Spinal Stenosis
A common ailment impacting a significant number of individuals in Singapore, particularly the aged, is spinal stenosis. This painful condition presents unique challenges that affect the quality of life for those contending with it.
What is spinal stenosis?
Degenerative lumbar spine stenosis (LSS) is a common problem in the lower back that occurs as the spine wears down. The spinal canal in the lower back narrows, putting pressure on the nerves. Spondylolisthesis can make it worse when one vertebra slides forward over another.
What causes spinal stenosis?
LSS is often caused by wear and tear on the spine, known as spondylosis. This degenerative condition is common in older adults, usually affecting specific sections of the lower back. Factors like obesity or a family history of the condition can increase the risk.
Various factors can lead to the narrowing of the spinal canal, such as:
- protruding or bulging disc
- disc height loss
- facet joint syndrome
- bone spur
- thickening of ligamentum flavum
- skeletal diseases
- space-occupying growths
- trauma or surgery
Rarely, it can be present from birth or result from metabolic syndromes.
Symptoms depend on how much pressure there is, and LSS usually develops slowly over time. However, it can sometimes worsen due to trauma or intense exercise. Some people may have years of mild back pain and then experience persistent stenosis symptoms after an episode of vigorous exercise or a minor accident.
Prevalence of spinal stenosis
The global prevalence of LSS is increasing due to the rise of ageing populations. LSS most commonly affects middle-aged and older people, and it occurs more in women than men.
Studies that used the International Classification of Diseases codes showed that LSS can be found in 7% to 23% of the population. The condition is more common in older individuals, with about 78% of those aged 67 compared to around 12% of those aged 40.
Therefore, special attention should be given to treating elderly patients with LSS.
How is spinal stenosis diagnosed?
Experiencing the following symptoms may suggest LSS.
- Back and leg pain while standing or walking
- Pain worsens with lumbar extension but is relieved with lumbar flexion and sitting
Cross-sectional imaging tests like MRI or CT scans are used to confirm an LSS diagnosis.
What are the available treatment options for spinal stenosis?
Spinal stenosis treatment can be split into conservative (non-surgical) and surgical treatments. Non-surgical treatments can be categorised into medication and physical therapy interventions.
Are there non-surgical alternatives to spinal stenosis?
Non-surgical alternatives are available for managing spinal stenosis. These options include lifestyle adjustments, such as:
- reducing the time spent standing or walking
- utilising walking aids like a rollator
- taking oral pain relievers like nonsteroidal anti-inflammatory drugs (NSAIDs)
- participating in physical therapy
Despite these non-surgical options, the majority of patients ultimately choose surgical intervention. This decision is often based on the fact that surgery tends to be more effective in alleviating symptoms than conservative measures.
Furthermore, many individuals may find it challenging or impractical to significantly limit physical activities or commit to ongoing physical therapy for the long term.
Can spinal stenosis be treated with surgery?
If patients don’t get relief from physiotherapy and pain medication, doctors often suggest a surgical procedure called lumbar spinal decompression. It can be done as an open surgery or minimally invasive / endoscopic spine surgery which enlarged facet joint(s) are partially removed and thickened ligaments pressing on spinal nerves are also removed
Although open surgery is the standard procedure, it can lead to complications like severe trauma and muscle injury due to extensive tissue dissection. Some older patients may not be suitable for open surgery because of increased risks like delirium, pneumonia, and stroke, especially if they have other health issues like diabetes or heart disease.
In recent years, a less invasive approach called endoscopic lumbar decompression has become more popular. Endoscopic spinal surgery has become a preferred choice as it enables shorter hospital stays, less perioperative pain, and comparable long-term outcomes to open lumbar spinal decompression. This technique aims to achieve accurate and customised decompression with minimal soft tissue trauma. Studies also show it promises to preserve more facet joints and posterior spinous process and ligaments than open and tubular lumbar spinal surgery
The success of endoscopic spinal stenosis surgery is attributed to three essential elements: an endoscope for a clear, magnified view, an endoscopic working channel with specialised instruments, and a continuous irrigation system to improve visibility.
What conditions or symptoms may indicate the need for spinal stenosis treatment?
Individuals with spinal stenosis commonly face discomfort in their buttocks and legs, affecting one or both sides. This pain intensifies when standing or walking short distances but eases when sitting or resting. Patients usually feel these sensations in the legs:
- hot or cold
- numbness
- aching
- cramps
- ant-biting feeling
The discomfort often prompts patients to reduce their walking activities and adopt a more sedentary lifestyle. In severe cases, spinal stenosis causes radiating pain in the leg and even interferes with basic functions like urination and bowel movements. Treatment is typically recommended for those encountering such symptoms.
Additionally, patients who do not experience relief from physiotherapy and pain medication may be advised to consider surgery as the next step in addressing spinal stenosis.
How long is the recovery period after spinal stenosis surgery?
Dr. Wu Pang Hung’s research indicates that patients undergoing minimally invasive spinal stenosis surgery typically recover and regain the ability to walk well within 6 to 23 hours after surgery. In his clinical practice, this procedure is commonly conducted as ambulatory day surgery, allowing patients to go home on the same day.
Usually, patients can walk a few hours after surgery, and there’s no need for inpatient rehabilitation or physiotherapy during their hospital stay. Most patients can return to sedentary work after 7 days and are ready to travel after 14 days once the wound is healed.
