DEAR MAYO CLINIC: It seems like everyone I know has some type of back pain. My husband and I both suffer from back pain but mine is a dull ache at the end of the day while he seems to have shooting pain. Why are our backs so susceptible to pain and how do I know when we should talk with our doctor?

ANSWER: Back pain is extremely common, so you and your husband are not alone. About 80% of adults in the U.S. will experience low back pain at some point. Your back is made up of 30 bones stacked in a column surrounded by muscles and ligaments. Nearly every movement you make involves your back in some manner. This constant movement and support mean that your back is susceptible to strain and stress.

Not all back pain is the same, though, and symptoms can vary widely. Occasionally, a person with back pain can pinpoint the exact time it started, like when attempting to lift a heavy object or after a fall. More commonly, no specific trigger or event led to the pain.

Here are the most common causes and descriptions of back pain:

• Muscle or ligament strains
  Muscle or ligament strains are usually caused by a single event, such as using poor body mechanics to lift a heavy object. Strains feel like a sudden stabbing, localized pain. This pain worsens when you contract the muscle or twist. Redness, swelling and bruising can occur. The pain can be intense. Occasionally, people state that they have "thrown out" their backs. In most cases, they have a muscle or ligament strain.
• Osteoarthritis
  Low back pain often is caused by osteoarthritis, the most common type of arthritis. Arthritis can lead to a narrowing of the space around the spinal cord or nerve roots, a condition called spinal stenosis. It occurs most often in the low back and neck. When this occurs in the low back, the most common symptoms are pain in both legs, tingling, numbness and sometimes muscle weakness.
• Bulging disk
  Disks act as cushions between the bones, or vertebrae, in your spine. The material inside a disk can bulge and press on a nerve. This is called a bulging disk. Pain from a bulging disk usually occurs in the low back and radiates into the hips, buttocks or legs. It often is worse with activity and feels better when resting.
• Herniated disk
  A herniated disk results when a tear in the tough outer layer of a disk allows some of the inner disk material to protrude outward. Herniated disks also are called ruptured disks or slipped disks. But compared with a bulging disk, a herniated disk is more likely to cause pain because it protrudes farther and is more likely to irritate nerve roots. Depending on where the herniated disk is, it can result in pain, numbness or weakness in one or both legs. These symptoms usually affect only one side of the body.
• Sciatica
  Sciatica is named after the sciatic nerve, which is the largest nerve in your body. It most commonly occurs when a herniated disk, bone spur or spinal stenosis compresses part of the nerve. Sciatica is a sharp, shooting pain that runs from your low back down the side or back of your leg. Typically, sciatica affects only one side of your body.
• Degenerative disk disease
  As you age, the disks between your vertebrae begin to shrink and lose their softer qualities. This narrows the space between the vertebrae and can make your spine less flexible. Degenerative disk disease does not always cause symptoms. If it does, symptoms vary widely in nature and severity. Generally, pain comes and goes over a long time. It may feel better when you change positions or walk, and worsen when you sit, bend or twist.

When to schedule an appointment

Most low back pain — even when severe — goes away on its own in six to eight weeks with self-care, such as resting from heavy lifting, applying heat or ice, using over-the-counter pain medications, and stretching. Physical therapy can provide tremendous relief from back and limb pain, and oftentimes people do not need more treatment.

Talk with your health care professional if you have a history of cancer, or if your pain:

• Is constant or intense, especially at night or when you lie down.
• Spreads down one or both legs.
• Causes weakness, numbness or tingling in one or both legs.
• Occurs with a fever, swelling or redness on your back.
• Occurs with unintended weight loss.
• Occurs with new bowel or bladder control problems.

