Spinal Canal Stenosis

Spinal stenosis is a condition that is caused by a gradual narrowing of the spinal canal (where the spinal cord is located) and or the vertebrae foramina (the opening the spinal bone where the nerves exit) better known as foraminal stenosis. Narrowing of the spinal canal is a result of disc degeneration, osteophytes (bone spurs), and the thickening of ligaments.

Back pain, pain in the buttock and or legs, along with weakness, are the most common symptoms of spinal stenosis. These symptoms are dependent on the size of spinal canal, the degree of compression within the foramina and the extent of misalignmements. Spinal misalignments have been observed in almost all patients suffering from back pain. A misaligned vertebra leads to a decrease in size of the vertebral formanina (opening between the spinal bones where the nerves exit). The degree of malfunction and pain is usually directly related to the severity of a misaligned vertebra. It is for this reason that a minor misalignment can cause moderate to severe pain in individuals inflicted with spinal stenosis. Stenosis can occur in virtually every person. The severity of pain can vary from mild pain to debilitating pain.

Degenerative Disc Disease (DDD)

Degenerative disc disease is a term used to describe physical alterations within a disc. Although often seen in the elderly, they can be present in young otherwise healthy individuals. Furthermore significant individual differences can be observed in the sense that young individuals may exhibit the disc of an elderly person and vice versa. Contrary to the common belief, degenerative disc disease is not an old person disease.

Spinal discs can degenerate at an alarming rate, far earlier than do other musculoskeletal tissue. About 20% of people in their teens have discs with mild signs of degeneration. Degeneration increases with age, particularly with males, so that around 10% of 50 year-old discs and 60% of 70 year-old disc are severely degenerated. The true cause for degeneration is still not clear. Some studies claim genetics is the greatest pre-disposer, while other studies examining athletes believe it is due to “wear and tear.”

Posterior Facet Syndrome

Posterior facet syndrome is a lower back condition that is characterized by back pain, with or without local tenderness. The pain from posterior facet syndrome can cause sciatic like pain, which can radiate from the back, down to the buttock and into the thighs. This pain is often caused by inflammatory reactions as a result of irritation in the synovial lining of the facet joints (the union of bony projections of two vertebrae, which allow the spinal column to bend forward and backward.)

Posterior facet syndrome can occur in people with scoliosis and joint instability. However, it is most commonly observed in individuals who have some abnormal stress on the facet joints caused by degenerative disc disease.

Posterior facet imbrication is often the cause of foraminal stenosis (narrowing in the size of the vertebral holes where spinal nerves exit). Foraminal stenosis causes nerve root irritation and eventually pain.

Herniated Disc

A herniated disc is also known as the “slipped dsc”, it can be one of the most painful conditions experienced. The intensity of pain is usually directly related to the severity of condition. It can be mild where it is affecting only the back, to a more intense condition where it may radiate down the legs. A herniated or slipped disc occurs most frequently in your lower back, but any disc can rupture, including those of your upper back and neck. A herniated disc is a damaged disc. It starts when the outer fibers of a disc protrude, allowing the “gel-like center” (nucleus) to slip. Slippage of the nucleus (gel-like center of the disc) is almost always towards the spinal cord and spinal nerves. When the slippage is large, it places pressure on the delicate and sensitive fibers of the spinal cord and spinal nerves. This means that a slipped disc cause pain in two places, one being the area of the protruding (herniated/slipped) disc and in any part of your body that’s is controlled by the nerve the disc is pressing on.

Once a disc herniates, it can compress the sensitive fibers of the spinal cord or spinal nerves. Compression of these fibers can lead to local or radiating pain of varying intensity. The most detrimental aspect of a herniated disc is not the pain caused by the compression, but rather the prolonged compression of the spinal cord or nerve.

