Published on September 29, 2024
A common cause of sciatica (pain in the buttocks or legs) in patients over 70 is some form of degenerative spinal stenosis (narrowing) of the spinal canal.
This narrowing may occur within the central spinal canal or may result from compression of the nerve as it exits the spinal canal. In some cases, nerve pain occurs when disc material presses on exiting nerves or when bone narrows.
Some patients develop spondylolisthesis (slippage), causing further narrowing of the spinal canal and pinching of nerves.
Patients with this stenosis have severe walking limitations. Many people have difficulty getting it delivered to their mailbox. Some people can barely stand it for more than 5 or 10 minutes. Most patients experience some relief when pushing a shopping cart or walker, and many patients bend forward when walking. Nighttime leg cramps may also occur.
If the pain does not respond to physical therapy and medications, initial treatment usually begins with an epidural injection. These injections inject the steroid directly into the area of inflamed nerves. If the pain has an inflammatory component, anti-inflammatory steroids should relieve the pain.
There are three types of epidural injections. These are:
• Midline method
• Along one exiting the nerve root
• Located above the tailbone (close to the tail)
Typically, we start with a midline epidural injection at the affected level if possible. If this approach does not respond, we can inject along the exiting nerve root via a transforaminal injection.
If these initial injections are successful, they can be repeated every three months.
However, in cases of severe narrowing of the central canal or bony canal, steroids may not be helpful. Instead, there may be an anatomical problem that may require a surgical solution or minimally invasive surgery to create space in the narrowed spinal canal.
If major surgery is not required, the excess ligaments at the back of the spinal canal can be removed through MILD surgery. MILD (minimally invasive lumbar decompression) is a 20-minute procedure that requires only a quarter-inch incision.
Alternatively, a spinal “spacer” device can be placed through the VERTIFLEX procedure. This creates more space in the center of the neural tube and opens up along the exiting nerve root.
Vertiflex is also a 20-minute procedure and is sometimes called a “jack on the back.” The procedure is performed through a small one-inch incision while the patient is comfortably sedated.
Of course, all recommended options depend on many factors, including previous surgery, spondylolisthesis (slippage), the presence of scoliosis, whether you take blood thinners, and your underlying medical conditions.
No matter what, we will try to find the least invasive way to successfully treat your sciatica and restore your comfort and ability to return to a more active life.
