Lumbar Spinal Stenosis

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Lumbar Spinal Stenosis

Patients with lumbar spinal stenosis—one of the most common reasons for spinal surgery in older people—are commonly recognized by a bent-forward, shuffling posture and a characteristic small-step gait. Stenosis surgery, however, is a major procedure that is recommended only when conservative methods of care aren’t effective—or when stenosis is caused by such things as tumors or accompanied by intolerable pain or severe neurological problems, such as loss of bowel and bladder function. 

What is Spinal Stenosis? - Spinal stenosis is created by the narrowing of the spinal canal. This narrowing may be caused by mechanical problems or by abnormalities in the aging spine. It may or may not result in low back pain, limping, and/or a lack of feeling in the legs. Stenosis is often a degenerative condition. It may exist for years without causing pain or discomfort, but a fall or an accident can trigger characteristic stenotic pain. Numerous factors can cause stenosis, such as thickened ligaments, expanding infection, abscess, a congenital or developmental anomaly, degenerative changes, vertebral fractures or dislocations, or a spinal cord tumor. Other conditions, such as a herniated disc, can mimic stenosis. While herniated discs usually cause rapid and acute muscle spasm, discomfort caused by stenosis builds gradually. Other conditions that can be confused with stenosis include vascular claudication, peripheral vascular disease, and abdominal aortic aneurysms. Claudication—pain triggered by walking—caused by vascular disease most often occurs after walking a fixed distance. Patients with spinal stenosis, however, walk variable distances before symptoms set in. Activities like riding a bicycle and walking up a hill can cause pain in patients with vascular claudication, but not in those with stenosis. On the other hand, standing makes pain worse for stenotic patients, while it relieves vascular claudication. 

How is stenosis diagnosed? Spinal stenosis can be diagnosed based on the history of symptoms, a physical examination, and imaging tests. An MRI is a very poor predictor of future disability in stenosis. An electrodiagnostic study is more dependable for information on a stenotic spine. To diagnose stenosis caused by an abscess or an infection, blood work analyzed by a laboratory may be required, while vertebral tumors and spinal tumors require finely tuned imaging. Although degeneration is the most common cause of the condition, spinal stenosis can also result from longterm steroid use. Degenerative stenosis also has multiple contributing factors, including disc degeneration, disc bulging, bone spur formation around the vertebrae and the facets, thickening of the soft tissues, and bulging around the disc. Some anatomical factors, such as the enlarged, weakened bones caused by Paget’s disease, can complicate both the degenerative process and treatment. 

How is stenosis treated? There are three basic treatment approaches to spinal stenosis: the conservative medical approach, which frequently involves bed rest, analgesics, local heat, and muscle relaxants; the conservative chiropractic approach, which includes manipulation, exercise and self-care techniques; and surgery. The source of the stenosis often dictates the treatment. Although medications can provide pain relief, those powerful enough to deaden the pain can also exacerbate patients’ already compromised sense of balance. When the patient loses bowel or bladder control, suffers from intolerable leg pain and claudication, and has progressive loss of function or spinal cord tumors, surgery is the first and only option. The standard stenosis surgical procedure usually involves opening up the spinal canal and decompressing the neural elements by removing the bony structures that contribute to canal narrowing. Although many patients do fairly well after the surgery, the symptoms are likely to return after a period of time. Home exercises are a major part of the conservative treatment program. Exercises designed to mobilize the involved nerves have been found to be particularly helpful. Recent studies show that although stenosis surgery will often have good results for up to two years, in the long run, outcomes are much the same between surgery and conservative care. Some surgeries have to be repeated years later. Many are far from fully satisfactory. Surgery is a complicated procedure that irreversibly changes the structure of the back. In many mild and moderate cases of stenosis, however, non-invasive conservative care, such as chiropractic, can help lessen pain and discomfort, maintain joint mobility, and allow the patient to keep a reasonable lifestyle, at least for some time. A technique called distraction manipulation may be helpful in reducing leg discomfort. Home exercises are a major part of the conservative treatment program. Recommended four or five times a week, the exercises, such as bicycle riding or lying on the side and grasping the knees with the arms, focus on flexing the spine in a forward position—stretching and strengthening the lower back and stomach muscles and improving muscle strength. Exercises designed to mobilize the involved nerves have been found to be particularly helpful. Ultimately, stenosis is a chronic condition that cannot be “cured,” but it often can be improved, and improvement can be maintained over the long term. Patients can work with a health care provider, such as a doctor of chiropractic, to reduce symptoms and improve their quality of life. 

Signs and Symptoms of Stenosis • Pseudoclaudication—pain triggered by walking or prolonged standing, which is usually improved by sitting in a forward leaning flexed position • Numbness, tingling, and hot or cold feelings in the legs • Muscle weakness and spasms

Tacoma Location

2611 N. Stevens St Tacoma, WA, 98407

Hours of Operation

Our Regular Schedule

Monday:

8:00 am-6:00 pm

Tuesday:

8:00 am-6:00 pm

Wednesday:

8:00 am-6:00 pm

Thursday:

8:00 am-6:00 pm

Friday:

8:00 am-6:00 pm

Saturday:

8:00 am-12:00 pm

Sunday:

Closed

Testimonials

  • "I have had personal experience as a patient there as well. The staff is very friendly and personable. Since I trust Robert and Cessalie to work on me, they are the only chiropractors I will recommend to my patients!"
    Anastasia, Family Medicine MD
  • "What a wonderful alternative to carpal tunnel surgery. Wrist adjustments work wonders."
    Teri
  • "My patients appreciate the help and professionalism in this office. Patients report improvement in pain and mobility and also appreciate being told when other modalities or treatment options are recommended."
    Greta, Internal Medicine MD
  • "Best place ever! The staff is always pleasant and nice- easy to get into, lots of parking, reasonable - the doctor really cares and wants you to get better! Highly recommend!!!"
    Amy - Tacoma, WA
  • "As a busy family practice physician, I have had the opportunity and privilege to work with DR’s. Robert and Cessalie Stalder for the past 10 years and we have built a very collegial relationship based on the fundamental principal of providing quality care for our patients. Their practice is directed at patient improvement, ultimate care and complete satisfaction."
    Janice, Family Medicine DO
  • "Tacoma chiropractic has always been super friendly and flexible. They've helped me with my back and neck issues through chiro adjustments and massage. Everybody I've worked with has been great!"
    Yvonne - Tacoma, WA
  • "I have worked with the Stalder’s for well over 10 years and continue to refer both my family and patients to them. I especially like referring my pregnant patients to them for the gently and effective care they receive."
    Gail, Ob/GYN Medical Doctor
  • "I have been coming here for services over the past 8 years. The Doctors are amazing, caring, passionate and knowledgeable. The front and back office staff are friendly, helpful and always polite. I have never had a scheduling or billing issue, ever in 8 years! Thank you TCC for helping me feel my best!"
    Rachel - Tacoma, WA