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Dr. Roach: Spinal stenosis might be cause of lower back pains

Dear Dr. Roach: I am an extremely active 79-year-old woman. For at least 10 years, I have had lower back pain. I assumed it was arthritis and ignored it.

By June, after an extremely tough exercise class, the intermittent pain became permanent. I called my orthopedic medical practice for an evaluation. The staff took X-rays, and later told me that I must have had a fall in the past. I said that I had had one about 10 years ago. They immediately referred me to a pain management spinal physician.

All the pain is left-sided, mostly from the lower back and butt area and sometimes in the knee and leg areas. The worst is the sharp, searing pain in the back. Going from a seated position to standing is extremely painful and sometimes takes my breath away. Once up, my right leg leads the way, and I can walk for a good amount of time. Standing, though, for any amount of time can become painful.

I am taking gabapentin every night to sleep. I take nothing during the day. I cannot do daily activities.

I saw this new doctor who said he needed an MRI to make a better judgment. The MRI showed a “compression deformity of the L4 vertebral body,” with spinal stenosis at L3-4 and L5-S1. Is this awful pain permanent? Can I never go on walks or bike again? Can anything be done about this?

— J.S.

Dear J.S.: There are two issues here. The first is the compression of your L4 vertebra (L stands for lumbar, which is in the lowest part of your back below the thoracic/chest vertebrae, but above the fused bones of the sacrum where the buttocks begin). That can happen with significant trauma, but may also be due to osteoporosis. If that’s really about 10 years old, it probably doesn’t have to do with the recent worsening of your pain. Your back expert should comment on this.

Spinal stenosis is when the spinal cord itself, or one of the roots coming off the spinal cord, is compressed by hard structures such as the bones and ligaments. The pain you have is consistent with spinal stenosis, but only a detailed look at the MRI in combination with a careful exam will help your spine specialist decide which abnormality of the MRI is causing your pain.

If, as I suspect, the spinal stenosis is causing your pain, you have nonsurgical options including physical therapy, medications (like the gabapentin you are taking) and epidural injections. These are usually given a good chance before considering surgery.

Surgery for spinal stenosis is considered when nonsurgical options have not been effective and when symptoms are bad enough to justify surgery. When you say you can’t do your daily activities, that is enough for me to recommend you consider surgical treatment, but only a surgeon can make the recommendation of whether surgery is likely to help you.

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