Spinal Stenosis

What is spinal stenosis and how can it be treated?

Spinal stenosis refers to the narrowing of one or several spaces in your spine. A reduced space in your spine can reduce the space available for your spinal chord and nerves that branch from it. Tightened spaces can result in the spine or nerves becoming irritated, compressed, or pinched. This can lead to back pain, sciatica, and even severe injury.

The progression of spinal stenosis is usually slow. Most often, it is caused by osteoarthritis and "wear-and tear" changes in the spine that occur with age. You may not feel any symptoms for a while, even though you might have some visible changes on X-rays and other imaging tests. You might feel pain, numbing or tingling depending on the severity of your spinal stenosis.

What is Lumbar canal stenosis?

Lumbar canal stenosis refers to a narrowing of the spinal channel or tunnels that nerves and other structures can communicate with it. The changes that occur with ageing can cause the spinal canal to narrowed, such as the movement of one vertebrae out-of-alignment.

A pinching of nerve roots can occur when the spinal canal narrows or side canals protect nerves. As the canal diameter shrinks, the nerves become more irritated.

Lumbar canal stenosis can cause pain, weakness, or numbness in the legs, hips and buttocks. The symptoms can be worsened when you stand or walk, and may decrease if you lie down, sit, or lean slightly forward.

Who is affected by spinal stenosis

Spinal stenosis is a condition that can affect anyone, but it's more common in those over 50. Spinal stenosis can also affect younger people born with narrower spinal canals. You may also be at risk of developing spinal stenosis if you have other conditions, such as Scoliosis or spine injury.

What are the different parts of the spine?

Your spine, also known as backbone, is a column or stack of 24 bones (vertebrae), plus the fused bone of the sacrum (or coccyx). It starts at the base your skull and ends at the pelvis. Your spine supports your body and protects the spinal cord. Each vertebrae is made up of a frontal portion (the body), an opening in the middle (the spinal canal), and flat bony areas (facet joint) where one vertebrae touches another. There are also bone sections along the sides and back (transverse processes and laminae). The spinous process, which is a part of the lamina, is the ridge that you feel when your hand runs down your back. An intervertebral disc is a round, flat cushion that acts as a shock absorber or cushion between each vertebrae. It is located between the vertebrae bodies. Ligaments are made of strong fiber bands and hold the vertebrae together. They protect the disks, stabilize the spine, and keep them stable.

The spinal cord, the "master cable cord" of the body that transmits and receives messages from the body (including organs and muscles) runs through the middle of the spinal canal. The bony spine parts surround it completely. The nerve roots are the first segment of a bundle that contains nerve fibers. They exit the spinal column via side spaces called the neural foramen. The "mini cable network" is then made up of nerve fibers, or "nerves", that go to all parts.

What causes spinal stenosis

There are many causes of spinal stenosis. They all affect the structure of your spine. This causes a narrowing in the space around the spinal cord and nerve roots that exit the spine. Low back pain, sciatica, and nerve root compression can cause the spinal cord and/or nerve roots to become pinched.

These are the causes of spinal stenosis:

• Bone Overgrowth/arthritic Spurs: Osteoarthritis This is a condition where cartilage and bone in your joints is worn down, including your spine. Cartilage protects the joints. The cartilage begins to wear away and the bones rub against one another. Your body will respond by creating new bone. Commonly, bone spurs are caused by an excessive growth of bone. The vertebral bone spurs extend into the spinal canal and pinch nerves in the spine. Paget's disease can also lead to bone overgrowth, which compresses the nerves.
• Bulging discs/ herniated :Between every vertebrae is an oval cushioning pad (vertebral disc) that acts as shock absorbers along the spine. The gel-like center of these disks can be damaged by age-related drying and flattening, as well as cracking at the outer edge. The disk bulge will then press down on the nerves.
• Thicken ligaments: Ligaments refers to the fiber bands that keep the spine together. Ligaments can become thicker with age and may bulge into the spinal canal space due to arthritis.
• Spinal injuries and fractures: Broken and dislocated bones, as well as inflammation caused by damage to the spine, can cause narrowing of the canal space and/or pressure on the spinal nerves.
• Spinal cord tumors or cysts: Space between the spine cord and vertebrae may be narrowed and pressure placed on the spinal chord and its nerves by growing within it or between them.
• Congenital spine stenosis: A condition where a person was born with a narrow spinal canal. Scoliosis is another congenital spinal defect that could put someone at risk of spinal stenosis. This refers to an abnormally shaped spine.

What are the signs and symptoms of spinal stenosis

When spinal stenosis develops, you may experience symptoms. The process of narrowing the spinal canal is slow and gradual. It can get worse over time. While spinal stenosis can occur anywhere along the spine column, it is most commonly found in the lower back (number 1 most common area) as well as the neck. The symptoms can vary between people and can change over time.

