Dr. Donohue: Approaches to treatment of spinal stenosis

Dear Dr. Donohue: I am writing to ask about spinal stenosis. Do many people have it? I am 74. I understand it comes from calcium deposits. Is this correct? Is the process stoppable or reversible? I heard that glucosamine can reabsorb the calcium. Is it effective? — A.B.

Answer: Our backs are a series of bones (vertebrae) stacked one on the other like a tower of building blocks. A tunnel — the spinal canal — runs through the middle of those bones. In it is the spinal cord, which connects with the brain in the back of the head and continues to stretch to the lower back. It ends about the middle of the lower back. Throughout its course, it sprouts nerves. It looks like a potato that’s sprouting eyes, but the spinal nerves come off in a regular pattern and they continue to emerge from the backbones almost all the way to the end of the spine.

Anything that narrows the spinal canal (spinal stenosis) or that narrows the exit passages for spinal nerves presses on the cord or nerves and causes pain. Lots of people have it. In the lower back, such narrowing leads to weakness of the legs, back pain, pain that runs down the legs or numbness or tingling sensations. The pain often intensifies with walking. Bending forward at the waist opens the canal and the passages for spinal nerves, dampening pain.

Calcium spurs and calcium deposits are one kind of spinal stenosis cause. Thickened back ligaments are another cause. So are bulging discs — the shock absorbers between adjacent backbones.

Not all spinal stenosis gets worse. Many people with the condition either improve or stay the same. I have not heard of glucosamine as a treatment. I am skeptical about that. Injections of numbing agents together with a cortisone drug — epidurals — can lessen pain. If pain interferes with life, surgically widening the spinal canal and the nerve exits can solve the problem.

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Dear Dr. Donohue: Can you give me some information on a condition nicknamed strawberry nose? It’s where a person’s nose gets big and red, and looks like a strawberry. What is the proper name? What causes it? Can it be treated? — J.V.

Answer: Do you mean the kind of nose that looks like the nose comedian W.C. Fields had? That’s rhinophyma (RYE-no-FIE-muh). It’s the end stage of another skin condition, rosacea. With rosacea, the tip of the nose, the cheeks and sometimes the chin become red. Then small blood vessels appear on the red spots. People often have acne on those sites too. Rosacea is treatable, and rhinophyma is preventable.

Plastic surgeons can repair rhinophyma if it develops. Laser treatments can also be used to remodel the nose.