By Becky Wiese
Wisdom comes with age. Unfortunately, so do aches and pains. Instead of just accepting physical discomfort as a rite of passage and succumbing to the inevitable, many older people today can take measures that will decrease or even eliminate some of their pain.
Take, for instance, the spinal stenosis of the lumbar spine. With age, the canal in which the spine and nerves lie becomes constricted due to stenosis and degeneration, such as bulging or herniated discs, bone spurs, or arthritis of the spine. This constriction compresses the nerves in the spinal column in the lower (lumbar) spine and makes walking difficult and uncomfortable.
The symptoms of this malady include pain, numbness, weakness, or tingling in the legs, especially after walking or standing for a long period of time. A typical presentation of this condition is that of an elderly person who is able to walk for a while, but begins to limp as the nerves get compressed and the legs become numb or start to tingle and feel weak. Sitting or lying down usually alleviates the tingling or numbness or weakness in the legs because spinal canal opens up enough that the nerves are less compressed. As time goes on, the distance the person can walk becomes shorter and the breaks to relieve the discomfort become longer.
This condition is referred to as neurogenic claudication — literally, nerve-caused limping. Conservative treatments such as pain medication, physical therapy, hot or cold compresses, or epidural steroid injections may provide relief for a time, but they are not typically effective in the long term.
“The majority of people benefit from surgery,” explains Dr. Emilio Nardone, a neurosurgeon at Central Illinois Neuro Health Sciences in Bloomington. However, the traditional procedure to resolve neurogenic claudication, called decompressive laminectomy, involves removing some of the backbone as well as moving muscle, tendons, and other thickened tissue to open up the canal that the nerves run through, making it less constrictive and thus relieving the discomfort.
“This surgery is quite effective in relieving symptoms,” says Dr. Nardone, “but it can also have a deleterious effect on the spine, meaning more stenosis may occur above or below the original surgical site, especially if a fusion was done at the same time. Or, it may make the spine unstable and necessitating a fusion in the future.”
For some patients, the invasiveness of the surgery itself, along with the potential future ramifications to their spine, is enough to scare them off. They simply choose to live with the pain and discomfort associated with neurogenic claudication.
More recently, a minimally invasive procedure has been developed that not only opens up the canal, but also is less damaging to the bone and soft tissue surrounding the spine. This technique, called a minimally invasive bilateral lumbar decompression with a unilateral approach, offers several advantages.
“There is a smaller incision and less soft tissue damage, plus the unilateral approach means the muscles on the opposite side of the spine are not touched,” says Dr. Nardone. “Additionally, the amount of bone work and ligament damage is minimized. The recovery is quicker, there is less pain and less blood loss, and the hospital stay is shorter. More importantly, there is less destruction to the spine structure itself, so the patient has a stronger spine and the chance that further procedures, including fusions, is decreased.”
For those who suffer from neurogenic claudication, this minimally invasive procedure has many benefits as well as allowing for a more positive future regarding back and nerve issues. And, “it’s good for people who are afraid of back surgery,” says Dr. Nardone.
If you’ve been suffering with tingling or numbness in your legs that causes you to limp and take frequent breaks — yet you’ve been reticent to undergo major back surgery, this just might be the procedure that brings relief!
For more information, contact Dr. Nardone at Central Illinois Neuro Health Services at cinhs.com or call 309-662-7500.
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