Lower back (lumbar), spinal stenosis symptoms include:

• Lower back pain. Sometimes, pain is described as dull ache or tenderness to an electric-like or burning sensation. It can be temporary or permanent.
• Sciatica. It is pain that starts in the buttocks, extends down the legs and can continue to your foot.
• Feeling heavy in your legs that can lead to cramping.
• Tingling or numbness ("pins and needles") in your buttocks or leg, or foot.
• As the stenosis worsens, you may feel a weakness in your foot or leg.
• Standing for prolonged periods of time can cause pain.
• Leaning forward, bending slightly forward, walking uphill, or sitting can reduce pain
• In severe cases, loss of bladder and bowel controls

The following symptoms are indicative of cervical (or neck) spinal stenosis:

• Neck pain.
• Tingling or numbness in the arm or leg, foot, or hand. You can feel the symptoms anywhere below the point where the nerve compression occurs.
• Clumsiness or weakness in the arm, hand or leg.
• Balance problems
• Function loss in the hands like problems writing or buttoning shirts.
• In severe cases, loss of bladder control or bowel control

The following symptoms are indicative of abdominal (thoracic), spinal stenosis:

• Numbness, pain, tingling, or weakness below the stomach level.
• Balance problems

Is spinal stenosis possible to cause paralysis permanent?

Although narrowing the spine can cause discomfort, it doesn't usually cause paralysis. Permanent paralysis or numbness can occur if the spinal nerves or spinal cord are compressed for a prolonged period. It is important to immediately see your healthcare provider if you feel numbness in your arms or legs.

How can spinal stenosis be diagnosed?

Your healthcare provider will examine your medical history, inquire about your symptoms, and perform a physical exam. Your healthcare provider might feel your spine and press on different areas to determine if it causes pain. To determine if different positions in your spine cause pain or other symptoms, your provider may ask you to bend in various directions. Your provider will assess your balance and movement, as well as your leg and arm strength.

• X-rays:X-rays are a low-dose radiation method that can reveal changes in bone structure. They can show changes such as a loss of disk height or the development of bone spurs, which narrow the space between the vertebrae.
• MRI (Magnetic resonance imaging): MRI uses radio waves and a strong magnet to create cross-sectional views of the spine. MRI images show detailed images of nerves, spinal cord, and any tumors.
• CT or CT Myelogram: A combination of Xrays and CT scans creates cross-sectional images. To see the spine cord and nerves clearly, a CT myelogram uses a contrast dye.

What are the treatment options for spinal stenosis

The severity of your symptoms, whereabouts and what caused them will all affect the choice of stenosis treatment. Your healthcare provider might recommend self-care remedies if your symptoms are not severe. If none of these work, and your symptoms get worse, your healthcare provider may recommend physical therapy or medication, and then surgery.

These self-help solutions include:

• Apply heat. Heat is usually a better option for osteoarthritis pain. Heat improves blood flow which reduces pain and relaxes the muscles. Heat can cause burns so be careful.
• Use cold: Heat is not the best treatment. Ice is usually applied 20 minutes before it becomes melted. Ice reduces swelling, tenderness, and inflammation.
• Exercise: Talk to your healthcare provider before you start, but exercise can help with pain relief, strengthening your spine, and improving your flexibility, balance, and coordination.

These are non-surgical treatments:

• Oral medication: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen, Motrin(r), naproxen(Aleve(r), aspirin), and acetaminophen(Tylenol (r), can relieve pain from spinal stenosis by relieving inflammation. Talk to your healthcare provider about potential long-term side effects of these medications, such as acid reflux or stomach ulcers. Other prescriptions with pain-relieving properties may be recommended by your healthcare provider, such as Neurontin (r), an anti-seizure drug (Neurontin(r), or tricyclic antidepressants like amitriptyline(r). For short-term pain relief, some opioids such as Oxycontin (r) and hydrocodone(r), may be prescribed. They should be used with caution as they can be addictive. Cyclobenzaprine, Amrix(r), and Fexmid(r), can be used to treat muscle spasms and muscle camps.
• Physical therapy. Physical therapists can work with you to create a back-healthy program that will help you gain strength, flexibility, and stability. Your spine will be more resilient if you strengthen your core and back muscles. The physical therapists can show you how to move in a way that opens the spinal canal. This can reduce pressure on your nerves.
• Steroid injections Injecting corticosteroids in areas where nerve roots are being pinched, or where worn bone surfaces rub together can reduce pain, inflammation and irritation. Because corticosteroids can cause bone and tissue weakness over time, it is best to limit the number of injections (typically 3-4 per year).
• This outpatient procedure is also called percutaneous image-guidedlumbar decompression. It treats lumbar spine stenosis due to thickening of one ligament (ligamentum flavum). The procedure is done through a small incision, and does not require general anesthesia or stitches. An X-ray is used to guide the procedure. A contrast agent is also injected during the procedure. A surgeon uses special tools and techniques to remove the thickened ligament. This opens up the spinal canal and reduces nerve root compression. This procedure has many advantages. The bony structure of the spine is preserved and the spine mechanics are not affected. People can recover quickly. Most people return home within a few hours and can begin walking or physical therapy shortly thereafter. You will be able stand and walk for longer periods of times, and you will feel less numbness, weakness, and tingling than before the procedure.