Also, if your back pain occurs after a fall or another injury, you should seek medical attention. — Dr. Kendall Snyder, Neurosurgery, Mayo Clinic Health System, La Crosse, Wisconsin

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Related Articles 

• Mayo Clinic Minute: How vertebroplasty can reduce back pain for some published 7/7/22
• Mayo Clinic Q and A: Additional opinions helpful in treating back pain published 6/1/22
• Mayo Clinic Minute: Solving back pain problems published 10/14/21
• Science Saturday: Could regenerative medicine relieve neck, back pain? published 8/14/21

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LA CROSSE, Wis. ― Neck pain is a common issue that affects most adults. It can make driving a vehicle, performing computer work and taking part in hobbies painful or impossible. Cervical disk replacement is a new surgical procedure that can relieve pain while preserving the neck's range of motion.

"The pain may involve just the neck and shoulders, or it may radiate down an arm. The pain can be dull or feel like an electric shock into your arm," says Navid Khezri, M.D., a neurosurgeon at Mayo Clinic Health System in La Crosse. "Your spine is a stacked column of two components: vertebrae and disks. Vertebrae are the bones in the spine, and disks are rubbery cushions that sit between the vertebrae. The disks act as shock absorbers, allowing your spine and neck to bend, flex and rotate. The neck consists of seven vertebrae, called cervical vertebrae, and corresponding disks."

Some people feel muscle strain causes neck pain, according to Dr. Khezri. This could be a result of maintaining poor posture, carrying a heavy backpack or purse, cradling your phone between your shoulder and neck, or sleeping with too few or too many pillows. Structural changes to the cervical vertebrae or disks, including cervical spondylosis, spinal stenosis or a herniated disk, also could cause neck pain.

Neck pain often responds to nonsurgical treatment, such as rest, steroid injection, stretching and massage. Surgery may be needed if pain continues.

"In the past, the most common types of surgery on the cervical disks were spinal fusion and decompression surgery. During a spinal fusion, a spacer graft material is placed two or more cervical vertebrae," Dr. Khezri explains. "Eventually, the vertebrae grow together, or fuse, over time. Spinal fusion and decompression surgeries are often performed together. While these procedures are safe and relieve the pain, they permanently immobilize the spine and change the way the neck moves."

Cervical disk replacement

The Food and Drug Administration recently approved cervical disk replacement surgery as an alternative to spinal fusion. Like a knee replacement surgery, the artificial disk allows for full or nearly full range of motion after the surgery.

"During a cervical disk replacement, your surgeon makes a small incision on the side or front of your neck. After other structures are moved to the side, your surgeon can access your spine. The worn-out disk is carefully removed and replaced with an artificial disk between two vertebrae. The artificial disk has two metal plates that are anchored to the roof and floor of the disk space to keep it in place," says Dr. Khezri.

Replacing a disk in your cervical spine may relieve pain in your arms while maintaining motion and flexibility in your neck. It also decreases the stress on your remaining vertebrae.

If you have a cervical disk replacement, a patient can expect to remain in the hospital one night and will be encouraged to begin walking the day after surgery. Physical therapy will begin about six weeks after surgery.

"If you experience neck pain, talk with your health care professional or neurosurgeon about treatment options that can make a difference," adds Khezri.

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About Mayo Clinic Health System

Mayo Clinic Health System has a physical presence in 44 communities and consists of 53 clinics, 16 hospitals and other facilities that serve the health care needs of people in Iowa, Minnesota and Wisconsin. The community-based providers, paired with the resources and expertise of Mayo Clinic, enable patients in the region to receive the highest-quality physical and virtual health care close to home.

Mayo Clinic Health System in La Crosse was the only health care facility in Southwest Wisconsin in 2021 that received the Centers for Medicare & Medicaid's 5-Star Quality Rating and Leapfrog Grade A for Safety, and was named in Healthgrades America's "250 Best Hospitals" and Newsweek's "Best Hospitals in the U.S."

