Spinal stenosis

Spinal stenosis is an abnormal narrowing (stenosis) of the spinal canal (the opening in each vertebra through which the spinal cord passes) that may occur in any of the regions of the spine. This narrowing causes a restriction to the spinal cord, resulting in a neurological deficit. Symptoms include pain, numbness, pins and needles and loss of motor control. The location of the stenosis determines which area of the body is affected. In people who have spinal stenosis, the spinal cord is narrowed at the space at the center of the spine, the canals where nerves branch out from the spine, the space between vertebrae (the bones of the spine). There are two types of spinal stenosis: lumbar stenosis and cervical stenosis. While lumbar spinal stenosis is more common, cervical spinal stenosis is more dangerous because it involves compression of the spinal cord.

Types

The most common forms are cervical spinal stenosis, at the level of the neck, and lumbar spinal stenosis, at the level of the lower back. Thoracic spinal stenosis, at the level of the mid-back, is much less common.Lumbar Spinal Stenosis vs. Cervical Spinal Stenosis

In lumbar stenosis, the spinal nerve roots in the lower back are compressed which can lead to symptoms of sciatica (tingling, weakness or numbness that radiates from the low back and into the buttocks and legs).

Cervical spinal stenosis can be far more dangerous by compressing the spinal cord. Spinal cord stenosis may lead to serious symptoms such as major body weakness and paralysis. Such severe spinal stenosis symptoms are virtually impossible in the lumbar spine, however, as the spinal cord is not present in the adult lumbar spine.

Cervical spinal stenosis

Cervical spinal stenosis is a bone disease involving the narrowing of the spinal canal at the level of the neck. It is frequently due to chronic degeneration, but may also be congenital. Treatment is frequently surgical.

Signs and Symptoms

Symptoms of cervical spinal stenosis include:

• Pinched nerve, causing numbness.
• Intermittent neurogenic claudication

Characterized by lower limb numbness, weakness, diffuse or radicular leg pain associated with paresthesis (bilaterally), weakness heaviness in buttocks radiating into lower extremities with walking or prolonged standing. Symptoms occur with extension of spine and are relieved with spine flexion. Minimal to zero symptoms when seated or supine.

• Radioculopathy (with or without radicular pain)

Neurologic condition- nerve root causes objective signs such as weakness, loss of sensation and of reflex

• Cauda equine syndrome

Lower extremity pain, weakness, numbness that may involve perineum and buttocks, associated with bladder and bowel dysfunction.

• Fever
• Nocturnal pain
• Gait disturbance
• Structural deformity
• Unexplained weight loss
• Previous carcinoma
• Severe pain upon lying down
• Recent trauma with suspicious fracture
• Presence of severe or progressive neurologic deficit
• Lower back pain

Due to degenerative disc or joint changes.

• Narrowing of spinal canal, nerve root canal or intevertebral foramina

Most Common Symptoms

• Standing discomfort (94%)
• Numbness (63%)
• Weakness (43%)
• Bilateral symptoms (68%)
• Discomfort above and below knee (78%)
• Buttock/Thigh only (15%)
• Below the knee (7%)

Causes

LUMBAR TREFOIL CANAL

Aging: All the factors below can cause the spaces in the spine to narrow:

• Body’s ligaments can thicken
• Spurs develop on the bone and into the spinal canal
• Cushioning disks between the vertebrae may begin to fall apart.
• Facet joints break down

Arthritis: Two types:

• Osteoarthritis
• Rheumatoid arthritis

Heredity:

• Spinal canal is too small at birth
• Structural deformities of the vertebrae can cause narrowing of the spinal canal.

Instability of the Spine, or Spondylolisthesis:

• A vertebra slips forward on another

Tumors of the spine:

• Irregular growths of soft tissue will cause inflammation
• Growth of tissue into the canal.

Trauma:

• Accidents and injuries can dislocate the spine and the spinal canal or cause burst fractures that yield fragments of bone that go through the canal.

Diagnosis

A healthy Human vertebral column.

Making the diagnosis of spinal stenosis involves a complete evaluation of the spine. The process always begins with a medical history and physical examination. Imaging studies (x-ray, MRI, etc.) are often used to determine the extent and location of the nerve compression.

Medical History The medical history is the most important aspect of the examination as it will tell your doctor about your symptoms, possible causes for your spinal stenosis, and other possible cause of back pain.Medical history The medical history is the most important aspect of the examination as it will tell your doctor about your symptoms, possible causes for your spinal stenosis, and other possible cause of back pain.

Physical Examination The physical examination in a patient with spinal stenosis will give your doctor information about exactly where the nerve compression exists. Some important factors that should be investigated are any areas of sensory abnormalities or numbness, the nature of your reflexes, and any muscular weakness.

MRI The MRI has become the most frequently used study to diagnose spinal stenosis. The MRI uses magnetic signals (instead of x-rays) to produce images of the spine. MRIs are helpful because they show more structures, including nerves, muscles, and ligaments, than seen on x-rays or CT scans. MRIs are helpful at showing exactly what is causing pressure on the nerves of the spine.

Treatments

Non-Surgical treatment includes:

Education about the course of your condition and how to relieve symptoms.

Medicines to relieve pain and inflammation, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).

Exercise, to maintain or achieve overall good health. Aerobic exercise-especially riding a stationary bicycle (which allows you to lean forward)-can relieve symptoms.

Weight loss, to relieve symptoms and slow progression of the stenosis.

Physical therapy, to provide education, instruction, and support for your self-care. Physical therapy helps you learn stretching and strength exercises that may lead to a decrease in pain and other symptoms.