DEAR DR ROACH: I read your recent response to the 79-year-old woman with spinal stenosis. I am an 80-year-old woman with a similar diagnosis (spinal stenosis along with slight herniations at L4, L5 and S1 vertebras). However, I do not have the pain typically described. For several years, my legs have gotten weaker and weaker, and at this point, my legs feel like lead. I need to take Tramadol to be able to walk.
Have you seen these particular symptoms, i.e., weakness in legs or feeling generally achy, with spinal stenosis? — A.L.
ANSWER: Compression on a nerve, due to any factor, most typically first causes sensory changes, especially pain or numbness, followed by loss of reflexes (you probably wouldn’t notice this because most people don’t check their reflexes). Last of all usually comes weakness. Progressive weakness is one indication to relieve the nerve compression, usually by surgery. However, as we say, not everybody’s body reads the textbooks, and nerve compression can sometimes cause weakness without pain.
It sounds like you have had advanced imaging, such as an MRI, to make an exact diagnosis of the cause, and I hope you have had evaluation by an expert to see whether surgery would be appropriate in your case. It often is not the appropriate choice, and many surgeons are reluctant to operate on people in their 80s. Still, I refer every patient I see with weakness due to spinal stenosis so that they can have an evaluation by a surgeon, as only the surgeon has the expe