Media contact:

• Rick Thiesse, Mayo Clinic Health System Public Affairs, thiesse.ricky@mayo.edu

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DEAR MAYO CLINIC: I was diagnosed with cervical spinal stenosis after several months of neck pain, along with weakness, numbness and tingling in one arm and hand that kept getting worse. My health care provider recommends surgery, including spinal decompression and fusion. Is there a less-invasive treatment I could try before surgery?

ANSWER: Although it is possible that nonsurgical treatment may be reasonable for you, it sounds likely that surgery is in your best interest. That decision should be based on several factors, though, including the severity of your symptoms and whether the condition is affecting your spinal cord function.

Spinal stenosis happens when the main channel for the spinal cord — called the central spinal canal — or the openings for individual nerve roots in your spine become narrowed, causing pressure on nerve tissue. Spinal stenosis often is a result of aging and the formation of bone spurs from arthritis. Many people also are born with a narrow spinal canal, making them more prone to stenosis as they age.

When spinal stenosis affects the spine in your neck, called the cervical spine, it can affect a single arm (as in your case) if an isolated nerve root is compressed, or it may affect the entire body if the spinal cord is involved. The spinal cord is a vital structure because all the movement-related messages your brain sends to your body, as well as all the sensory messages your body generates below your neck, travel through the cervical spinal cord.

Cervical spinal stenosis often triggers pain; weakness; numbness; or clumsiness in a hand, foot, arm or leg. It also can cause problems with walking and balance. If left untreated, these symptoms may worsen, and additional symptoms, such as bowel or bladder problems, may develop.

When spinal stenosis is suspected, a detailed medical history and physical exam are necessary to find the cause of the symptoms. Imaging with MRI typically is performed to confirm the diagnosis and localize the stenosis. X-rays and CT scans usually are part of the evaluation, too, especially when there is significant neck pain, a spinal deformity or history of trauma. An electromyogram and blood tests also may be needed to confirm that symptoms are a result of spinal stenosis.

Spinal stenosis treatments that don’t involve surgery include self-care measures, medication, physical therapy and steroid injections. These treatments often can relieve symptoms of mild spinal stenosis. But for individuals like you who have complaints that grow steadily worse, surgery may be necessary to prevent permanent spinal cord or nerve root damage, and relieve — or at least stabilize — symptoms.

When surgery is necessary, the goal is to create more space for the nerve tissue. During spinal decompression, a surgeon removes the bone, ligament or disc that’s putting pressure on the spinal cord or nerve roots. Spinal fusion is performed if the spine is deformed or unstable, or if the spine’s alignment and stability are compromised by decompression.

Spinal fusion involves reinforcing the spine by linking two or more of the vertebrae together with a bone graft. Metal implants are used to maintain proper alignment and aid bone fusion. Spinal fusion is needed more often when stenosis surgery is performed in the cervical spine because that area tends to become unstable as a result of spinal decompression.

In some cases, an artificial disc can be inserted instead of performing a fusion to allow the vertebrae to continue to move normally. But that approach is only appropriate for people who have a well-aligned spine without instability or significant arthritis. Occasionally, the cervical spine can be decompressed without fusion, especially when opening it from the back instead of the front.

Surgery for spinal stenosis usually is not a matter of urgency, so take time to discuss your concerns with your health care provider. Together, you can review the goals, risks and benefits of surgery, and decide what’s best for you. Results of surgery for spinal stenosis generally are excellent when the operation is performed for the right indications and the correct procedure is chosen. — Dr. Bradford Currier, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

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Related Articles

• Spinal stenosis / mental health benefits of tidying up / helping cancer patients quit tobacco: Mayo Clinic Radio published 3/31/19
• Mayo Clinic Radio: Spinal stenosis published 3/28/19

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On the next Mayo Clinic Radio program, Dr. Bradford Currier, a Mayo Clinic orthopedic surgeon, will discuss treatment options for spinal stenosis. Also on the program, Dr. Craig Sawchuk, co-chair of Mayo Clinic’s Division of Integrated Behavioral Health, will explain the mental health benefits of the cleaning fad that's swept the country.  And Dr. J Taylor Hays, medical director for the Mayo Clinic Nicotine Dependence Center, and Dr. Carrie Thompson, a Mayo Clinic hematologist, will explain a Mayo Clinic program that’s helping cancer patients quit tobacco.

