Back pain could be spinal stenosis, a condition where the spinal canal - the protective area that houses the spinal cord - narrows, placing pressure on the spinal cord or spinal nerves. This can lead to pain, weakness or numbness in the back, neck, legs, shoulders or arms - depending on which part of the spinal cord is affected. Spinal stenosis most often results in lower back pain and neck pain.
At The University of Vermont Medical Center, our highly-trained neurology team uses sophisticated technology and minimally invasive surgical techniques to diagnose and treat spinal stenosis.
Spinal Stenosis Care at UVM Medical Center
Through all stages of your treatment for spinal stenosis - from diagnosis to surgery to rehabilitation - we provide a caring, personalized approach that puts patients at the center of everything we do.
- Leading surgical techniques - The UVM Medical Center neurosurgeons are specially trained in the most recent techniques, including robotic surgery, microsurgery, laser surgery, and image-guided therapies. These techniques result in faster recovery times and reduced pain.
- Experienced team - Our fellowship-trained neurologists work with neuroradiologists to quickly and precisely diagnose your spinal stenosis. Depending on the type of treatment needed, orthopedic surgeons, neurosurgeons, rheumatologists, and physiatrists provide expert care.
- State-of-the-art technology - Machines like our computed tomography scanner provide some of the most advanced technology available. Using these scans, we can see exactly where the spine is damaged.
- Evidence-based care - As a university hospital and health system, we make all diagnostic and treatment recommendations for spinal problems based on the latest thinking in the field. Through patient education, we answer all your questions and help you become as informed as possible throughout your care.
Spinal Stenosis: An Overview
If you have lower back pain and are over the age of 50, you could have spinal stenosis. It's a common condition that gets worse over time.
Spinal stenosis causes include:
- Bone spurs - A bone overgrowth that presses into the spinal canal.
- Disk degeneration - The disks that act as a cushion between your spine's vertebrae can dry out with age.
- Thickened ligaments - Ligaments hold the spine together. If they get thick and stiff, they can press into the spinal canal.
- Tumor(s) - Abnormal cell growth can happen anywhere in the spine.
- Spinal injuries - Any kind of trauma to your spine can affect the spinal canal.
Spinal Stenosis Diagnosis
If you have persistent back pain and need diagnosis and evaluation of spinal stenosis, you will be referred by your primary care physician to a neurologist or neurosurgeon. The UVM Medical Center's goal is to ensure a high level of accuracy in screening and diagnosis for you and your family.
Specialists on your team may include:
- Rheumatologists - Medical doctors who specialize in the treatment of arthritis and related disorders.
- Neurologists - Physicians with advanced training in neurology, and treating disorders of the brain and nervous system.
- Neurosurgeons - Surgeons with advanced, fellowship-level training in operating on the brain and nervous system. Neurosurgeons treat diseases and conditions affecting the brain, spine and spinal cord and the peripheral nerves - the nerves located outside the brain and spinal cord. They provide non-surgical and surgical therapies.
- Orthopedic surgeons - Surgeons with advanced training in the diagnosis, care and treatment of patients with disorders of the musculoskeletal system (bones, joints, muscles, ligaments, tendons, nerves and skin.)
- Physiatrists - Physicians with specialized training in rehabilitative medicine, and in diagnosing and treating pain.
- Pain Medicine Experts - Physicians with advanced training in anesthesiology and pain medicine who provide advanced therapies for treating acute and chronic pain
- Physical therapists - Health care providers that help pre-surgery or with recovery after surgery
Our neurological imaging specialists - called neuroradiologists - work closely with your care team. They help determine the best tests for your condition. These professionals are specially trained in conducting brain imaging studies to detect the presence of a tumor.
Our neuroradiologists use a wide range of imaging technologies to diagnose spinal stenosis. You'll have access to some of the highest levels of expertise and technology anywhere in the country.
Diagnosing spinal stenosis may involve the following:
- Physical exam - Your specialist will conduct a thorough physical exam and medical history. He or she will examine your range of motion, muscle strength, and reflexes. The specialist will also assess your balance, ability to feel pain and the ability to walk, among other factors.
