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HPC | Hertfordshire Pain Consultants

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  • I wanted to write a letter to you because I'm so grateful to you and your team at the pain management clinc. After spending over 15 years with the most horrendous headaches and seeing dozens of different doctors and therapists finally you have managed to get them under control. Thanks you for taking the time to genuinely listen to me and my problems. Much appreciated.

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    Hertfordshire
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Content

Spinal Stenosis

Spinal stenosis is a term used to describe a narrowing of the spinal canal that gives rise to symptoms of compression of the spinal nerves or sometimes the spinal cord. Narrowing that affects the spinal cord is sometimes called a myelopathy.

Causes

There are several forms of lumbar spinal stenosis. The most common is degenerative stenosis, which occurs in virtually the entire adult population as a result of the natural process of ageing. As the body dehydrates with age, bones become less dense and the discs of the spine lose mass. The discs compress, causing tilting, slippage and rotation of vertebral bodies. This results in compression of the spinal sac and nerve roots. As this narrowing results in a compression of the spinal nerve and nerve roots, this in turn causes a wide range of symptoms.
Symptoms

The symptoms experienced are those of leg pain typically worse on walking that can be associated with  leg numbness, weakness or feelings of unsteadiness sometimes in both legs or sometimes in just one.  Back pain does not follow the same pattern and increased back pain on walking is not a feature of spinal stenosis. 

Classically the sufferer can walk a certain distance (sometimes 50m or further- say -500m) and then they need to stop because the pain & numbness intensifies.  Most find that sitting down or leaning forward enables them to recover so that they can then walk again. 

Diagnosis

Will require assessment by a hospital specialist, who will assess and confirm the diagnosis with an MRI scan or rarely a CT scan.

Prognosis

The course of the problem has some uncertainty, but a general rule can be applied that 20% will improve with time, 60% will stay the same, 20% will worsen with time. 

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First Treatment

  • Improving spinal mobility, strength & overall fitness

Static bike cycling little and often to start with. Patients can often cycle without as much leg pain as when they walk. The use of an exercise bike can enable improvement in fitness and leg muscle tone. Start with just two or three minutes twice a day, and increase the time a little every few days.

Walking up to symptom threshold then just a little further despite the pain will often improve walking distance over time.

  • Improving pain control

These can range from simple over the counter medications to specific anti- nerve targeted mediactions such as amitriptylline or gabapentin etc.

Second Treatment

These can be particularly helpful for leg symptoms rather than the back pain.  Often by blocking the nerve pain with anaesthetic the symptoms will improve permanently or for quite a while. About 60% of patients will respond well. They are low risk procedures and can be repeated.

Thrid Treatment

The 'Gold standard' operation for spinal stenosis is a decompression. This is where the bone that is compressing the nerves is removed to give the nerves more room. Generally surgey is better for leg pain than for back pain. The specific details of surgery needs to be discussed with someone who is familiar with doing that type of surgery. Usually a surgeon with a special interest in spinal surgery.

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