Here's your Mayo Clinic Radio podcast.

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Last summer, Scott Walling was in excruciating pain, and he could barely walk. Today he's pain-free and enjoying his favorite hobbies again, thanks to a new procedure offered by Mayo Clinic's Department of Neurosurgery.

One of Scott Walling's favorite activities is trapshooting, especially because it's a pastime he gets to share with his children — two of whom are on a trap shooting team at school.

"It's a different challenge each time you walk out to the line. There are so many factors that you need to overcome: rain, sun, wind speed and direction, and cold," Scott says. "I can't wait for the trap season to start back up this month."

Last summer, the chances of Scott being able to enjoy this year's season with his kids seemed slim. At that time, the 50-year-old road construction worker could barely walk. The back pain he had been experiencing for two years that would shoot down his leg and cause him to feel pins and needles in his toes was getting progressively worse. Scott went to a chiropractor, and he tried steroid medications. Nothing provided consistent relief.

"It got to the point where I was in excruciating pain all day. I wasn't sleeping. It was so bad, it would make me cry," Scott says. "I had to stop working at the end of July."

Scott went to see a neurologist in Mason City, Iowa, not far from where he lives, and he was told surgery would leave him in a wheelchair.

"I couldn't walk or stand up straight. I was hunched over," Scott says. "I had to do something."

That's when he decided to go to Mayo Clinic.

A chance for something better

When Scott arrived at Mayo Clinic in August 2018, he saw Physical Medicine and Rehabilitation physician Karen Newcomer, M.D. After a steroid injection didn't significantly ease his pain, he had a consult with neurosurgeon Mohamad Bydon, M.D.

Dr. Bydon diagnosed spinal stenosis and spondylolisthesis, a condition in which one vertebra slips forward and onto the vertebra below it, causing severe back pain or nerve crowding that produces leg pain or numbness. Dr. Bydon discussed a new surgical procedure with Scott that he was confident would help — a minimally invasive lateral lumbar inner body fusion, followed by robotic placement of posterior pedicle screws.

"Dr. Bydon is a cheerful, wonderful man. He told me, 'This is fixable.' His confidence and his expertise make you feel so comfortable about him. I trusted him immediately."

Scott Walling

"Dr. Bydon is a cheerful, wonderful man. He told me, 'This is fixable.' His confidence and his expertise make you feel so comfortable about him. I trusted him immediately," Scott says. "He kept reassuring me that everything would be OK, and I felt this was the only way I could get back to normal."

The procedure Dr. Bydon proposed to Scott offered a range of benefits. "The robotic software allows surgeons to determine the size of the screws and their trajectories. Then a robotic arm is used to guide the placement of the screws. This provides greater precision and safety when operating near critical neural structures," Dr. Bydon says. "Robotic spine surgery is still in its early stages. But over time, it will help us make surgeries more accurate, safer and more individualized."

After the procedure, patients typically have a shorter hospital stay and less need for narcotic pain medications.

A return to well-being

Mayo Clinic was the first center in the Upper Midwest to offer this robotic procedure and the first hospital nationally to offer it at all its locations. "Robotic spine surgery is available at Mayo Clinic's campuses in Rochester, Minnesota, as well as Florida and Arizona," says Dr. Bydon, who performed the first robotic spine surgery at Mayo Clinic.

On Nov. 1, 2018, Scott was one of the first patients to undergo the procedure. "I went to the world's best hospital. After the surgery, they had me wearing a brace, and I started moving up and down the hallways with the help of the phenomenal nursing staff," Scott says. "When I got home, I wore my brace for eight weeks. Now I get around fantastic. I've been able to spend time outside in my shop."

