Donald Corenman, MD, DC

Congratulations on your weight loss. That will be helpful in your overall recovery from this disorder.

Being 24 years of age and carrying a diagnosis of lumbar canal stenosis means you have congenital stenosis (your canal is small to begin with). The condition called neurogenic claudication can occur with canal narrowing. The symptoms are characterized by low-lower back pain (back of the pelvis pain) caused by prolonged standing and walking. Symptoms can radiate into the thighs the longer you stand or walk.

If your pain is lower back pain brought on by lifting and bending and feels better when you stand and walk, you probably do not have symptoms of neurogenic claudication but have symptoms of degenerative disc disease.

Each condition is treated differently. You want to encourage flexion activities with neurogenic claudication (cycling, skiing, modifying swimming with a snorkel) and encourage extension exercises with degenerative disc disease (swimming, gym workouts, swiss ball extension activity). Epidural injections can help in either case.

Dr. Corenman

Disc herniations in the thoracic spine are difficult to treat if epidurals are ineffective. The pain can originate from four potential generators: the nerve root compression, the degenerative disc itself, compression of the spinal cord or from a condition called Scheuermann’s.

Nerve compression should cause pain that radiates around the chest wall associated with numbness of that dermatome (the sensory area the nerve serves). This condition is unlikely to be the painful disorder as it is very uncommon.

The most common pain generator is disc degeneration itself. Discs act as shock absorbers. When discs become degenerative, they tear which can cause pain as the disc wall is full of pain nerves in some patients. Patients with this disorder have more pain with loading and vibration (unfortunately, airplane vibration compounds this problem).

Scheuermann’s disorder is associated with degenerative disc disease. In this disorder, which initially occurs when the patient is young, the endplates of the vertebra deform but the pain might not develop until later in life. This disorder which is more common than you think is recognized by the irregular endplates and wedging of the vertebral bodies.

Finally, herniations that cause cord compression are not typically severely painful (but can be). Symptoms are mainly pins and needles in the legs along with imbalance (legs do not function well).

The good news is that as long as there is no cord compression, this condition is not dangerous. Chiropractic manipulation can be helpful to manage the symptoms. Since, typically the symptoms occur with prolonged sitting or standing, extension strengthening can be helpful. Lying face-up over an exercise ball to stretch the spine and then lying face-down and doing back extensions (reverse sit-ups) can be helpful.

There are portable seat pads made of sorbothane, a viscoelastic polymer that might be helpful to reduce the vibration imparted by your occupation.

Medications such as membrane stabilizers (Lyrica and Neurontin) can occasionally help with symptoms as long as side effects are minimal. These meds work in about 30% of patients effectively without significant side effects.

Facet blocks can relieve pain. If these blocks temporarily eliminate pain (see facet blocks and keeping a pain diary on the website), you might be a candidate for rhizotomies. Rhizotomies are a more permanent procedure to relieve pain.

If nothing else works, surgery could be considered but that would be if everything fails and the pain is absolutely debilitating. I won’t go into details but surgery is the last resort if nothing else works and a work-up indicates you are a candidate.

Dr. Corenman

My pleasure. Hope your mother does well.

Dr. Corenman