In contrast, open spinal stenosis surgery with laminectomy typically takes 3-5 days to control lower back pain and enable the patient to walk and go home. Larger wounds in open surgery require more painkillers and additional supervision from physiotherapy before discharge.
According to information from the National Health System in the United Kingdom based on mainly open spinal surgery data most patients resume sedentary work after 4 to 8 weeks. For jobs involving driving, lifting heavy items, or strenuous activities, a recovery period of 3 to 6 months may be necessary. Based on available literature, Endoscopic spine surgery shortens the recovery period.
What is the cost of spinal stenosis surgery in Singapore?
In Singapore, spinal stenosis treatment costs vary according to several factors. In our experience, as well as comparing local data obtained from websites, we find that open surgery costs similar to endoscopic spinal decompression.
Compared to longer stays in open spinal decompression with its accompanying daily hospital costs, the early recovery and patient’s fitness for discharge after day surgery or one night stay offset the additional equipment costs of endoscopic spine surgery.
What is the role of a spine doctor in spinal stenosis treatment?
Spinal stenosis is typically treated by orthopaedic or neurosurgical spine surgeons specialising in spinal disorders. These specialists are skilled in various non-surgical and surgical methods to help manage pain and develop strength to prevent further injuries.
Dr Wu Pang Hung also developed a protocol for performing day surgeries for patients who present with spinal stenosis with endoscopic spine surgery performed in Singapore and gave guidance to foreign centres on how to establish their practices.
Spinal stenosis treatment in Singapore
Spinal stenosis necessitates careful consideration and specialised care. Achieving spinal wellness and a smooth recovery is possible with a skilled specialist.
Achieve Spine & Orthopaedic Centre is ready to be your dedicated partner on this path. Our team in Singapore is committed to providing compassionate care for spinal issues such as spinal stenosis. Your comfort and long-term well-being precede our commitment to delivering effective treatment. Our specialist are subject matter experts in minimally invasive spinal surgery and the earliest practitioner and wrote extensive literature for advanced endoscopic spinal surgery such as multiple levels endoscopic lumbar decompression , endoscopic lumbar spinal fusion and cervical thoracic endoscopic spine surgery.
Schedule a consultation with us to learn more about spinal stenosis treatment.
Frequently Asked Questions (FAQs)
Age: The primary cause of most spinal stenosis cases is ageing. The physical demands of daily life can result in wear-and-tear injuries to your spine, which can eventually lead to arthritis.
Women: Spinal stenosis affects women more frequently than it does men.
Spinal trauma: Spinal stenosis is more likely to occur after any back, neck, or spine injury or surgery. When your body is injured, the healing process may result in short-term swelling that could develop into chronic swelling if you don’t heal fully or keep irritating the injured area.
Injury or surgery: Injuries to the back and neck can also harm protective tissues like cartilage, resulting in arthritis and bone spurs that narrow the spinal canal. In addition to altering your posture, an injury or surgery may result in a misaligned spine that puts pressure on your spinal nerves.
Guided stretches and exercises will increase your strength, flexibility, and circulation. Besides strengthening and stabilising the muscles that support your spine, you’ll also improve your range of motion and balance.
Non-surgical treatments like physical therapy and pain medication help many people with mild spinal stenosis stay active and relieve their symptoms. For severe spinal stenosis, the definitive treatment is surgery.
Maintain good posture: Proper posture is key for those with spinal stenosis. Ensure your back is properly supported when you sit, and choose a chair with the proper lumbar support. Do not slouch or bend forward. Avoid standing still for extended periods, and distribute your body weight equally when standing.
Stay active: Walking, swimming, and cycling are low-impact exercises that help you build muscle, improve blood circulation, and increase flexibility. Speak with a healthcare expert to design a training program that suits your needs and skills. Do not let spinal stenosis limit you.
Strengthen your core: A robust core provides vital support for your spine. Include exercises that strengthen your core to help stabilise your spine and relieve pressure on the injured area.
Maintain a healthy weight: Being overweight puts additional strain on your spine, making spinal stenosis symptoms worse. Eat healthily and exercise regularly as part of your weight management strategy.
Create an ergonomic environment:
- Make small ergonomic changes to your surroundings to make them more spine-friendly.
- Purchase a supportive mattress to ensure your spine is properly aligned while sleeping.
- Choose an ergonomic chair with lumbar support to prevent strain on your neck and back.
Avoid prolonged standing and sitting: Prolonged standing and sitting can worsen spinal stenosis symptoms. If your work involves sitting for long periods, take regular breaks to stretch and move around. Use supportive shoes and consider using a footrest to relieve pressure on your lower back when standing for extended periods.
Osteoarthritis, the gradual deterioration of your joints over time, is the most common cause of spinal stenosis. Since osteoarthritis starts to alter most people’s spines by the time they are 50 years old, spinal stenosis is a common condition. Because of this, most patients with spinal stenosis are 50 years of age or older.
A conservative approach should be the initial course of treatment for older patients with spinal stenosis. Reducing activity and using anti-inflammatory medications and epidural steroid injections can often relieve symptoms. Physical therapy can also help.
Yes. High-impact exercises such as sprinting, jumping, and climbing can worsen spinal stenosis symptoms. Repeated impacts to the spine from these activities can exacerbate pain.
Yes. Neurological symptoms include pain in the back, burning pain shooting down the buttocks and into the legs, numbness or weakness in the legs, loss of sensation in the feet, and weakness in the foot, causing the foot to slap down when walking (foot drop). Severe spinal stenosis may affect bladder and bowel control, leading to changes in urine and bowel habits.