DR. HOOK- Shake a leg: Spinal stenosis' shooting pain

Penny pinching is no longer just a memory of the '30s and the Great Depression. When gasoline and milk flirt with $3/gallon, Elsie the cow is going to be a billionaire but not able to afford to drive around in her Rolls Royce. She's going to have to walk to moooooove along. Medical co-payments are up to $50 or more– which sometimes actually causes a patient to overpay for a visit– while health insurance pays, at least according to this doctor, diddly-squat.

What happens when your body starts to pinch down on things? For people in their 50s and 60s, spinal stenosis can pinch down on the spinal cord or roots and cause a lot of misery. The lower back, a.k.a. lumbar (not to be confused with lumber, the wood– unless you happen to be Pinocchio), has five vertebrae. The spinal cord travels through the spinal canal, which are the holes in the center of the vertebrae. If the spinal canal starts to close up, the spinal cord gets pinched– leading to neurological pain and weakness in the legs.

 The biggest reason for spinal stenosis is osteoarthritis. When the facet joints of the vertebrae start to degenerate, bone spurs and other "garbage" start to close in on the vertebral opening to the spinal cord. Actually, in the lumbar region, the spinal cord isn't really a cord anymore but a bunch of fine hair nerves that looks like a ponytail on a "My Little Pony" doll. (By the way, I was born in the year of the horse, but I never quite understood those little equine toys. Tickle Me Elmo– yes; My Little Pony– no.)

When the spinal "cord" gets pinched by bones or supporting ligaments, neuropathic pain shoots down the legs to the calves. It feels different to different people. It can feel like a burn, a tingle, numbness, or heaviness. So if you feel like you have a "twinkle in your toes," it might be spinal stenosis. In fact, some people mistake it for poor circulation due to PAD (peripheral arterial disease), and that is why we call it pseudoclaudication.

However, unlike PAD, pseudoclaudication occurs with hyperextension/lordosis of the lower back– such as walking down the hill to get to the mailbox. That's probably the #1 presentation I hear from my patients who have spinal stenosis. 

"Doc, my legs hurt going to my mailbox. I lean against my mailbox until the pain goes away, and then I'm fine walking back up to my house." Leaning over something or using a cane that allows the lower back to bend forward relieves the pinch until the legs feel fine again. Sitting down or lying in bed also relieves the pain. (I guess a snob would say, "I bow down to no one– except my spinal stenosis pain. Ouch!)

A simple back x-ray can indicate spinal stenosis if there is a lot of spondylosis seen– meaning degeneration of the lumbar vertebrae. CT scans confirm the diagnosis, and myelograms can see if the nerves are really pinched. MRI is also a very good diagnostic tool.

Treatment doesn't necessarily require surgery because about 2/3 of cases don't get worse. Anti-inflammatories, physical therapy, and aerobic exercise can all be beneficial. But for those who need it, surgery is pretty effective in the short run. Down the road, though, osteoarthritis can cause more stenosis to pinch the nerves.

A pinch of salt can make food delicious. Pinching pennies can allow you to eat with the electricity on. A mad elephant can give you "such a pinch" on a Bugs Bunny cartoon. But a pinch in the spinal cord can be a pain in the...leg.