Spinal Stenosis

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Spinal stenosis is a condition in which the bony spaces in the spine gradually narrow and eventually compress the nerves traveling through the spine.

Stenosis occurs most commonly in the neck and lower back. When it occurs in the lower back or lumbar spine area, it is referred to as lumbar spinal stenosis. In the neck, it is referred to as cervical stenosis.

Some patients may suffer simultaneously from both types of spinal stenosis. However, lumbar stenosis is more common. Stenosis of the spine at the back of the chest (thoracic spine) is much less common than both lumbar and cervical stenosis.

According to an article from John K. Hsiang published in Medscape in March 2020, spinal stenosis appears to be part of the normal aging process. Additionally, no clear correlation has been observed between the incidence of the condition and factors such as ethnicity, occupation, gender or even body type.

According to the same source, the overall prevalence of the condition is about 1 out of every 1000 US residents older than 65 years and about 5 of every 1000 residents older than 50 years. The actual prevalence is difficult to establish, since a proportion of people with the condition do not have any symptoms. In total, around 250,000 to 500,000 US residents currently show symptoms of spinal stenosis.

Most cases of stenosis appear in individuals aged 60 or over. At younger ages, the condition is usually traceable to trauma from an accident or to other medical conditions such as scoliosis

Symptoms vary widely among the affected population. Some people who have spinal stenosis may actually experience no symptoms at all.

Others, however, may experience back pain as well as tingling sensations in the back. They may also experience numbness and muscle weakness in the affected area. When symptoms are present, they can sometimes get more severe as time progresses.

The most common cause of spinal stenosis is wear and tear of the bones in the spine due to the effect of osteoarthritis. However, other factors (which we mention below) can sometimes contribute to the appearance of the condition.

When the symptoms are severe, surgeons can operate to create additional space in the spinal column for the spinal cord and the accompanying nerves.

Causes Of Spinal Stenosis

The spine contains a canal that protects the nerves carrying signals between the brain and the lower body. To function properly, these nerves require sufficient space in the canal. However, if the nerve roots are compressed inside the canal, symptoms of spinal stenosis can subsequently appear.

In some cases, spinal stenosis is congenital, i.e. the individual is born with a narrow spinal canal.

However, the majority of spinal stenosis cases are the result of something happening to progressively narrow the spinal canal as the individual ages.

Some of the factors that can cause this to happen are:

  • The development of osteoarthritis on the bones of the spine can cause bone spurs to form. If these spurs then grow into the spinal canal, it will result in a narrowing of the canal, which then causes stenosis;
  • Paget’s disease is a bone disease that can also cause bone overgrowth in the spine. Just as with the bone spurs produced by osteoarthritis, this can eventually cause narrowing (stenosis) of the spinal canal;
  • Another potential driver of spinal stenosis is the condition known as herniated discs. This occurs when the discs of the spine (layers of tissue that act as shock absorbers between the spinal vertebrae) start to deteriorate. As this happens, cracks can appear on the exterior of the discs. The soft inner material can then start to leak through the cracks and exert pressure on the nerves inside the spinal cord;
  • Yet another possible driver of spinal stenosis is thickening of the ligaments that hold the spinal bones together. As they thicken, they take up the room needed for the spinal cord nerves so that those nerves become compressed over time;
  • Sometimes, growths (or tumours) can appear inside the spinal cord.They can reduce the available space inside the cord, which then leads to stenosis;
  • In some cases, spinal stenosis can be the result of trauma to the spine from an auto or other accident. This trauma may displace spinal vertebrae and reduce the available room inside the spinal canal. Spinal nerves are then compressed, leading to the symptoms we describe in detail below.

Spinal Stenosis Risk Factors

As mentioned at the start of this article, there are no noticeable correlations to date between the incidence of spinal stenosis and factors such as occupation, race, gender or build. This said, however, most cases of stenosis appear in individuals aged 60 or over.

Symptoms

As mentioned above, many individuals with spinal stenosis (as evidenced by an MRI or CT scan) do not have any actual symptoms.

Others have symptoms that start gradually and gradually become more severe .The symptoms depend on where the stenosis is located (neck or lower back). They also depend on the nerves that are being compressed by the stenosis.

Cervical Stenosis

In cases in which the stenosis is in the neck:

  • The patient can experience numbness or tingling in the arms, hands, feet or legs;
  • He or she may also experience weakness in one or more of the limbs indicated above;
  • There may also be problems with maintaining balance while walking;
  • Neck pain may also be a factor;
  • In the most severe cases, the patient may also exhibit difficulty controlling bladder or bowel function.

Lumbar Stenosis

If the stenosis is in the lower back area, the patient may experience the following symptoms:

  • Numbness, tingling or both in a foot or leg (unlike cervical stenosis, patients are unlikely to experience these sensations in a hand or arm);
  • Some patients may experience weakness in the feet or legs;
  • Leg pain or cramping. This may worsen after long periods of standing or after walking. However, bending forward or sitting down will usually mitigate the leg pain;
  • Back pain may also be a factor.

Symptoms depend on whether the stenosis causes compression of the spinal cord in the central canal of the spine or of the nerves that emerge from between the vertebrae to the side of the spine. In the former case, symptoms are usually bilateral (though not symmetrical). In the latter case, symptoms occur only on one side of the body.

Diagnosis

To diagnose whether a patient has spinal stenosis, a doctor will question him or her about the symptoms he or she is experiencing..

The doctor will likely also review the patient’s medical history. A medical examination will likely be conducted.

Finally, the doctor may order several imaging studies of the spine to confirm his or her suspicions of stenosis. These may include X Ray, CT and MRI scans. An MRI of the spinal cord is the gold standard method of investigation. It is preferred to CT myelography because the latter is invasive.

Sometimes an X-ray of the spine is done before MRI and CT in order to exclude alternative diagnoses.

Treatment Of Spinal Stenosis

To treat a case of spinal stenosis with mild or no symptoms, doctors may recommend simply monitoring the patient via regular visits. This may be supplemented with physical therapy to mitigate any mild symptoms that the patient may be experiencing.

In cases with more severe symptoms, doctors can recommend from a range of treatment options including medication, physical therapy and other options such as surgery. Where possible, many doctors would prefer to use minimally invasive procedures as much as possible.

Medications

The patient may be prescribed medications to relieve pain from the condition (e.g. ibuprofen or naproxen). In addition, doctors may prescribe antidepressants, anti seizure drugs or opioids for additional pain relief. Occasionally, medications for neuropathic pain like amitriptyline, pregabalin or gabapentin may be needed.

As with any type of medications, patients and doctors should be vigilant and look for any possible side effects. If any appear, alternative medications will need to be considered.

Physical Therapy Exercises

These will have the goals of increasing the patient’s strength and endurance and preserving as much spinal flexibility and stability as possible.

Other exercises may be recommended to improve the patient’s balance, which may be affected in cases of cervical stenosis.

Other Treatments

If the above measures do not prove to be adequate in controlling symptoms, doctors may recommend alternative measures such as:

  • Steroid injections near the roots of the affected nerves to reduce pain and inflammation. This won’t correct the actual stenosis (narrowing) however;
  • A decompression procedure in which ligament tissue at the back of the spine is removed to increase space in the spinal column. This is normally performed only in cases of lumbar stenosis;
  • Doctors can also discuss a range of surgical options to increase the space in the spinal cord and reduce pressure on nerve roots. Patients should be careful to ensure that the surgeon has adequate experience with this type of surgery, as complications can easily develop.

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