Question: My wife has "stenosis of the spine." Although she is in constant pain, she absolutely refuses surgery that is supposed to help the pain. I agree since I have yet to locate any person with stenosis of the spine that had pain relieved with surgery. What would you recommend for pain relief?

Dr. Hibberd's Answer:

Spinal stenosis refers to a narrowing of the spinal canal. When allowed to progress, this narrowing may cause permanent nerve and/or spinal cord damage.

Surgical intervention is indicated when permanent, irreversible damage to nerve or spinal cord tissue is predicted, or for pain not controlled by conservative medical treatments. The most common area for this is in the lower back or lumbar area. Surgery for advanced spinal stenosis involves nerve root decompression by removal of scar and degenerative bone and tissue to free up the nerve roots and untether the spinal cord by foramenotomy, laminectomy, and occasionally spinal fusion when the spine is unstable.

You are correct in placing surgery behind conservative treatment most of the time, but there are times when surgery should not be delayed, especially when nerve tissue is at risk for irreversible but preventable injury. I advise you seek an alternate neurosurgical professional opinion before deciding whether intervention is in your wife's best long-term interest.

While awaiting your opinions, engage your primary physician to assist her with aggressive pain management according to established protocols. Most chronic pain patients respond to anti-inflammatories mixed with selected antidepressant medication.

Open spinal surgery for pain in the absence of possible neurological damage tends to trade one discomfort for another, but remember there are now minimally invasive procedures available by scope and laser that may be worth considering. These decisions should be made by consultants you trust, and who ideally have no vested interest in any treatments offered except for the comfort of their patient, your wife.