"The joy on Dr. Bydon's face was awesome. He can definitely put a check in the win column for me."

Scott Walling

By the start of this year, Scott's back and leg pain was gone completely.

"I feel great. With all the walking I've been doing, I'm getting back to where I was before the pain started," Scott says. "I'm able to do everyday basic tasks like cooking or getting dressed by myself, which were difficult before surgery. It's also nice to be able to drive my car and have my independence back."

At his three-month follow-up appointment, Dr. Bydon told Scott he's doing exceptionally well. "The joy on Dr. Bydon's face was awesome. He can definitely put a check in the win column for me," Scott says.

Physical therapy to strengthen Scott's core muscles and the muscles in his back will help him improve even more. In the meantime, he's returned to another one of his favorite hobbies: running a blacksmith shop out of his shed, where he makes items such as plant hangers and grilling utensils.

"I'm grateful for my health and my family. My wife and kids have been so supportive. And I'm thankful for the doctors and nurses and everyone who took care of me," Scott says. "Everybody at Mayo is phenomenal. They're just so concerned about your well-being."

HELPFUL LINKS

• Watch a video to learn more about robotic spine surgery.
• Read about spinal stenosis.
• Check out Mayo Clinic's Department of Neurosurgery.
• Connect with others talking about brain and nervous system conditions on Mayo Clinic Connect.
• Explore Mayo Clinic's Rochester campus.
• Request an appointment.

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When Bob Goldberg was given a diagnosis of Alzheimer's and Parkinson's diseases, he was dubious and decided to get another opinion at Mayo Clinic. A year later, after two successful surgeries, Bob can once again think clearly and walk on his own.

Bob Goldberg has always been great with numbers. His natural ability to do rapid computations helped him go from working as a messenger for the Chicago Board of Trade in 1958 at age 15 to becoming a broker in 1963 to serving as the exchange's chairman in 1985.

"I always liked doing things that required a quick reaction time and making quick decisions," Bob says.

So in October 2017, when the 76-year-old couldn't add two simple numbers together, Bob became concerned. He and his wife began noticing other symptoms, as well, including lack of balance and coordination, confused thinking and, within a short period of time, the inability to walk.

The Goldbergs spend winters in Sarasota, Florida. After seeing his primary care doctor there and getting an MRI, Bob was referred to a local neurology practice. He had further testing and was diagnosed with Alzheimer's disease and Parkinson's disease.

"They gave me a book to read about Alzheimer's and the names of the two drugs to slow down its progression," says Kathy, Bob's wife. "At that point I stood up and said, 'No, we're not going to do that. The doctor asked, 'What are you going to do?' and I said, 'We're going to go to Mayo.'"

Frightening symptoms

After that, Bob's condition continued to deteriorate. His balance got so bad that he fell several times, and he was forced to use a wheelchair.

"Once he fell, he couldn't get up. He couldn't lift his arms or legs. I had to get him on a rug and pull him," Kathy says. "He just kept getting worse by the day, and I would have to lift his legs to get him into the car. He couldn't shower or go to the bathroom by himself. We all thought he was going to die."

Kathy's worry mirrored Bob's own concern for his well-being.

"I knew something was very wrong. The things I was once able to do to take care of myself, I could no longer do. I was scared and confused," Bob says. "But I was going to go to the best of the best to figure it out."

A pair of problems

At the end of January 2018, Bob had an appointment at Mayo Clinic's Rochester campus, where he met with Orhun Kantarci, M.D., a Mayo Clinic neurologist, along with a neurology fellow.

"The fellow started examining Bob. Forty-five minutes into the appointment, he turned and asked the two of us, 'Hasn't anyone mentioned normal pressure hydrocephalus to you?' Bob and I had never heard of it," Kathy says.

