Spinal Stenosis – Main Line Spine

It’s normal to experience aches and pains in our back, particularly as we get older. Roughly 75 to 85% of adults in the U.S. experience back pain sometime in their lifetime.

Our back pain may be a simple sign of an aging spine. Or sometimes, it may indicate we have a disease or injury. A visit to our doctor can help sort through what is normal from what may be a problem.

One common back pain progression begins with age-related degeneration of the spine. Spondylosis is a broad term that encompasses different types of spine degeneration.

“Over time, spondylosis in the lower back can cause lumbar spinal stenosis,” says Farzad Karkvandeian, DO. Dr. Karkvandeian is a doctor at the Philadelphia region’s Main Line Spine medical practice.

He continued, “The mild procedure can relieve lumbar spinal stenosis back pain for some patients who don’t respond to traditional conservative treatments.”

What Is Spondylosis?

Spondylosis results from normal “wear and tear” degeneration of soft structures and bones in our spine. It can appear in any part of the spine. However, it is most commonly observed in the neck (cervical) and lower back (lumbar) regions.

“Osteoarthritis of the spine” is an alternative name for spondylosis.

Patients with this degenerative condition may or may not experience symptoms. Most people don’t experience significant pain or other issues related to these arthritic changes, Dr. Karkvandeian noted. Spondylosis frequently evades detection until a patient undergoes an imaging scan triggered by a different condition.

“Nevertheless, some individuals experience a decline that ultimately results in discogenic pain,” he added. “This can limit a patient’s range of motion. In the lower back, it also indicates a patient may have lumber spinal stenosis.”

Research indicates that spondylosis affects approximately 90% of individuals aged 60 and above. Lumbar spinal stenosis is present in about 20% of this same population in the United States.

What Is Lumbar Spinal Stenosis?

Lumbar spinal stenosis (LSS) usually occurs from an injury or changes in the spine as we age. It can cause the spinal canal in the lower part of the back to narrow.

This narrowing can create pressure on nerves running through the hollow space in the center of the spine’s vertebrae. The pressure may lead to a set of lumbar spinal stenosis symptoms called pseudoclaudication, also called neurogenic claudication.

“When lumbar spinal stenosis occurs, it typically impacts the lower L3 to L5 levels of the spine,” Dr. Karkvandeian noted. “When patients have lumbar spinal stenosis, their legs will often feel heavy. Some describe it as if they were walking in cement.”

Other early symptoms may include cramping or discomfort in the leg(s) after a long walk. Those with the condition may also feel leg numbness or achiness after prolonged standing. In the later stages, pseudoclaudication may progress into even more severe leg pain that worsens when walking.

Illustration of lower spine S1 and L5 to L1 and spinal canal — Illustration of the lower portion of the spine from S1, L5 to L1, and illustration of the spinal canal.

Back Pain Relief with the mild Spine Procedure

According to Dr. Karkvandeian, one of the major causes of lumbar spinal stenosis is the presence of excess ligament tissue. This usually develops on the spine with spondylosis.

Over time, the strong ligament cords that help hold the spine’s bones together can become thick and stiff. As this happens, these thick ligaments can push into the spinal canal.

Spondylosis and lumbar spinal stenosis are not one in the same and shouldn’t be confused for each other. But Dr. Karkvandeian emphasized that it would be uncommon to find thickened ligaments and LSS without the presense of spondylosis.

“The mild procedure provides us with a minimally invasive way to remove that excess ligament tissue,” Dr. Karkvandeian says. “By doing that, we can restore space in the spinal canal. This relieves pressure on spinal nerves and the associated low back pain.”

Mild stands for minimally invasive lumbar decompression.

The mild back surgery procedure typically takes less than an hour. It is performed with specialized instruments through a single, tiny incision that measures less than the diameter of a baby aspirin (5.1 mm). mild® is normally completed in an outpatient surgery center using local anesthetic and light sedation.