- X-rays - An x-ray may be taken to help rule out other problems with the spine, such as a fracture or bone tumor, which may cause similar symptoms.
- Magnetic Resonance Imaging (MRI) - An MRI uses magnetic fields and radio waves to produce cross-sectional images of your body. The UVM Medical Center offers the latest technology in Open MRI, offering a comfortable option for patients who prefer an open setting. This test can identify damage to the disks and ligaments, as well as any pressure on the spinal cord or nerves.
- CT (computed tomography) myelogram - This test uses x-ray images from many angles to create detailed, cross-section images of the body. The UVM Medical Center offers some of the most advanced CT technology available today, including a 64-slice CT scanner, capable of imaging organs in the body within seconds. With this test, a liquid dye is injected into the spinal column before the CT scan is taken. It can show pressure on the spinal cord and nerves and reveal the presence of herniated discs, bone tumors or bone spurs.
Treatments for Spinal Stenosis
At The University of Vermont Medical Center, we offer a full range of options to treat spinal stenosis. Whenever possible we work with patients to provide the most minimally invasive approach, with the goal of reducing risk and improving quality of life.
Spinal Stenosis treatment options at The UVM Medical Center include:
- Physical therapy - Licensed physical therapists with The UVM Medical Center's rehabilitative therapy services are committed to helping you regain your maximum level of function and independence.
- Medications, including:
- Pain and anti-inflammatory pills
- Anti-inflammatory injections
- Surgery, including:
- Laminectomy - A procedure where a major part of the spinal bone - called the lamina - is removed. This turns the spinal canal from an "O" shape into an open-ended shape, creating more room in the canal. A related procedure known as laminotomy involves making a small hole in the lamina and removing only a small portion of the bone.
- Laminoplasty - This procedure enlarges the width of the spinal canal without removing the lamina. One or both sides of the lamina are cut away from the vertebrae. The surgeon creates a flap of bone that can be held open with metal fasteners, to allow more room in the spinal canal. This keeps the canal permanently widened.
- Foraminotomy - With this procedure, neurosurgeons enlarge the passageway surrounding a spinal nerve root - relieving pressure on the root that can cause inflammation and pain. The surgeon will remove any bone spurs, thickened ligaments or herniated disk tissue. This leaves more space for the nerve root.
- Medial Facetectomy - A procedure that involves removing part of the facet - a bony structure in the spinal canal. This increases space in the canal and relieves pressure on the spinal nerves.
- Discectomy - A common spine surgery that involves removing a portion of a disc that is putting pressure on the spinal cord or nerves.
- Interspinous Process Decompression - This minimally invasive procedure involves implanting a special device between two bones (spinous processes) located in the spine. The implant keeps the space between the two bones open, relieving pressure on the nerves. The goal is to allow patients to maintain their normal posture and avoid having to lean forward to relieve pain.
- Spinal Fusion - A procedure that involves joining together two or more vertebrae into a single bone. Metal screws and rods are typically used to stabilize the vertebrae as the bone heals. The goal is to stop motion at the part of the bone that causes pain.
- Anterior Interbody Fusion - A type of spinal fusion where surgeons approach the spine from the front (anterior) of the spine. It involves removing a spinal disc, usually from the lower or lumbar spine. Surgeons then insert a bone graft at the place where the disc was removed, in between two vertebrae. The goal is for the vertebrae to grow together into a solid bone.
Robotic Surgery for the Spine
Robotic surgery for the spine uses an endoscope with a tiny camera on the end, inserted through a small incision in the skin. This gives neurosurgeons an inside view of the affected area of the spine. Microsurgical instruments are guided to the area to repair the damage or remove tissue. Robotic surgery is minimally invasive spine surgery and carries less risk than open spine surgery as well as other benefits, including:
- Smaller incisions
- Less blood loss
- Less pain
- Reduced harm to muscles
- Shorter hospital stay
- Quicker recovery
- Reduced scar tissue
Our neurosurgeons perform the following robotic surgeries or minimally invasive procedures: