Re: Spinal Stenosis

Posted By CCF Neurology MD:NT on December 06, 1998 at 21:16:58:

In Reply to: Spinal Stenosis posted by J on December 03, 1998 at 19:11:53:






I am an 47 year old with chronic back/pelvic pain with ongoing acute periods for the past year. I  daily have shooting pain (mild to excrutiating) down one leg into the foot. I have had pain in the waist area for nearly a decade along with cramps and aching pain in both thighs with numbness and tingling moving about.
I have been diagnosed in the past with Hashimoto's syndrome, then fibromyalgia and neuropathy and a recent diagnosis of spinal stenosis and arthritis of the spine and hip.  I have begun water walking/running five days a week. I can no longer stand/ walk without having to sit down frequently to  reduce the pain, and then when I sit the waist  thigh and shooting pain problems mount.
I have been told I will not be in a wheelchair because surgery could be done once I could not walk.    MRI indicated: 1. Spinal stenosis L2-L3 and inferiorly, most prominent at L3-L4 and L4-L5, where it is moderately severe, and primarily secondary to extensive degenerative changes of the facets, which were noted at multiple levels. 2. Central and slightly to the right of center disc herniation at L5-S1 with disc material in close proximity to the S-1 nerve root. 3. Bulge of the annulus possibly with a small central disc herniation at L4-L5 contributing to the spinal stenosis noted.  
Here are my questions, can and does the spinal stenosis in some way contribute to the facet degeneration and/or the arthritis in the hip? Is the blood supply being reduced to the bone resulting in degeneration?
Although I am extremely obese and would be a high risk candidate for any invasive procedure are my doctors watch and see tactics appropriate in light of my current level of involvement? Before I understood the spinal stenosis diagnosis my ortho asked me about my walking and I said I walked alot the past weekend without clearly addressing the fact that I had to sit down all the time. Should I wait until my Feb appointment or shall I solicit another opinion at this time?
Thank you very much for the consideration of my problems.
J




Dear J:
Your symptoms are indeed quite consistent with the syndrome of neurogenic claudication, which is typically found with lumbar spine stenosis.
The spinal stenosis does not contibute to facet joint or hip arthritis. Spinal stenosis and facet joint arthritis/hypertrophy commonly coexist, and are manifestations of degenerative joint disease of the spine. Hip arthritis occurs frequently with obesity.
A second opinion is quite appropriate with your surgical risks due to obesity. A wait of some months is usually not a problem.