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Spinal Stenosis – is surgery the cure?

Posted Sep 30 2009 12:00am

Spinal Stenosis. Scary sounding isn’t it? More and more people are getting diagnosed with stenosis every day (read about former Vice President Dick Cheney here ). If you are one of those people there are many questions that are running through your head like:

  • What causes stenosis?
  • What treatments are most effective?
  • What choices do I have?
  • Is surgery the best option?

The most common explanation for “what causes stenosis?” is described here by the Mayo Clinic:

“The main cause of spinal degeneration is osteoarthritis, an arthritic condition that affects the cartilage that cushions the ends of bones in your joints. With time, the cartilage begins to deteriorate and its smooth surface becomes rough. If it wears down completely, bone may rub painfully on bone. In an attempt to repair the damage, your body may produce bony growths called bone spurs. When these form on the facet joints in the spine, they narrow the spinal canal.”

They also explain herniated discs, degenerative changes to ligaments, spinal tumors (I can hear the little boy in Kindergarden Cop telling Arnold “it might be a tumor” and Arnold’s sharp reply ), and accidents and injuries can all lead to arthritis and degeneration. This website even has a visual map of everything spinal stenosis!

The problem with these “causes” is that they are also symptoms, not the true source of the problem. We have to dig a little deeper. I like to start by asking more questions. Like:

  • If spinal stenosis is caused by osteoarthritis, what causes osteoarthritis?
  • I hear people yelling “accidents and injuries!”

The answer to “what causes osteoarthritis?” can be found in the Mayo clinics description above:

“With time, the cartilage begins to deteriorate and its smooth surface becomes rough. If it wears down completely…”

The key words being “wears down.” What causes your car tires to wear down? What causes the soles of your shoes to wear down? What causes your brakes pads to wear down? Friction. We all know this. But we don’t often think about friction inside our bodies. Friction comes from movement right? So is the answer not to move? No. We (our spines included) are designed to move – move constantly every day of our lives. The problem isn’t that we are moving, but that we are moving incorrectly. This incorrect movement comes from our posture being compromised when we do move which increases friction in certain joints causing them to “wear down.”

All of us share the same basic design or posture . Since muscles move bones, compromised posture is a muscle problem. Use it or lose it. If we are not reminding our muscles of their job daily, these inactive, atrophied, and compensating muscles will alter the lumbar, thoracic, and cervical curves of our spine and affect the position of our load bearing joints (ankles, knees, hips, shoulders). Pete Egoscue describes how this happens in his book, Pain Free :

The muscles around the spine don’t all go at once. The rate of atrophy depends on the person’s lifestyle and working conditions, but gradually, as the body gets less and less stimulus from the environment, the magical S (curve of the spine) diminishes, taking with it the spine’s flexibility, load-bearing strength, and shock-absorbing capacity.

This can cause a multitude of problems including: back spasms, herniated discs, facet joint problems, spondylolisthesis, spondylolysis, spondylosis, scoliosis, and spinal stenosis. In Pain Free, Pete Egoscue explains the typical medical approach to stenosis and his take on it:

The standard sugical remedy is to remove the lamina of the vertebrae – basically, one slope of the arch or ridge that runs along the posterior of the spine – enter the canal, and scrape away the calcium.

I have rarely seen a case of stenosis where this procedure was really necessary. Yes, there is calcium in the spinal canal, and there is nerve impingement. But if the lumbar, thoracic, and cervical curves are restored to a functional state, the spinal cord and branching nerve roots usually have enough room to operate without interference.

He continues:

In this and every circumstance that the body confronts, the old architectural slogan is absolutely right: Form follows function. Reintroduce proper design function, and the form – the structure – isn’t a problem. Back pain, no matter what it is called, is most often a symptom of a breakdown of form that has been generated by a loss of function…Whatever the contributing factors, a pain treatment that starts with function will rarely require you go after the body’s form.

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