“It’s important to remove the excess ligament tissue from both sides of the spinal segment during the procedure,” Dr. Karkvandeian emphasized. “There are no half-measures that are adequate when you want to maximize the long-term outcome for a patient.”

mild Procedure Durability

“Every patient is different, and the outcomes have varied,” says Dr. Karkvandeian. “We have witnessed individuals transition from experiencing extreme pain levels of 10 out of 10 to complete pain relief. When the procedure works well, it is an extremely gratifying experience for our patients and medical team.”

“Like with all procedures of this kind,” Dr. Karkvandeian added with caution, “it doesn’t work for everyone.” “However, a study of the five-year follow-up of Cleveland Clinic mild procedures shows encouraging results.”

Seventy-five individuals received mild® treatment at the Cleveland Clinic between 2010 and 2015. Of that group, only 9 needed additional lumbar surgical decompression during a 5-year follow-up afterwards¹.

“We will continue to learn more from clinical studies that will follow this one,” Dr. Karkvandeian said. “But for now, Cleveland Clinic’s experience provides an objective record of long-term success with mild. Our own direct experience with mild procedure outcomes with our patients remains positive.”

Reference

Mekhail N, Costandi S, Nageeb G, Ekladios C, Saied O. The durability of minimally invasive lumbar decompression procedure in patients with symptomatic lumbar spinal stenosis: Long-term follow-up. Pain Pract. 2021 Nov; 21(8): 826-835 [PubMed]

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Pain felt in your shoulder area can sometimes be coming from your neck. Conversely, neck pain can actually be hiding a shoulder problem.

Why? Because the neck and shoulder muscles share the same densely packed nerve pathways. And when an injury occurs, your nerves don’t always tell your brain the correct location where your problem is located. When you feel pain in one part of your body that is actually caused by pain or injury in another part, it is known as “referred pain.”

Neck Pain Referred to the Shoulder

There are many nerves and muscles that arise from your neck that pass through your shoulder on the way down the arm. Referred neck pain is usually felt at the top of your shoulder over your trapezius muscle. When shoulder pain originates from an injury in the shoulder itself, it normally is felt over your upper arm.

However, further complicating diagnosis is that many who have neck-originating shoulder pain also develop weakness in their shoulder rotator cuff muscles along with shoulder bursitis. Thus, diagnosis often requires your musculoskeletal specialist to distinguish between these different two sources of pain.

Neck-referred shoulder pain can often be from your cervical spine neck joints and ligaments, or from a trapped nerve. The common causes of shoulder pain from the neck include:

Spinal Osteoarthritis: a condition where disks narrow and bone spurs form.
Spinal Stenosis: a narrowing of the space around the spinal cord, usually due to arthritis.
Herniated Disk: when one of the cushioning disks between your spine’s vertebrae tear or leak
Ligament or Muscle Injuries: frequently the result of a sports injury, fall or accident

Shoulder Pain Referred to the Neck

One of the sources of shoulder pain that can be referred to the neck can originate in the acromioclavicular, or AC joint. So let’s simplify that a bit.

The AC joint joins your collarbone, also known as your clavicle, with the acromion section of your shoulder blade (scapula). Just like it is for most parts in your body where bones meet, there is cartilage between the two bones – which is the tissue that allows the bones to move on each other. Think of it like Teflon smoothly allowing two ball bearings to rub against each other.

While the AC joint is vulnerable to many different kinds of injuries, the most common conditions are arthritis, fractures, and separations. And AC joint pain, as well as a number of other shoulder conditions, can radiate pain to the neck.

Woman with neck pain that actually originates in her shoulder joint. — Some neck pain may actually be “referred” from a damaged shoulder joint.

Figuring Out the True Source of Your Shoulder or Neck Pain

Your healthcare provider will start with a physical examination to diagnose referred neck or shoulder pain. They’ll also be looking to rule out other possible conditions. They may couple their initial examination with imaging (MRI, CT, Ultrasound, or X-rays) and blood tests.