The neurologists at Mayo suspected that there were two underlying conditions triggering Bob's symptoms: a combination of spinal stenosis and normal pressure hydrocephalus. Spinal stenosis is a narrowing of the spaces within the spine, which can put pressure on the nerves that travel through the spine. Normal pressure hydrocephalus happens when the fluid-filled chambers in the brain, called ventricles, become enlarged, due to an accumulation of extra cerebrospinal fluid, and press on the brain, even though the fluid pressure within the chambers remains normal.

To ease the symptoms being caused by normal pressure hydrocephalus, Bob underwent a high-volume spinal tap to drain the excess fluid. The result was a rapid change in mobility that thrilled Kathy and Bob.

"The most encouraging part was no one knew what it was and couldn't help me get better, and within an hour after arriving at Mayo, I heard the words, 'We can fix this.'"

Bob Goldberg

"They drained five big tubes of cerebrospinal fluid, and he was able to walk down the hall," Kathy says. "I started to cry."

"The most encouraging part was no one knew what it was and couldn't help me get better, and within an hour after arriving at Mayo, I heard the words, 'We can fix this,'" Bob says. "There was a lot of professionalism and compassion."

To achieve long-term relief of Bob's symptoms, his care team believed surgery would be necessary. He was referred for a neurosurgical evaluation to Joshua Hughes, M.D., Mayo Clinic's chief neurosurgery resident at the time, and neurosurgeon Benjamin Elder, M.D., Ph.D. Dr. Elder and Dr. Hughes agreed Bob had symptoms of cervical myelopathy — a condition related to spinal stenosis that leads to imbalance and arm, hand and leg weakness when the spinal cord becomes compressed — and normal pressure hydrocephalus.

Addressing both conditions would require two surgeries. First, they recommended Bob undergo a posterior cervical decompression and fusion procedure. That surgery would relieve the spinal cord compression and stabilize Bob's neck. Second, the surgeons proposed that Bob have another procedure one to two months after the first surgery to place a ventriculoperitoneal shunt. The shunt would act as a drainage system for the excess cerebrospinal fluid, so the fluid would no longer build up in the ventricles.

After hearing that plan, Bob and Kathy were ready to go ahead with the first surgery. "We had so much confidence in all of the doctors," Kathy says. "They were so confident and calm."

Complete turnaround

Three days after Bob's consult with them, Dr. Elder and Dr. Hughes performed the decompression and fusion procedure. Afterward Bob returned home to Chicago. Over the next six weeks, he wore a neck brace and participated in rehabilitation to aid in his recovery.

On March 23, Dr. Hughes and Dr. Elder implanted the ventriculoperitoneal shunt in Bob's brain. That surgery involved placing a long, flexible tube in one of the brain's ventricles. The tube has a valve on it that keeps fluid from the brain flowing in the right direction at the proper rate. The tube is run to another part of the body, so the excess cerebrospinal fluid drains into an area where it can be absorbed more easily, such as the abdomen.

"Dr. Hughes came out and said everything went well," Kathy says. "That afternoon, Bob got up and walked. It was unbelievable. Just to see him walking down the hall was a miracle."

"It was a privilege that Dr. Hughes and I were able to help treat both his spinal cord compression and hydrocephalus and help him return to a more normal life."

Benjamin Elder, M.D., Ph.D.

Bob stayed in the hospital for 18 days after his second surgery, and he did speech and physical therapy as part of the recovery process.

"Everyone was so caring. If he ever put his light on, they were there in seconds," Kathy says.

"They have a compassion that I haven't seen at most places. It's a whole different feeling. You feel like it's family taking care of family because they care."

After returning home, Bob had physical, occupational and speech therapy for 12 weeks. He continues to work with a therapist twice a week on his mental focus and memory retention. But the overall improvement in his condition since the surgeries has been dramatic.

