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Options abound to get relief from chronic back pain

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Dr. Michael McNamara

 Dr. Michael McNamara


If you are living with back pain, you already know that it can be extremely debilitating. However, you may not know that often there are steps you can take to alleviate the pain and restore a fuller range of motion. 

If you are over age 50, odds are high that the cause of your back pain is related to some degree of spinal stenosis. According to Dr. Michael McNamara, an orthopedic and spinal surgeon, spinal stenosis is a condition that occurs as the spinal canal narrows, restricting or compressing the nerve roots and spinal cord. It often is caused by osteoarthritis of the spinal column. Common symptoms are pain in the legs or lower back when standing or walking. 

Spinal stenosis affects about one person per 1,000 over age 50 and about five of every 1,000 people older than 65. The narrowing of the spinal canal often happens in the lower back (lumbar spine) and neck (cervical spine) or, on rare occasion, the thoracic region of the spine (upper back). The symptoms of pain, weakness or numbness can occur in several areas, depending on the region of the spinal cord that is constricted.

The condition can be congenital, with some people having a narrow spinal canal from birth. However, more often, it results from degenerative changes in the spine and the wear and tear that leads to osteoarthritis. Bony overgrowth from osteoarthritis, thickening of a ligament in the back and bulging discs can contribute to the condition.

“Lumbar spinal stenosis is a progressive condition that generally worsens if you do nothing; however, that doesn’t mean there is nothing you can do,” McNamara said. “Many patients are surprised to learn that there are a number of conservative approaches to treatment that do not entail surgery.”

There are actually two types of spinal stenosis. Foraminal stenosis occurs when a nerve is pinched as it exits the spinal cord. Central stenosis, meanwhile, compresses the entire canal, according to McNamara.

“A combination of anti-inflammatory medications and physical therapy often can be very effective in treating the symptoms of spinal stenosis,” he said. “We also know that yoga and Pilates can have a profound benefit. Epidural steroid injections also can be an effective, less invasive option than surgery.

“If patients can get better and beat surgery, they are better for it. For that reason, any time we can find conservative remedies that relieve pain and restore movement, our goal is to pursue those options for as long as possible.” 

In instances where surgery is required, McNamara strives to keep incisions as small as possible. 

“The type of surgery required depends on the type of stenosis and the condition of the spine,” he said. 

A laminectomy is performed when the stenosis is causing pressure on the spinal cord and nerve roots. The surgeon removes part of the lamina or bony portion of the spinal canal, and the extent of the removal depends on the extent of the stenosis. 

Likewise, a laminotomy is performed to remove some of the facet joints along the spine and to restore the spinal canal to its native size.

Nerves enter and exit the spinal canal through specialized gaps in spinal joints called foramina. Occasionally, the surgeon needs to reopen the foramina when they have been narrowed by an overgrowth of bone, causing the stenosis. 

In most cases, these procedures do not affect the strength of the spine. However, if the tissue removal is significant or the spine has been weakened by an underlying condition, the surgeon may perform a spinal fusion. 

“These are big surgeries that require extensive recovery,” McNamara said. “It is important for patients to know they do not need to suffer in silence or out of fear that surgery is their only option.

“In our practice, we are dedicated to using the most conservative management and treatment of spinal stenosis possible. It is important for those suffering from back pain to find a spine specialist who listens carefully and partners with them to map out a treatment plan that is the least invasive but still relieves their pain and helps them get their life back.”  

Dr. Michael McNamara is a board-certified orthopedic surgeon and chief of surgery at Williamson Medical Center. The Bone and Joint Institute of Tennessee is at 3000 Edward Curd Lane in Franklin. For more information, visit or call 615-791-2630.

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