by Dr. Mark W. McFarland, DO
Acute and chronic neck and back pain represents a major health concern in the United States. Nearly everyone has back pain, which at some point, interferes with work, routine daily activities, or recreation. Americans spend at least $50 billion each year treating back pain, which is the most common cause of job-related disability and a leading contributor to missed work. Fortunately, most occurrences of back pain go away within a few days. Others take much longer to resolve or lead to more serious conditions. There are many conditions that can cause lower back pain, including fibromyalgia, sciatica, a bulging disc, spinal degeneration and spinal stenosis. In this article, I will explain spinal stenosis and its treatment options. Before I delve into the condition itself, a quick anatomy lesson might be helpful in understanding this condition and why it happens.
The back is an intricate structure of bones, muscles, and other tissues. The core of the back is the spinal column, which houses and protects the spinal cord — the delicate nervous system structure that carries signals to and from the brain, which control the body’s movements and convey its sensations. Stacked on top of one another are more than 30 bones — the vertebrae — that form the spinal column, also known as the spine. Each of these bones contains a central opening that, when stacked with all the others, creates a channel that surrounds the spinal cord. The spinal cord descends from the base of the brain and is about 18 inches long in men and 17 inches long in women, which is much shorter than the length of the bony spinal column. Small nerves enter and emerge from the spinal cord through spaces between the vertebrae. The spaces between the vertebrae are maintained by round, spongy pads of cartilage called intervertebral discs. These discs allow for flexibility in the lower back and act much like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments and tendons hold the vertebrae in place and attach the muscles to the spinal column.
Starting at the top, the spine has four regions:
- the seven cervical or neck vertebrae (labeled C1 – C7)
- the 12 thoracic or upper back vertebrae (labeled T1 – T12)
- the five lumbar vertebrae (labeled L1 – L5), which we know as the lower back
- the sacrum and coccyx, a group of bones fused together at the base of the spine
The lumbar region of the back is where most back pain is felt. It has the important task of supporting the weight of the upper body, which can be put under a great deal of strain and stress by daily activities, job-related tasks, and recreation.
Another factor working against us is time: as we age, bone strength and muscle elasticity and tone tend to decrease. The discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae, so the likelihood of experiencing low back pain from disc disease or spinal degeneration increases with age.