Identifying Spinal Stenosis, Pathology and Appropriate Treatment Options

On the hardwood floor at his local Y, John McFadden was engaged in a game of pick-up basketball. Moving across the court during one sequence, the 64-year-old longtime recreational player crossed paths with a player on the opposing team. They made contact, and the other player immediately fell to the ground in pain. Thinking the other player had tripped over his foot, John continued up and down the court without a second thought.

As their casual game ended and the other player limped over to him with an incredulous mien, the 64-year-old was in for a surprise. He was to discover the reason behind the other player’s abrupt fall to the ground and his shock in finding his opponent without any noticeable damage in the aftermath. During that sequence of the game when the two players crossed paths, they had, in fact, slammed their knees together.

The strange thing was, he never felt a thing.

Creeping Sensations

While John McFadden, a retired vice president of sales for Motorola Communications who lives in Wayne, Pa., stays active and keeps in shape, he
is not a man of steel, nor a superheroic figure oblivious to the pain of mortal men. No, the explanation is far simpler. And much more dangerous. The hard kernel of it is this: he has spinal stenosis.

At its most basic, spinal stenosis is known as a narrowing of the spine. This could mean a narrowing at several points, including the center of the spine, in the canals diverging from the spine, or in the spaces between the 26 vertebrae that make up the spinal column. As the osteal fortress around the spinal cord and emerging nerve roots, the spine plays a crucial role in our daily movements and motion, and any degradation or aberrance of it can carry severe consequences.

With spinal stenosis, these problems are characterized not by a single, specific disease presentation but by a host of outcomes that can occur due to the disease state’s tendency toward narrowing, according to Dr. Rolondo Puno, an orthopaedic surgeon at the Leatherman Spine Center in Louisville, Ky.

“Stenosis is a term we use where it’s not just the disc,” says Puno. “It’s kind of like a global problem. There are ligaments. There are bone spurs digging into the nerve. And sometimes there is what we call instability, where the ligaments get loose and the bone slips and you have movement of the vertebra in relation to another vertebra.”

Alternatively, some conditions, in the symbiotic fashion common to orthopedic maladies, can themselves lead to a diagnosis of spinal stenosis. In John McFadden’s case, he’s not sure what caused his condition. But unlike his wife, who also has spinal stenosis and saw a gradual progression with her disease, his symptoms appeared with a fury. About 10 years ago he was standing in line at a sporting goods store when a sudden jolt of pain shot down the back of his leg. It was severe enough that it made him consider ditching the store without checking out. As soon as he sat down in the driver’s seat of his car outside, the pain disappeared. But back at the office, standing up again, it returned.

The pain was enough to prompt a visit to his doctor, who performed an MRI and confirmed the condition. Since then he has been struggling with the condition day to day, though he has been able to maintain an active lifestyle, including tennis and basketball. But he does not know how much longer that will remain true.

“It’s becoming more and more of a problem,” says McFadden, who is wary of surgery and views it, like his doctors, as a last recourse. “It hurts basically all the time, at a low level.”

His wife, Mary Joe, after suffering from persistent back pain, had her condition diagnosed by an orthopedist about a dozen years ago. Since that time she has endured alternating cycles of pain and, with treatment, symptom-free living.

“When I first had it, and for several years after, I was almost crippled by the pain,” she says. “There were times when I couldn’t even walk. Where I needed help getting out of the chair. This severe pain was really debilitating when it was at its worst.”

Over the past decade, her treatment regimen has cycled through physical therapy, a chiropractor, a spinal decompression machine, steroids and pain medication. For the time being the treatments have worked, and she is without symptoms. “I’m free as a bird,” she says.