DR. ALEX VALADKA: Today, we'll talk about spinal stenosis. Stenosis means narrowing. And if you think about the purpose of your spine is to form a circular bone around your spinal cord, spinal stenosis means the circle gets narrower and narrower. There are a couple of different reasons for that. Let's look at this model to talk about some of that. If this is your front and this is your back, you see these are the bones and these are the disks. Spinal stenosis is most common in older patients in which the disk pushes back a little bit. Some ligaments that you don't see on the model which are present back there can push in from this way. You often get some bone spurs forming to push it from this side. And then on top of all that, these little posts here that kind of connect the front of the spine with the back of the spine may be a little bit shorter than usual. So if you think about a dachshund, a dachshund is a dog with a congenitally narrow spine because those posts are pretty short. And as this canal gets narrower and narrower, you can push on the nerves that are trying to come out through here and here. The classic symptom for this is that someone suddenly notices they can't stand upright or walk as much as they use to. So people may say that they're standing at the sink doing dishes and they have to lay down. Because when you stand upright, you crunch the spine this way and those nerves get pinched. When you sit down and bend forward, you take pressure off them. Other common stories, people can't walk in the mall, or they used to walk a few miles a day and they have to cut it back to shorter and shorter lengths, or they can't play golf as much as they use to. The best treatment for this really is surgery to open up the spine and take some of the pressure off. And at surgery, we make an incision in the back. And depending on the type of stenosis, the surgeon may take off the entire piece of bone in the back or maybe just a little bit of a window here over the affected sides. They usually operate on both sides, because some patients may have symptoms worse than one side or the other, but usually both are affected. In severe cases, if there's a lot of arthritis and other disease in the spine, the surgeon may actually want to do a fusion as well as a decompression to prevent problems down the road. The key issue here is making sure that the symptoms are in fact due to disease in the spine and not to some other common conditions, for example, poor circulation from clogging of the arteries that go to your legs, which in some ways can mimic this condition. And again, if the operation is really indicated, if your symptoms are really so bad that is really interfering with your life, most patients do very well and these patients are very, very happy and grateful that they went through this.
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