Spinal Stenosis: Spinal stenosis is the narrowing of the spinal canal, which can put pressure on the spinal cord and the nerves that travel through the spine to arms and legs. If the stenosis is located in the lower part of the spinal cord is called lumbar spinal stenosis. Stenosis in the upper part of the spinal cord is cervical spinal stenosis.
While spinal stenosis can be found in any component of the spine, the lumbar and cervical areas are most commonly affected.
Causes of Spinal Stenosis
- Herniated disks–Bulging or herniated discs are more prevalent. Spondylolisthesis (slipping of one vertebra onto another) also occurs and leads to compression of the nerve.
- Thickened ligaments-As people age, the ligaments of the spine may thicken and harden (known as calcification). Bones and joints may enlarge, and bone spurs (called osteophytes) also occur.
- Bone spur- Wear and tear from osteoarthritis of spinal bones may prompt the formation of the bone spurs, which also can grow into the spinal canal. The bone disease(known as Paget’s disease) that customarily affects adults, additionally can cause bone overgrowth in the spine.
- Tumors –Tumors of the spine are eccentric growths of soft tissue that may affect the spinal canal directly by inflammation or by the magnification of tissue into the canal. Tissue magnification may lead to bone resorption (bone loss because of overactivity of certain bone cells) or displacement of bone.
- Osteoarthritis–Osteoarthritis of a spine is also causing spinal stenosis. Osteoarthritis is the most common form of arthritis and is more common in middle-aged and older people.
- Rheumatoid Arthritis– Rheumatoid arthritis usually affects people at an earlier age and is associated with inflammation and enlargement of soft tissues ( synovium) of the joints. Although it’s not a common cause of spinal stenosis.
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Symptoms of Spinal Stenosis
Patients with lumbar spinal stenosis may feel pain, numbness, or weakness in the legs, calves or buttocks. In the lumbar spine, symptoms may increase when walking short distances and decrement when the patient sits, bends forward or lies down.
In the case of cervical spinal stenosis can cause similar symptoms in the shoulders, arms, and legs; hand clumsiness and gait and balance disturbances may also occur.
Spinal Stenosis Diagnosis
A brief medical history and physical examination may conventionally identify any earnest conditions that may be causing the pain. The physicians will also an exam for any loss of extremity reflexes, muscle weakness, sensory loss, or any abnormal reflexes which may suggest spinal cord involvement.
After examining, the physicians can use a variety of tests to look at the inside of the body. Examples of these tests include:
- X-ray
- Computerized Tomography (CT)
- Magnetic resonance imaging (MRI)
- Myelograms
Non-Surgical Treatment of Spinal Stenosis
- Medications, that includes non-steroidal anti-inflammatory drugs (NSAIDs) for reducing swelling and pain, and analgesics to mitigate pain.
- Corticosteroid injections (epidural steroid injections) can avail reduce swelling and treat acute pain that radiates to the hips or the leg. This pain palliation may only be temporary and patients are customarily not advised to get more than 3 injections.
- Rest or restricted activity (this may depend on nerve involution).
- Physical therapy and/or prescribed exercises to stabilize the spine, build endurance and increment flexibility overall.
Surgical Treatment of Spinal Stenosis
- Laminotomy- When a small portion of the lamina is removed to relieve pressure on the nerve roots.
- Medial Facetectomy-When part of the facet (the bony structure in the spinal canal) is removed to increase space.
- Foraminotomy-When the foramen ( where the nerve roots exit the spinal canal) is removed to increase space of a nerve canal. This surgery may be done alone or along with a laminotomy.
- Anterior Cervical Discectomy and Fusion (ACDF)- The cervical spine is reached through a small incision in front of the neck. The intervertebral disc is removed and replaced with a small plug of bone.
- Laminoplasty-A posterior approach where the cervical spine is reached from the back of the neck and involves surgical reconstruction of the posterior elements of a cervical spine to make more room for a spinal canal.
- Cervical Corpectomy- A portion of the vertebra and adjacent intervertebral discs are removed for decompression of cervical spinal cord and spinal nerves.