DEAR DR. DONOHUE: I am 78 and have been diagnosed with spinal stenosis. The doctor says I am not ready for an operation, which makes me glad, since I really don’t want one. I take ibuprofen for pain. What would an operation entail, and what kinds of results could be expected? My husband says that the doctor said if I don’t do anything, I will be in a wheelchair later. — M.F.

A: We need a mental picture of the back and spine. The spinal cord is an extension of the brain. It contains nerve cells and connections to and from the brain. It’s as wide as your little finger and is extremely delicate, so nature protected it by encasing it in the backbones (vertebrae, the spinal column). Visualize the spinal column as a stack of building blocks with a hole drilled through their centers. The hole is the spinal canal, and through it runs the spinal cord. Spinal stenosis is a narrowing of the hole. Such narrowing puts pressure on the spinal cord and the nerves that emerge from it. Depending on which nerves or which section of cord is compressed, pain results. Most often, the narrowing takes place in the lower back. Bone spurs from arthritic changes, thickened ligaments from aging and the slipping out of place of backbones are some of the things that narrow the spinal canal.

Surgery isn’t the only treatment. Physical therapy, injections of steroids into the canal to suppress inflammation and reduce swelling, anti-inflammatory drugs like your ibuprofen and the application of hot or cold packs to the painful back are a few of the things that can relieve spinal stenosis pain.

When the pain is intolerable, then thoughts turn to surgical treatment. The surgeon enlarges the spinal canal and sometimes unroofs parts of the spinal column to afford the spinal cord and its nerves more room. At times, the doctor has to stabilize the backbones by “fusing” them — welding adjacent bones together. You won’t wind up in a wheelchair by delaying surgery. You might never need it.

DEAR DR. DONOHUE: What is the difference between ruptured, herniated, slipped and bulging disks in the back? Is surgery always recommended? — M.S.

A: Back disks are cushions sandwiched between adjacent backbones to shield the backbones from the daily stresses they have to endure. They’re circular affairs, with a tough outer ring and a soft inner core. When the outer ring develops a crack or split, as it often does, the inner core protrudes through it. That’s a ruptured, herniated, slipped or bulging disk, whichever term you want to use.

If the bulge presses on a nerve, pain results. Surgery is recommended for pain that doesn’t yield to conservative treatment like physical therapy. It’s also recommended when the bulge presses on nerves that control bladder and bowel function.

DEAR DR. DONOHUE: My son gained 15 pounds in a few days and was bloated and unable to urinate. He was hospitalized and had a kidney biopsy. It was determined he had “minimal change disease.” The doctor didn’t explain how this happened. Will you? — D.H.

A: Your son had nephrotic (nef-ROT-ik) syndrome, which consists of much protein in the urine, red blood cells in the urine, edema (swelling), a rise in blood pressure and elevation of cholesterol. (“Nephros” is a root word for “kidney.”) Your son’s rapid weight gain was retained fluid. Minimal change disease means that no disturbances could be seen on the biopsy with a regular microscope. With an electron microscope — a scope that magnifies many times more powerfully than a microscope with lenses — changes can be seen.

In most instances, the cause of minimal change disease is never discovered. It’s called idiopathic, or cause unknown.

Up to 90 percent of children with minimal change disease recover completely with cortisone medicine in about eight weeks. Some children can even continue to attend school while they’re treated. The illness might relapse, but it can be treated again effectively.

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