What is the best time to have spinal stenosis surgery?

Surgery is often recommended for spinal stenosis patients who have exhausted all other options. Most people with spinal stenosis do not need surgery. Talk to your healthcare provider about surgical options if you are interested in:

• You are experiencing symptoms that are unbearable.
• Pressure on the spine cord causes pain.
• It is difficult to balance and walk.
• You may have problems with your sexual function or lost bladder or bowel control.

What surgical options are available for spinal stenosis treatment?

There are many options for surgery, including the removal of bones, bony growths on facet joint or disks and pinching spinal nerves.

There are many types of spine surgery:

The most common form of surgery to treat this condition is laminectomy. This involves the removal of the lamina (Types of Spine Surgery). You may also need to remove some ligaments or bone spurs. This procedure allows for the nerves and spinal cord to be freed up, which can relieve your symptoms.

Laminotomy This procedure is a partial one. This procedure removes only a portion of the lamina - the part that puts the greatest pressure on the nerve.

Laminoplasty This procedure is performed in the neck area (cervical). A portion of the lamina can be removed to create more canal space. Metal plates and screws are used to make a hinged bridge over the bone area.

Foraminotomy The foramen in the vertebrae is where the nerve roots exit. This procedure involves the removal of bone or tissue from this area in order to make more room for nerve roots.

Interspinous space spaces: This minimally invasive procedure is for people who have lumbar spinalstenosis. The spinous processes are the spacers that are placed between the vertebrae's bones. Spacers are used to keep the vertebrae from colliding, making it easier for nerves to move. This procedure can be performed under local anesthesia. It involves the removal of a portion of the lamina.

Spinal Fusion: If you are experiencing radiating nerve pain due to spinal stenosis or if your spine has not stabilized and you have not had any other treatments, this procedure may be considered. Two vertebrae are permanently fused together by Spinal Fusion Surgery. A laminectomy is performed first. The bone that was removed during the procedure is used to build a bridge between the vertebrae. This stimulates bone growth. The vertebrae can be held together by hooks, wires, screws or rods until they heal and become one. Six months to one year is required for the healing process.

How can I prepare for spine stenosis surgery

To speed up your recovery, stop smoking and do some exercise. If you are taking non-essential medication, supplements, or herbal remedies that may react with anesthesia, ask your provider. Ask your healthcare team any questions or concerns you might have.

What happens after a spinal surgery?

You may spend a few days in hospital if you have had a laminectomy. A three- to five-day stay may be required for spinal fusion patients. You may be transferred to rehabilitation facilities if you are older to receive further care before you go home.

To reduce swelling and pain, you will be prescribed pain medication and/or non-steroidal anti-inflammatory drugs. For comfort, you may be provided with a brace or corset. It is likely that you will be encouraged to walk as soon after your surgery. To ensure that your spine does not become stiffer and reduce swelling, your healthcare provider or physical therapist may recommend light exercise immediately after surgery. Your physical therapist will create an exercise program to strengthen and stretch your muscles and support your spine.

Hot compresses and hot showers can help relieve pain. You can also use an icepack to ease your pain after and before exercise.

What is the recovery time after spinal stenosis?

The average time it takes to fully recover from spinal stenosis surgery and get back to your normal activities is three months. It could take longer depending on how complex your surgery was and how far you are in rehabilitation.

What is the best time to return to work after a spinal surgery?

After a laminectomy, most people can return to work within days. You'll be able to return work in a few weeks if you have had spinal fusion.

Is spinal stenosis possible to prevent?

Because spinal stenosis is mostly caused by normal aging conditions like osteoarthritis, loss of bone mass and bone fractures, it's impossible to prevent. You can reduce your risk and slow down the progression of spinal stenosis by taking these steps:

• Maintain a healthy weight by eating a nutritious diet
• Stop smoking. Quit smoking. For help quitting smoking, ask your healthcare provider.
• Keep a good posture.
• Do not exercise if you are experiencing pain. Keep moving. Before you start a home exercise routine, consult your doctor or physical therapist. Exercising too much can lead to more harm than good.

Remember that spinal stenosis is not curable. However, it can be managed with nonsurgical and surgical options.

What should I do if I have spine stenosis

The first is that spinal stenosis can develop slowly and over time. You may not notice any symptoms, even though there are changes in your spine. The first signs you may notice are pain, numbness or weakness in your spine, neck, arms or legs, depending on where the stenosis is located. For a short time, conservative treatments such as anti-inflammatory and pain-relieving medicines, heat, ice, or physical therapy may be sufficient to alleviate the pain. Talk to your healthcare provider if your quality of living is not improving due to stenosis. Many people who have spinal stenosis surgery experience good to excellent pain relief. Your general health, presence of any other medical conditions, severity of spinal stenosis and location, the experience and skill of your surgeon, and your dedication to your recovery plan will all affect your surgery results.