After recently visiting my doctor with a painful lower back and numbness in my legs, he diagnosed spinal stenosis in the lower vertebrae.
I am in my mid-50s with a decent level of fitness (I cycle, walk and use weights) and am concerned about the long-term effects.
My specialist has told me there are three stages of treatment: drugs, physio and finally surgery. Is there a record of success for surgery or should I stick with the first two options?
Phil Cundale, London.
Bad back: The only cure for spinal stenosis is surgery - but you can take drugs to alleviate the symptoms
You must find it both disappointing and worrying to be only in your mid-50s and athletically fit, yet discover you have a significant degree of degeneration of your spine.
This part of the spinal column carries the greatest load, and dealing with it correctly has considerable implications for your future mobility.
But first a few words about anatomy and the exact meaning of spinal stenosis.
The vertebral column, the spine, is the main chassis around which your body is built. It also contains and protects the main pathway of nerves to and from the brain to the other parts of the body— called the spinal cord. The hollow space through which these nerves pass is known as the spinal canal.
The spine is built of a column of bones stacked one on top of the other— the vertebrae.
The vertebrae of the lower spine— called the lumbar vertebrae— are subject to considerable loads because they carry the weight of the entire upper part of the body, and inevitably wear and degenerate in all of us as the years pass.
This happens to a varying extent— some people experience symptoms such as pain and stiffness, and some, like yourself, have worse consequences.
The body makes attempts at repair by creating new bone, but this can impinge on the spinal canal and reduce the space available for the nerves to pass through.
The discs in between the vertebrae can also break down and degenerate, pressing into the spinal canal and taking up more space, causing further pressure on the critical nerve supply to the lower part of your body.
The factors leading to spinal stenosis are a combination of genetics— the way you are made— and environmental factors such as your weight, and the amount of stress you have placed on your body with your high-impact exercise regime.
The first stage of treatment— drugs— will be simple painkillers such as paracetamol along with the occasional use of non-steroid anti-inflammatory medicines, such as ibuprofen, which may reduce the pain and stiffness.
Injections of steroids into the joints either side of the main vertebrae— called the facet joints— may also provide many months of relief.
However, medicines will not make any difference to the fundamental problem of the nerves being squeezed by the narrowing of the spinal canal, and at best there may be modest help with some of the symptoms.
The value of physiotherapy lies in making the best of what you have got.
This includes keeping reasonably supple, maintaining good muscle strength in your back and legs, and keeping a good level of general posture and agility.
Even just one session with a good physiotherapist can be enough to teach you how to achieve this.
Again, it will not make any difference to the mechanical problem of the nerves being squeezed. This is where surgery comes in. Here, the excess new bone is removed to open up space for the nerve pathways and can save them from increasing pressure and damage.
This cannot be achieved by any other form of treatment.
Definitive relief comes from an operation, and surgery for this has a good track record, particularly in younger individuals such as yourself, who are fit and also well-motivated for rehabilitation.
If your spinal stenosis is so severe that your activities are restricted by pain and numbness, and surgery is offered, accept this option.
I am deeply worried about my 46-year-old daughter, who has recently been diagnosed with the skin condition chronic idiopathetic urticaria.
There are approximately ten large areas on her back which are constantly affected, and she has been told to expect the condition for the next 30 years.
Can you tell me more about the condition— and can anything be done to ease it?
E. Lowrie, Bristol.
Urticaria, or hives, is common— one in five of us is affected at some time in our lives.
The condition is furiously itchy, migrating around to various sites of the skin, looking just like stinging nettle rash (urtica is the Latin plant name for stinging nettle) with patches of urticaria suddenly occurring in a few minutes and disappearing equally quickly.
Sometimes there is associated swelling deeper in the skin, described as angioedema, and this may affect the face, tongue or lips— giving rise to concerns about whether the airway might get blocked— though it can also occur anywhere on the body.
CONTACT DR SCURR
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His replies cannot apply to individual cases and should be taken in a general context.
Always consult your own GP with any health worries.
In people with a recent onset, it is sometimes possible to identify a trigger such as a food or a medicine.
Chronic urticaria is when the rash occurs on most days for a period of more than six weeks, and in 90 per cent of those who get this a causecannot be found.
This is the type your daughter suffers. In such patients, 40 per cent have accompanying angioedema as described above.
We know that it is caused by an overreaction by the body’s immune system, but we don’t know why this occurs. Initial treatment is with high doses of antihistamines. However, a patient of mine had this since Christmas and despite being treated with three high-dose antihistamines,the condition persisted.
Relief has arrived at last— four months on— after treatment with ciclosporin, a medicine that was originally used as an immunosuppressant in kidney transplantation.
What this case shows is that treatment can be complicated and is bestcarried out under the supervision of an expert dermatologist.
In the past, with such cases I have prescribed steroids in the form of tablets of prednisolone, but I think that this has now been superseded with advanced immunosupressants such as the one mentioned above— and thus avoiding the inevitable side-effects of steroids, such as weight gain.
But the important point is that it is known to be a self-limiting disorder in most patients, which means it clears up on its own accord— in around half of patients, it clears in a year.
However, I must advise you that one person in five does still have some symptoms at five years.
But the picture is not so bad as you have previously been advised— there is hope.
By the way... GPs don't need to know your blood group
If you ask your doctor what blood group you are and he appears not to know¿ it is not dereliction of duty
Never a month goes by when a patient does not ask me to check their records and tell them what blood group they are.
Mostly we don’t know— but telling them that sounds a bit incompetent, so there has to be a detailed explanation.
Why are they asking? Usually they are filling in a form before joining a gym, or maybe they are dutifully filling in the front page of their diary and listing their next of kin, passport number and all those details.
The fact is, if you are in dire need of a blood transfusion after an accident or a medical crisis, the first thing that the hospital laboratory will do is check your blood group, which takes less than an hour.
The reason for this is that besides the familiar ABO and rhesus systems— whether you are O negative or A positive for example— we also have the MNS system, the Kell system, the Lewis system and the D+ and D- group. In all there are 30 blood group systems, and they can all be relevant to what blood transfusion you receive.
It’s a bit like knowing you drive a Ford or a VW or a Toyota; it might also be petrol or diesel, front-wheel or rear-wheel drive, soft-top coupe or family saloon. There are many different ways of classifying cars, and so it is with blood.
If you have a rare blood group, the medics may struggle to find the right blood for you, but there is a fallback— blood group O negative is known as‘universal donor’ blood and can, in most circumstances, be given to anybody.
So if you ask your doctor what blood group you are and he appears to show hardly any interest— it is not dereliction of duty, it has simply never been necessary to know. But it’s worth remembering that volunteers are always needed to give blood, and it’s not often that we get a chance in life to be so altruistic.
Call The National Blood Service on 0300 123 23 23.
