My doctor says I have spinal stenosis. She saw this on the X-rays and my symptoms match what she says is typical for this problem. Now she wants to send me for a CT scan and an MRI. Do I really need all these extra steps? Seems like an unnecessary expense. Is it?
According to the North American Spine Society (NASS), spinal stenosis describes a clinical syndrome of buttock or leg pain. These symptoms may occur with or without back pain. It is a condition in which the nerves in the spinal canal are closed in, or compressed.
The spinal canal is the hollow tube formed by the bones of the spinal column. Anything that causes this bony tube to shrink can squeeze the nerves inside. As a result of many years of wear and tear on the parts of the spine, the tissues nearest the spinal canal sometimes press against the nerves. This helps explain why lumbar spinal stenosis (stenosis of the low back) is a common cause of back problems in adults over 55 years old.
The diagnosis is made on the basis of the patient history, signs and symptoms, and clinical findings. The physician may perform some specific tests to pinpoint the problem but imaging studies are used to confirm the diagnosis.
Other tests may be ordered such as myelography, a type of radiographic examination that uses a contrast medium (dye) to detect pathology of the spinal cord. It helps show the extent of the stenosis. CT scans are better for seeing the surrounding bone and to look for bone spurs. Myelography and CT scans are also used for patients who can't have an MRI because of a pacemaker or spinal stimulator.
These additional tests help in determining the best treatment for you. Surgery may be needed and the anatomical details that are provided by these tests will be important for the surgeon. Although conservative (nonoperative) care is always advocated first, if a person fails to respond to it, then surgery may be needed.
Sometimes imaging studies provide a baseline picture of what's happening inside the spine. The physician can monitor the patient and use repeat images to tell if the condition is getting worse over time. That's important because if surgery is going to help, it must be done within the first few years before the disease progresses too far.