Spinal stenosis occurs when the cervical spine or lumbar spine is compressed. Due to extra pressure applied within the spine, the existing open spaces get compressed. This in turn puts pressure on the nerves traveling through the spinal cord transmitting pain in the neck and lower back region. The term “stenosis” means choking in Greek and here the open spaces available in the spine is compressed. Spinal stenosis can cause pain in the leg or tingling sensation. Cervical stenosis causes pain in your arm. Anti-inflammatory drugs, physiotherapy and epidural injections are the available treatment for spinal stenosis. In severe cases surgery may also be done.
Spinal Stenosis Types :
Spinal stenosis is of two types namely lumbar and cervical stenosis. Lumbar stenosis is quite common and cervical spinal stenosis is rare and dangerous since it involves the spine directly. In severe cases of lumbar stenosis it can cause persistent pain and weakness of legs. Depending on the part of the spine compression, spinal stenosis can be further divided into 3 types.
- Foraminal Stenosis :
It is the most commonly occurring spinal stenosis in which the nerve root gets compressed by the existing bone spur (osteophyte) originating from the degenerating disc. Here the nerve root would normally leave the spine through lateral foramen (side hole) which becomes impossible due to the development of bone spur. This type of stenosis often develops at the lowest lumbar spine.
- Central Stenosis :
In this type the central canal area would compress the nerve roots of the cauda equina or horse’s tail portion. This condition often occurs in the second lowest lumbar spine and due to the overgrowth of disc margin and its ligaments.
- Far Lateral Stenosis :
This is a rare type of spinal stenosis wherein the nerve gets compressed by the bony spur or bulging disc after it has emerged from the spine. All the above stenosis are types of spinal stenosis and named on the basis of its anatomy.
Spine Structure :
Spinal cord is made up of hundreds of tiny bony structures and attachments that give durability to the spine. It also protects the spine and the nerve groups that pass down from the brain to all parts of the body. Spinal segment is the term given to group of vertebral body together with its attachments. There are spaces or holes in each side of the central canal through which nerve endings emerge from the spine. Such holes exist at each level of the central canal. When these hole spaces are compressed by the bulging disc the spinal cord along with nerve roots gets affected causing spinal stenosis. More than 70% of stenosis occurs in the lower back (lumbar spine) causing pain in the back of the leg.
Spinal Stenosis Symptoms :
Spinal stenosis do not produce any symptoms in many people. In some cases signs of pain starts gradually and gets worse over time. Symptoms of spinal stenosis vary according to the location of the spine that gets compressed. Some of these symptoms include weakness of leg, arm and foot and tingling sensation. Some people may feel imbalance in walking and they walk clumsily with pain and in rare cases bowel movements can also get affected when the nerve endings of the bladder gets compressed. For some people stenosis can cause cramps in the legs especially when they are in standing position for long duration.
Spinal Stenosis Causes :
Many factors can cause spinal stenosis. Some people are born with defective spinal canal. But in most of the cases compression of space is the main cause for stenosis. Prolonged osteoarthritis can cause wear and tear of bones gradually leading to the formation of bone spur. Bone spur will eventually occupy the available space exerting pressure over the spine and nerve roots. Paget’s disease may also be a reason for spinal stenosis.
Herniated disk can cause stenosis over time. Soft cushions present in the spine may wear as one grows forming cracks pushing the soft matter outside. This would build pressure on the spinal cord causing stenosis. Ligaments that bind the bones present in the spine can become tough and thick over time exerting pressure on the spine leading to spinal stenosis.
Development of any tumor inside the spine would occupy the available space in the vertebral column exerting pressure. Any injury or trauma of the spine can cause fracture pushing the soft materials out of spinal canal. In rare cases spinal stenosis can cause weakness of spine and numbness on the affected part of the body like leg or hand. If the nerves leading to the bladder are collapsed it may cause incontinence.
Since some of the symptoms of spinal stenosis is common with old age it is difficult to detect stenosis. Based on observation your doctor may request for imaging tests like X-rays, MRI or CT myelogram to get accurate picture of spinal stenosis.
Images, Pics, Photos and Pictures of Spinal Stenosis :
Spinal Stenosis Treatment :
Mild form of spinal stenosis needs no treatment. It is enough if you make changes in lifestyle. By making changes in posture one can get relief from the pain or tingling sensation in the legs. Instead of sitting for long duration one should walk for few minutes to regain flexibility. Bend your knees forward till the line of your chest slowly. This would relieve the nerves from compression. Over the counter painkillers like Brufen or aspirin can be taken to get quick relief from pain. Prescription medications include Amrix or Flexeril to manage muscle spasms. For those with unbearable chronic pain affecting the quality of sleep antidepressants like amitriptyline is recommended.
Anti seizure drugs like gabapentin and pregabalin are prescribed to control pain caused by damaged nerves. For managing severe pain opioids like Percocet or oxycontin are given in limited doses. Take complete rest from work if you have pain. This would heal the compression gradually. Physiotherapy is effective to manage pain and regain muscle strength and flexibility. Steroid injections are given directly into the open space of the spine to relieve the extra pressure and to control inflammation. But this should not be made regular.
In rare cases surgery is done to get rid of extra pressure on the nerves of the spine. Laminectomy procedure is done to build spine strength in which the back part of the affected spine is removed. In Laminotomy the surgeon would create enough space on the central canal so that pressure cannot be exerted on the spine. Metals are used to bridge the gap of the opened sections in the spine. However there is no guarantee that symptoms of lower back pain will be reduced after spine surgery. It may remain the same or even get worse. For mild form of spinal stenosis over the counter anti-inflammatory agents like Advil or Motrin or Aleve can be taken. You can apply ice pack or hot water pack on the area. To maintain the posture while walking, you can use walkers for additional support.