Questions About Spinal Stenosis

Back in 2008 I was having a lot of hip, back and leg pains and I had a MRI.  I thought I was going to need a hip replacement but the hip doctor said no, and sent me to another back specialist, one who specialized in pain management.  He told me I had arthritis in my L5 vertebra and physical therapy exercises would help.  They did.  I had to stop walking for exercise because it flared up my back and made my legs numb, but if I did my PT I could keep the pain under control.  In 2010 I went back to the doctor to ask if there was anything I could do to fix me so I could go back to walking for exercise.  He said no.  He then told me I had spinal stenosis and I should be prepared for a slow decline.  He said when things got very bad he could do nerve block shots, but I should put off thinking about surgery as long as possible.

Having the label “spinal stenosis” gave me something to research on the Internet, and generally I found the same recommendations to hold on off surgery for as long as possible – but with reasons why.  Many people ended up worse after surgery.  I even watched videos of surgical techniques for spinal stenosis.  Mucking around so close to the spine scares me.  By the way, how do surgeons know what they seeing, body parts aren’t color coded like in books and the old Illustrated Man model.

I decided to bide my time and see if new surgical techniques would be developed.  A few months ago I started seeing sites on the Internet advertising laparoscopic surgery that promised miracles for spinal stenosis sufferers, so I set up another appoint with my doctor.  I was hoping he’d have good news.  He said microsurgery was still surgery and warned me that a lot of places made a business off of selling procedures and they might not work for me.

The time I can spend standing and walking has greatly diminished.  I’m now down to 15-30 minutes.  My doctor said before I thought about surgery I needed to try a nerve block shot, but also said I was controlling my pain so well with PT that I could still put that off too.  I asked him if I could go back to walking after a shot, and he seemed iffy.  He thought a shot would extend my standing and walking time but it would wear off in months.  I asked him how they worked, and he said they reduced the inflammation in the nerves near the stenosis sites.

My doctor and internet sites warned not to do surgery until I was facing a quality of life issue.  That’s sort of vague.  I can go to work, but I can’t walk between buildings.  I can’t do much shopping.  I don’t want to go on vacations.  However, I’m a bookworm and TV watcher, so I’m reasonably comfortable for that.  I’m surviving without pain by walking a razor’s edge with physical therapy and not aggravating my back by standing or walking too long.  I could risk the surgery, but what if it causes permanent pain of another type?  Right now my feet and legs go numb and I have other weird sensations, and sometimes my back tightens, but I’m not suffering real pain.  I’ve been there, so I know.

If I had surgery how many holes, passages and paths would have to be widen?  And how long will it be before they fill in again?  I’m really fighting arthritis.  Are there ways to fight arthritis in general?

I also got to thinking about inflammation.  If steroids shots would reduce inflammation why wouldn’t other things do the same thing?

My doctor did tell me something that I totally wasn’t expecting but I should have.   He said arthritis was now affecting my L4 and L1 vertebras too.  So things were getting worse.  I didn’t ask, but did that mean I’d need multiple surgeries?

That’s the thing about this condition.  I have a hard time picturing it.  I haven’t seen the MRI or X-rays.  I have seen photos on the net but they aren’t me and they aren’t specific.  I would like to visualize how arthritis degenerates the spine.  I did find this at AAOS.org.  The caption said, “When we are young, disks have a high water content (left). As disks age and dry out, they may lose height or collapse (right). This puts pressure on the facet joints and may result in arthritis.”

This explanation doesn’t explain why steroid nerve blocks would help, but it makes me wonder if inversion tables would?  It also makes me wonder if there are diets to help stop the degeneration, or foods that make it worse.  I am overweight, so I also wonder if losing weight would help, I can’t imagine that it wouldn’t, but two doctors have said it wouldn’t.  The trouble is I’ve been trying to lose weight for half my life and haven’t succeeded.

I also wondered if chiropractic techniques would help.  Physical therapy exercises have saved me from years of pain.  I can limit the pain to almost nothing with daily exercises, and that might be the same as what a chiropractor could do.  The trouble is the arthritis is also building up deposits that squeeze the spine, and squeezes the nerves branching from the spine to my legs, which I don’t think would be reduced by manipulation or exercise, unless exercise reduces inflammation, or causes the nerves to rub against the arthritic growths and kept it from expanding.  But that’s just me wondering, I have no evidence of that.

But I do have a lot of questions, especially for people who have this condition.  I’d like to hear from people who have had surgery, of any type, and people who used chiropractors or other alternative medical techniques.  Do inversion tables help?  Got any diet tips?

I know I need to lose some weight to see if that can help.  I wish I could be as disciplined with my weight loss as I’ve been with my PT exercises.  I need a diet that is non-inflammatory in general, causes weight loss, and is anti-arthritic.  I bought a Bow-Flex to see if more exercise and stronger exercises would help.  All my life I ran or walked for exercise and I can do neither now.  I should swim, but that ain’t in the cards.

I’ve known since I was a kid that getting old means breaking down physically, but I always pictured it happening fast.  I never pictured not being able to walk – I always pictured dying of a heart attack.  When I was at the Campbell Clinic I saw lots of people that looked much worse than me, some were in wheel chairs.  In recent years I’ve noticed old people having trouble walking, the ones with canes, or wheelchairs, or those little scooters.  I’ve seen a lot of people struggle just to go out to eat or or see a movie.  I suppose there are even more that stay at home.  There are millions of people worse off than me, and the thing is I need to pay attention to them, because they are my role models and trail blazers.

Unless I find a miracle cure, and I will try, I’m starting to see my future much differently than I ever imagined it.

JWH – 1/18/12