When a disc herniates, its fibers protrude (slip) and compress either the spinal cord and or the spinal nerves. Prolonged compression of these delicate issues lead to cellular damage within the nerve fibers. As a result, a person with a herniated disc (slipped disc or protruded disc) usually develops pain, tingling, numbness, and even worse, weakness in the muscles and ligaments of their extremity. There are also numerous cases where patients have lost bowel and bladder control in the presence of a lumbar (lower back) disc herniation.


Spondylolisthesis is a condition in which a bone (vertebra) in the lower part of the spine slips forward onto a bone below it. In children Spondylolisthesis usually occurs between the fifth bones in the lower back (lumbar spine) and the first bone in the sacrum.

Spondylolisthesis can range from mild to severe. It can produce an increased lordotic curve (swayback), but later stages may result in kyphosis (round back) as slippage progressively worsens. The symptoms may include lower back pain, pain in the thighs and buttocks, muscle tightness in the spine. Neurological damage (leg weakness or change in sensation) may result from pressure on nerve roots and may cause radiating pain down the legs.


The sciatic nerves are the largest (and longest) nerves of the body, reaching about the size of your thumb in diameter, and running down the back of each leg. When these nerves are irritated or affected by the inflammation of nearby tissues, doctors refers to this as sciatica. Sciatica is not a diagnostic term, but rather a descriptive term for symptoms such as pain, numbness and or tingling sensations felt in the posterior aspect of the lower extremities (back of thigh, knee and leg). The clinical diagnostic term for sciatic-like symptoms is radiculopathy.

The important thing to understand is that sciatica is a symptom of a problem where something is compressing the sciatic nerve, rather than a medical diagnoisis or medical disorder in and of itself. This is an important distinction because it is the underlying diagnosis that needs to be treated in order to obtain lasting relief.

For some, the condition can be very severe and debilitating. For others, it can be infrequent and irritating, but has the potential of getting worse. Sciatica can occur at any age, but it is most often seen in people between 30 to 50 years of age, often developing as the result of excessive wear and tear of the vertebral discs and joints. Common causes of sciatic-like symptoms can be a herniated lumbar disc, disc bulge, spinal stenosis, degenerative disc disease, spondylolisthesis, piriformis syndrome or posterior facet syndrome.

Low Back Pain

Low back pain can be a painful burden to anyone. With the many conditions that stem low back pain comes the varying treatments and time expectancy for recovery. More and more evidence today supports the conservative approach to treating low back pain over the irreversible surgical route.

As a new patient to the clinic Dr. Khanjian will assess you with a regional physical to ensure the pain from the low back is not “organic” in origin (performed to rule out life threatening vascular and organ referring diseases). Dr. Khanjian will next perform neurological, neuromuscular and orthopedic testing to identify the root cause and nature of your condition. This process may involve a series of diagnostic evaluations consisting of x-ray or M.R.I. Once a diagnosis has been established Dr. Khanjian will then explain your condition to you, the various treatment options available and the estimated time for your improvement.

With an emphasis throughout much of his early career mastering the arts of chiropractic in treating low back pain. Dr. Khanjian has successfully treated cases involving severe disc herniations, extrusions, sciatica, canal stenosis and facet syndrome. Dr. Khanjian pursued specialization with post graduate work earning the “Cox” certification, (an FDA approved flexion-distraction technique for the treatment of low back pain). A technique which decreases your spinal disc pressure by an estimated 60% and widens the spinal canal space by an estimated 28% restoring your physiological range of motion gently, safely and effectively.

In addition to treating your low back pain, our clinic will provide core strengthening exercises with rehabilitation and ergonomic training. Strengthening of key muscles within your core have been shown to reduce tension in the low back. Proper ergonomic training will not only provide a safeguard for your low back condition during your period of treatment but as well will prevent any future issues to arise. With the combination of experience and knowledge to treat and diagnose your symptoms, supplied with the state of the art technology for noninvasive disc decompression and inter-segmentation you will not only see changes within your gait and posture but will also feel the differences in your daily activities throughout your path to full recovery.