"It's wonderful to see Bob go from being wheelchair-bound to being able to walk and return to many of his prior activities. I remember how excited he was to show off how well he was able to walk in the hospital immediately following the shunt surgery, and he's only improved from there," Dr. Elder says. "It was a privilege that Dr. Hughes and I were able to help treat both his spinal cord compression and hydrocephalus and help him return to a more normal life."

In September, the Goldbergs returned from a trip to London, where they walked for hours taking in the sights, seeing a musical and enjoying family.

"Just eight months ago, he couldn't move or put a sentence together and make sense," Kathy says. "It's a miracle."

"I'm happy to be alive," Bob says. "I'm going to start playing golf again, going to Cubs games and coaching my grandson who plays basketball. We're so grateful."

HELPFUL LINKS

• Learn more about spinal stenosis and hydrocephalus.
• Read about Neurosurgery at Mayo Clinic.
• Explore Mayo Clinic's Rochester campus.
• Request an appointment.

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DEAR MAYO CLINIC: I was diagnosed with spinal stenosis about 12 years ago. I haven’t had many symptoms over the years, but about six months ago I started noticing increasing discomfort in my legs. Is surgery an option to treat spinal stenosis? If not, what else can I do? The leg pain is making it hard for me to walk.

ANSWER: Surgery usually isn’t necessary to treat spinal stenosis. Often a combination of lifestyle changes, physical therapy and medication can effectively decrease the pain and discomfort caused by this common back problem.

Spinal stenosis occurs when the open space within your spine narrows, causing pressure and irritation to the nerve tissue. It can happen for a variety of reasons, but most of the time spinal stenosis is a result of aging and the buildup of arthritis. In some cases, spinal stenosis does not cause any symptoms and may be found during a medical test done for another reason. Spinal stenosis, and the nerve compression that is associated with it, tends to develop slowly. Over time, it can put pressure on your spinal cord and the nerves that travel through the spine to your arms and legs, and possibly cause symptoms.

If the nerves affected are in your neck — the part of your spine called the cervical spine — that may cause numbness, weakness or tingling in an arm or hand, or trouble with coordination in a leg or foot. It often causes problems with walking and balance. Nerves to your bladder or bowel can be affected, too.

When spinal stenosis affects nerves in your lower back, called the lumbar spine, that may lead to pain or cramping in your legs when you stand for a long time, or back discomfort when you stand up and when you walk. The discomfort usually eases when you bend forward or sit down.

When spinal stenosis causes symptoms that interfere with daily activities, treatment usually begins with self-care steps. For example, people with mild symptoms often benefit from changes to their diet and nutrition. A healthy weight loss can take some stress off the back, particularly the lumbar portion of the spine. Working with a physical therapist can help, too. He or she can teach you exercises to help maintain the flexibility and stability of your spine, as well as build your strength and endurance and improve your balance.

Medications such as pain relievers and muscle relaxants can also temporarily ease the discomfort of spinal stenosis. They are typically recommended for a short time only, though, as there’s little evidence of benefit from long-term use.

If those measures aren’t enough, then injecting a corticosteroid medication into the spinal canal may be another option. Your nerve roots may become irritated and swollen at the spots where they are being pinched due to spinal stenosis. A corticosteroid can help relieve some of the pressure by reducing the inflammation. Corticosteroids are powerful drugs, however, so you can only get these injections a few times each year.

Surgery for spinal stenosis is used only after other treatment options have failed to provide relief. The goal of surgery is to create more space for the spinal cord. During the procedure, a surgeon removes the bone that’s putting pressure on the spinal nerves. In some cases, no further intervention is needed. If removing the bone decreases the spine’s strength or stability, then the spine may need to be reinforced by linking two of the vertebrae together with metal implants and a bone graft.

Talk to your doctor about the treatment that’s best for your situation, and ask about choices that are less invasive than surgery, such as weight loss and exercise. Together, the two of you can create a treatment plan to fit your needs and help you feel better. — Paul Huddleston, III, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.

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Here's the podcast: Mayo Clinic Radio PODCAST March 7 2015

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