-- By Dr Gaurav Raj Dhakal

 

As one begins to age, the strands of hair turn grey. A relatively similar process occurs in the spine. The changes occurring in the spine due to aging is called degeneration. The process of degeneration can affect the discs, vertebrae, ligaments and the small joints of the spine (facet joints). As the process of degeneration worsens, the spinal canal (the space which holds the spinal cord and nerve roots) narrows and presses on the spinal cord and nerve roots. This compression of the cord and the nerves in the spinal canal is called stenosis.

 

Spinal stenosis can lead to pain in the legs while walking and standing. This pain is usually relieved by sitting or bending forwards. There may be associated back pain and tingling and numbness in the legs. As the condition worsens, the power in the legs may decrease, as a result, walking becomes difficult. The individual may also experience difficulty in passing urine.

 

If the degeneration affects the neck, then neck pain and stiffness frequently occur. The patient may complain of tingling and numbness in the hands, difficulty in writing, eating and putting on a shirt. Walking on a straight line may become progressively difficult.

 

Any individual experiencing these symptoms must promptly consult his or her spine surgeon. The basic work up includes plain X rays of the neck or the back and an MRI. The MRI will show the type, location and amount of compression of the spinal cord and nerve roots. Sometimes, in diabetic patients EMG and Nerve Conduction Studies are also done to rule out diabetic nerve involvement. Progressive symptoms warrant surgical intervention, hence, a complete work up is essential. Because this condition affects elderly, therefore, a medical fitness prior to surgery is of paramount importance.

The initial treatment consists of analgesics, strengthening of the muscles of the neck and the back and supportive braces. If the initial pain is severe then a short period of rest with gradual return of activities as soon as possible. Severe symptoms require surgery and surgery is quite effective and allows patients to walk farther and stand longer. It involves removing the elements that cause compression and freeing the nerve roots. In summary, neck and back pain may be due to various causes; however, neurological problems like weakness and numbness, difficulty in walking require urgent spine surgical consultation, proper evaluation and treatment to prevent serious permanent loss of function.