spinal stenosis is caused by a combination of genetic factors, anatomy and lifestyle that put wear and tear on the spine. Many people live with symptoms of spinal stenosis for lengthy periods and only seek treatment when it limits activity so much they can barely walk.
While it's not life-threatening, Duncan says patients with these symptoms should be diligent about seeking a diagnosis. "I see patients who learn to live with it in the background, but they wait so long to seek treatment that it can become very difficult for us as spine surgeons to reverse the problem," he says. The condition is painful because it leads to compression of the nerve roots from thickening of ligaments, bone spurs around the joints (known as osteophyte formations) and bulging discs.
It’s sometimes difficult to diagnose because symptoms resemble other health problems that come with age. An astute family member may notice differences in seniors that hint at spinal stenosis, including being less active, walking in a stooped posture and leg weakness. "There are lots of things going on as we age, so these symptoms may well be spinal stenosis, but they could also be peripheral vascular disease (poor circulation) or diabetic neuropathy to name a couple," he says.
MRIs are used as a diagnostic tool, but results can be ambiguous because abnormal MRI’s are common for patients in this age group, whether they have spinal symptoms or not. “This is why it is so important to find a spine specialist who can be trusted to recommend what is best for you,” Duncan says.
In some cases, doctors may prescribe drugs to treat nerve pain and exercises, such as riding a stationary or regular bike to help open the spinal canal and remove pressure from the nerves.
Pain is usually most acute when the patient stands or walks, both of which put the spine in an extended position. “Some of my patients sleep in a recliner because it keeps their spine in a flexed position that’s less painful,” he says.
Surgery is typically the treatment of last resort, used only after conservative measures such as physical therapy, anti-inflammatories and other medications, and epidural steroid injections fail. For patients who are healthy enough to have surgery, the procedure removes structures that compress the nerves. "I see patients who are in their 80s and they have so many pressing health concerns that surgery for spinal stenosis becomes a lot riskier," he says. "It may have been a lot easier to deal with when the patient was in their 70s, when symptoms were less advanced and the patient was medically healthier."