Treating Spinal Stenosis in Time

Shopping Cart Syndrome If you have tingling and burning in your legs that subside when you go grocery shopping and lean forward on your cart, you could very well have spinal stenosis. Dr. Justin Tortolani refers to this as “the shopping cart sign: People lean over their shopping carts, which relieves their symptoms by opening up the space that’s pressing on the nerves in the spinal canal. These people also get relief by leaning forward while they sit,” he says. Symptoms of Spinal Stenosis: Pain in buttocks, thigh or legs when standing or walking that improves with rest Numbness, weakness and tingling in the legs “Foot drop” — a tendency to drag or slap the foot down while walking If a patient with spinal stenosis experiences loss of bowel or bladder control, the situation is very serious, and he or she needs to see a doctor immediately. At St. Joseph Medical Center, spine surgeons take a team approach to spinal stenosis by holding a spine conference review of every individual case. “We have five brains looking at each case, instead of only one surgeon, to ensure that our diagnosis and treatment plan is the most appropriate for each one of our patients.” In addition to Dr. Tortolani, the team consists of Dr. Ira Fedder, Dr. Paul McAfee, chief of Spine Surgery, Dr. John Sefter and Kathy Mulford, CRNP

Approaches vary from physical therapy to surgery

When Marshall Young developed numbness and a burning sensation down his legs while walking, he just tried to ignore it. Young had played semi-pro football with the Hagerstown Bears and had his share of injuries. Pain came with the territory. “No pain, no gain,” he thought. As a result, at age 53, he has had 12 knee operations, including two total knee replacements and a hip replacement by orthopaedist Dr. Brian Mulliken.

“I was trying to be a tough guy, which wasn’t such a good idea,” he says, knowing now that his symptoms were the warning signs of spinal stenosis. “I would look at myself as weak if I couldn’t take the pain,” he adds.

By the time Young sought help from spinal specialist Dr. Justin Tortolani, a colleague of Mulliken’s, the spinal stenosis was advanced. Not only did Young need to sit down frequently when trying to walk, he had trouble with bowel function.

Spinal stenosis is a narrowing of the spine that increases pressure on the spinal nerves. It may be caused by arthritis, injuries, calcium deposits or just the aging of the spine that results in the development of bone spurs, thickening bands of tissue that support the spine, or bones and joints getting larger. All these can create tingling, burning and numbness down the legs.

Although not all spinal stenosis patients need surgical intervention, Marshall’s condition required it as soon as possible. Tortolani performed a laminectomy on Marshall, who was at risk of becoming paralyzed due to severe lower back nerve compression.

“We usually consider surgery when the nerve compression affects the patient’s ability to walk, and they cannot enjoy a reasonable quality of life,” explains Tortolani. For less severe stenosis, “non-surgical approaches include physical therapy and medications or injections to reduce inflammation and pain.

“Surgery involves removing the lamina, which is the covering over the spinal canal, to make room for the nerves. We also may remove bone spurs or ruptured discs that are problematic. Spinal stenosis is often a combination of these factors.

“The operation is minimally invasive; it takes about an hour, and people are back on their feet functioning relatively quickly.”

Since Marshall’s condition was advanced, his recovery took six weeks before he returned to work, but he now works in his yard and enjoys long walks. “I’m doing great. From where I was to now, it seems like a miracle,” he says. “It was a very successful operation. I thought I was never going to walk without a burning or tingling sensation.”

Latest Advances in Spine Treatment

On the Cutting Edge... Spine surgeons at St. Joseph Medical Center stay on the cutting edge of treatment by offering the latest FDA-approved methods and by participating in clinical trials

• XSTOP SURGERY is one of the newest types of treatment, explains Dr. Justin Tortolani. “It’s producing very good results in the right type of patient. It’s an interspinous spacer device that is placed in between symptomatic disc levels to prevent pressure on the nerves.”
• Clinical Trial for TOPS™ SYSTEM, an alternative to spinal fusion: The TOPS™ System is a mobile posterior device designed to stabilize but not fuse the affected vertebral level to alleviate pain stemming from spinal stenosis with or without degenerative facet arthrosis (inflammation and enlargement of the facet joints) and spondylolisthesis (slipped disc).

The first TOPS procedure was performed in September 2006 by Dr. Paul McAfee, chief of Spine Surgery at St. Joseph Medical Center. “The TOPS device allows for a wide decompression that is often necessary for severely stenotic patients,” he says.

Study participants must be between 40 and 75 years of age with moderate to severe lumbar spinal stenosis at a single level. The study is designed to determine if TOPS system is at least equivalent to spinal fusion for relieving pain caused by spinal stenosis.

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