Recommended treatments will vary depending on what they determine the underlying condition to be.

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Musculoskeletal pain is a broad term. It refers to any pain affecting the bones, muscles, tendons, ligaments and nerves. It can come on suddenly with severe symptoms, be acute or chronic, and be either localized to one area of your body or widespread.

The most common type of musculoskeletal pain is lower back pain. According to the National Institute of Health, about 80 percent of adults experience low back pain at some point in their lifetimes.

A man with lower back pain clutches his right back with his hand.

Lower back pain is the most common cause of job-related disability and a leading contributor to missed workdays. In a major survey, more than a quarter of adults reported experiencing low back pain during the past three months.

The good news is that if you are suffering with lower back pain, there are a wide range of options to treat it that don’t require major orthopedic surgery. Identifying appropriate treatment options however starts with identifying the underying causes.

What causes lower back pain?

Your lower back is subject to a lot of mechanical stress and strain. This happens because the weight in your upper body is supported by your spine.

The spine is made up of more than 30 small bones called vertebrae stacked on top of one another. A spongy piece of cartilage, called a disc, sits between each vertebra. It acts as a shock absorber, preventing the bony vertebrae from grinding against one another as the body moves.

The vast majority of lower back pain is mechanical in nature. As we age, the discs in our spine can gradually wear away and shrink, a condition known as degenerative disc disease or spondylosis. The National Institute of Health outlines some of the examples of mechanical causes of low back pain to include:

Sprains and strains account for most acute back pain. Sprains are caused by overstretching or tearing ligaments, and strains are tears in tendon or muscle. Both can occur from twisting or lifting something improperly, lifting something too heavy, or overstretching. Such movements may also trigger spasms in back muscles, which can also be painful.
Degenerative disc disease is one of the most common mechanical causes of low back pain, and it occurs when the usually rubbery discs lose integrity as a normal process of aging. In a healthy back, intervertebral discs provide height and allow bending, flexion, and torsion of the lower back. As the discs deteriorate, they lose their cushioning ability.
Herniated or ruptured discs can occur when the intervertebral discs become compressed and bulge outward (herniation) or rupture, causing low back pain.
Radiculopathy is a condition caused by compression, inflammation and/or injury to a spinal nerve root. Pressure on this nerve root results in pain, numbness, or a tingling sensation that travels or radiates to other areas of the body that are served by that nerve. Radiculopathy may occur when spinal stenosis or a herniated or ruptured disc compresses the nerve root.
Sciatica is a form of radiculopathy caused by compression of the sciatic nerve, the large nerve that travels through the buttocks and extends down the back of the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and the adjacent bone, the symptoms may involve not only pain, but numbness and muscle weakness in the leg because of interrupted nerve signaling. This condition may also be caused by a tumor or cyst that presses on the sciatic nerve or its roots.
Spondylolisthesis is a condition in which a vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column.
A traumatic injury, such as from playing sports, car accidents, or a fall can injure tendons, ligaments or muscle resulting in low back pain. Traumatic injury may also cause the spine to become overly compressed, which in turn can cause an intervertebral disc to rupture or herniate, exerting pressure on any of the nerves rooted to the spinal cord. When spinal nerves become compressed and irritated, back pain and sciatica may result.
Spinal stenosis is a narrowing of the spinal column that puts pressure on the spinal cord and nerves that can cause pain or numbness with walking and over time leads to leg weakness and sensory loss.
Skeletal irregularities include scoliosis, a curvature of the spine that does not usually cause pain until middle age; lordosis, an abnormally accentuated arch in the lower back; and other congenital anomalies of the spine.

With these and so many other potential causes and types of lower back pain, it’s best not to assume your pain is simply overuse or old age. Like most conditions, the earlier the problem is identified, the more treatment options are available. It naturally follows that early diagnosis also supports a higher probability of success with treatment.

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