Q&A: Spinal expert on David Wright, stenosis prognosis

SAN DIEGO -- New York Mets captain David Wright described his case of lower-back stenosis as coming from a variety of factors: being born with a narrower spinal cavity than the average person, calcium deposits that accumulated after a 2011 stress fracture, and the cumulative effect on disks of swinging and other baseball twisting motions.

Wright’s doctors at the Hospital for Special Surgery in Manhattan as well as in California believe he will return to the majors this season and “sooner than later,” according to the third baseman.

After reviewing Wright’s interview, Dr. Andrew Hecht, chief of spine surgery at The Mount Sinai Hospital and director of the spine center at the Icahn School of Medicine at Mount Sinai, believes many young athletes with those types of issues have a “good track record of improving with conservative care.”

Hecht, to be clear, is not treating Wright. Still, he explains lumbar spinal stenosis and its treatment in this Q&A:

How do you define lumbar spinal stenosis -- just a narrowing of the spinal cavity?

Lumbar spinal stenosis refers to a narrowing of the spinal canal. If you think about the spinal canal sort of like the highway, think of it like the traffic on the highway. With spinal stenosis it narrows. And then as the nerves travel down they give off branches, like exit ramps off the highway. And sometimes you get traffic on the exit. That’s called foraminal stenosis, which is a type of spinal stenosis. In young people, when people in their 30s have spinal stenosis, it’s usually a congenital type of spinal stenosis, where the actual canal size you were born with is smaller than the average person.

Is it degenerative, where you are trying to mitigate the discomfort so an athlete can play through the issue? Or can it be treated and resolved without anything invasive?

A lot of times you can resolve it without an invasive procedure -- depending upon the kind of stenosis that a player has. Sometimes they have a stenosis that’s associated with a stress fracture called a spondylolysis, which is a crack in the bone where the bone starts to heal and it creates the type of stenosis called foraminal stenosis. And then there’s the congenital stenosis -- which is God gave you a smaller spinal canal than the average person.

And if you had a smaller spinal canal by birth, is it solvable?

Most of the time in spinal stenosis you have in the young person or young athlete, it’s not overwhelmingly the main highway or the main canal. Very often it’s in the foraminal, where the nerves go out in the tunnels. But you could have a combination of both. You could have a congenital stenosis in combination with a foraminal stenosis. And, very often, when treated conservatively with physical therapy and anti-inflammatories and spinal injections, there’s a very high success rate.

When someone is trying to prove to a physical therapist that they’re able to resume activity, what type of things are they testing?

The goal of physical therapy is to get stronger, to sort of strengthen the muscles. Think of it as a brace made of muscle and it gives you more flexibility and strength. Once you can do the physical therapy, and you’re not having a lot of pain, you usually will then progress to sports-related activity depending upon your particular sport to get you ready to participate in the particular sport that you excel in.

Is it solvable to the point where even if you have the congenitally narrow spinal cavity, if the nerves calm enough, it’s conceivable that you can resume playing pain-free? Or you’ll inevitably continue to be managing discomfort?

I’ve never met the player or seen his films. But based on what you just described (a combination of a narrow spinal cavity from birth, a stress fracture that led to calcium deposits and further narrowing, and disk issues from the movements of baseball), he probably has this thing called spondylolysis with foraminal stenosis in addition to the congenital stenosis. It sounds like the stress fracture is probably something called a spondylolysis. And that, as it heals, sometimes can create a foraminal stenosis. So we have congential stenosis. Think about the main highway. That’s one kind of stenosis. Then the spondylolysis creates the stenosis on the exit ramp. Those two things can give you discomfort. And, very often, you can be treated conservatively with a good return to play.

He has excellent doctors both at Special Surgery taking care of him as well as Dr. [Robert] Watkins, who is a world-class spine surgeon. You have a great medical team taking care of him. So the expectation is with most players that there’s going to be a good track record of improving with conservative care.