16 Aug Spinal Stenosis
Spinal stenosis is an abnormal narrowing of the spinal canal that may occur in any of the regions of the spine. This narrowing causes a restriction to the spinal canal, resulting in a neurological deficit. Symptoms include pain, numbness and loss of motor control. The location of the stenosis determines which area of the body is affected.
With spinal stenosis, the spinal canal is narrowed at the vertebral canal, which is a foramen between the vertebrae where the spinal cord (in the cervical or thoracic spine) or nerve roots (in the lumbar spine) pass through.
There are several types of spinal stenosis, with lumbar stenosis and cervical stenosis being the most frequent. While lumbar spinal stenosis is more common, cervical spinal stenosis is more dangerous because it involves compression of the spinal cord whereas the lumbar spinal stenosis involves compression of the cauda equina.
Spinal stenosis is most common in people age 50 and older, and affects more women than men. As a rule, spinal stenosis is relatively rare in patients younger than the fifth or sixth decade of life.
Causes of spinal stenosis
Most cases of spinal stenosis are classified as acquired spinal stenosis. In those cases, spinal stenosis is “acquired” due to age-related osteoarthritis and associated conditions, such as the development of bone spurs (osteophytes), degenerative disc disease (spondylosis), herniated discs or the thickening of spinal ligaments. Acquired spinal stenosis can also be caused by the growth of tumours in or near the spine, spinal injuries or Paget’s disease, an uncommon condition that causes bones to become large and soft.
Stenosis can occur all along the spine — in the neck, in the lower back (lumbar) and in the central spine.
Symptoms of spinal stenosis
Many people can have spinal stenosis without experiencing any symptoms. If the spinal canal narrows until it places pressure on the spinal cord or nerve roots, however, the patient will develop symptoms over time.
“Spinal stenosis can be a relatively insidious process in that it typically affects just the extremities first,”. Patients will typically have trouble using their hands if the problem is located in the neck, or have trouble walking even short distances if the problem is located in the lower back.
Symptoms can differ, depending on what part of the spine is affected. According to the Mayo Clinic, if the neck is affected, the patient may suffer from numbness, weakness or tingling in a leg, foot, arm or hand, or, in severe cases, incontinence. If the problem is located in the lower back, the patient may suffer from pain or cramping in the legs.
Treatment options are either surgical or non-surgical. Overall evidence is inconclusive whether non-surgical or surgical treatment is the better for lumbar spinal stenosis.
The effectiveness of non surgical treatments is unclear as they have not been well studied.
- Education about the course of the condition and how to relieve symptoms
- Medicines to relieve pain and inflammation
- Exercise, to maintain or achieve overall good health, aerobic exercise, such as riding a stationary bicycle, which allows for a forward lean, walking, or swimming can relieve symptoms
- Weight loss, to relieve symptoms and slow progression of the stenosis
- Physical therapy to support self-care.Also may give instructs on stretching and strength exercises that may lead to a decrease in pain and other symptoms.
Lumbar decompressive laminectomy: This involves removing the roof of bone overlying the spinal canal and thickened ligaments in order to decompress the nerves and sac of nerves. 70-90% of people have good results.
- Interlaminar implant: This is a non-fusion U-shaped device which is placed between two bones in the lower back that maintains motion in the spine and keeps the spine stable after a lumbar decompressive surgery. The U-shaped device maintains height between the bones in the spine so nerves can exit freely and extend to lower extremities.
- Surgery for cervical myelopathy is either conducted from the front or from the back, depending on several factors such as where the compression occurs and how the cervical spine is aligned.
- Anterior cervical discectomy and fusion: A surgical treatment of nerve root or spinal cord compression by decompressing the spinal cord and nerve roots of the cervical spine with a discectomy in order to stabilize the corresponding vertebrae.
- Posterior approaches seek to generate space around the spinal cord by removing parts of the posterior elements of the spine. Techniques include laminectomy, laminectomy and fusion, and laminoplasty.