Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The most common cause of lumbar spinal stenosis is degenerative arthritis and degenerative disc disease. As with other joints in the body, arthritis commonly occurs in the spine as part of the normal aging process and as a result of osteoarthritis. This can lead to loss of the cartilage between the bones at the joints, formation of bone spurs (osteophytes), loss of the normal height of the discs between the vertebrae of the spine (degenerative disc disease, also known as spondylosis), and overgrowth (hypertrophy) of the ligamentous structures. Further degeneration of the lumbar discs can lead to slippage of one vertebra on another, a process referred to as spondylolesthesis. Each of these processes can reduce the normal space available for the nerves in the spinal canal and result in direct pressure on nerve tissues to cause the symptoms of lumbar spinal stenosis.
Lumbar spinal stenosis can also be caused by other conditions that decrease
the space of the spinal canal or vertebral foramen. These can include
tumor (abnormal tissue enlargement of structures that make up the spinal canal),
infection,
various metabolic bone disorders that cause bone growth, such as
Paget's disease of
bone.
These causes, however, are much less common than degenerative arthritis.
What are the signs and symptoms of lumbar spinal stenosis?
weakness, numbness,
pain, and
loss of sensation in the legs.
In most situations, the symptoms improve when the patient is sitting or leaning forward. Typically, painful sensations shoot down the legs with continued walking and diminish with resting. Standing and bending backward can make the symptoms worse. This is because bending forward increases the space in the spinal canal and vertebral foramina, while bending backward decreases this space. It is therefore more comfortable for patients to sit or lean forward. Patients are frequently unable to walk for long distances and often state that their symptoms are improved when bending forward while walking with the support of a walker or shopping cart.
The symptoms commonly worsen with time. This is because degenerative arthritis is a progressive disease that gradually becomes more severe with time. If left untreated, the compression on the nerves from lumbar spinal stenosis can lead to increasing weakness and loss of function of the legs. It can also lead to loss of bowel and bladder control and loss of sexual function.
Your doctor can help determine if your symptoms are from lumbar spinal stenosis or a different condition. Many other disorders can cause similar symptoms that mimic lumbar spinal stenosis
including
A pinched nerve can be caused of a variety of conditions, for example, carpal tunnel syndrome, herniated disc, sciatica, arthritis, spinal stenosis, trauma, and more. Common symptoms of a pinched nerve include pain, numbness, tingling, and weakness. Treatment of a pinched nerve depends on the cause of the pinched nerve.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Degenerative disc disease makes the disc more susceptible to herniation (rupture) which can lead to localized or radiating pain. The pain from degenerative disc or joint disease of the spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises and medications to relieve pain, muscle spasm and inflammation.
The five types of spondylolisthesis include 1) dysplastic, 2) isthmic, 3) degenerative, 4) traumatic, and 5) pathologic. The most common symptom of spondylolisthesis is lower back pain. Treatment depends on the type and severity of spondylolisthesis. Surgery is required in some cases of spondylolisthesis.
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
A common form of short stature, achondroplasia (dwarfism) is a genetic condition causing a disorder of bone growth. Complications of achondroplasia that need monitoring include (this is not all inclusive) stenosis and compression of the spinal cord, a large opening under the skull, lordosis, kyphosis, spinal stenosis, hydrocephalus, middle ear infections, obesity, and dental crowning. Achondroplasia is caused by mutations of the FGFR3 gene.
Bowel or fecal incontinence refers to the loss of voluntary control of stool, or bowel movements. The condition can include partial incontinence, in which a person loses only a small amount of liquid waste, to complete incontinence, in which the entire bowel movement cannot be controlled. Diet changes and elimination of certain medications can help patients to regain bowel control. Treatment involves a combination of medication, biofeedback, and exercise.
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