Spinal Stenosis

Spinal Stenosis means a narrowing of the spinal canal. Some individuals have a lower than normal diameter of the spinal canal that they are born with. Most of us develop spinal stenosis with time just as the joints in your fingers and wrists become larger with age and wear and tear - the joints in the spine do as well. In the case of the spine, this enlargement of the facet joints and the intervertebral joints results in the narrowing of the neural foramina and of the spinal canal.

In this condition, bone spurs, called osteophytes, which develop because of the excessive load on the intervertebral disc, grow into the spinal canal. The facet joints also enlarge as they become arthritic, which contributes to a decrease in the space available for the nerve roots. The ligaments of the spinal column, especially the ligamentum flavum, become stiff, less flexible, and thicker with age, which also contributes to spinal stenosis. These processes narrow the spinal canal and may begin to impinge and put pressure on the nerves roots and spinal cord, creating the symptoms of spinal stenosis.

Some distortion of the spinal canal will occur in virtually every person as they age, but the severity of the symptoms will depend on the size of a person's spinal canal and the encroachment on the neural elements. The rate of deterioration varies greatly from person to person, and not everyone will feel symptoms.

Spinal stenosis may be caused by a number of processes that decrease the amount of space in the spinal canal available for the neural elements. Degenerative causes are the most common, but there are a few unusual causes of stenosis. These include calcium pyrophosphate crystal deposition, amyloid deposition, and intradural spinal tumors. The reason why stenosis causes weakness and pain is the subject of a significant amount of debate and medical research. Pain in the buttocks or leg, which is a common symptom of lumbar spinal stenosis, may be associated with the compression of the micro-vascular structures carrying blood flow to the nerve roots.

Spinal Stenosis Canal

Symptoms
Some people with degenerative disease of the lumbosacral spine may be totally asymptomatic, some may complain of mild discomfort in the low back, and others may not even be able to walk. In patients who have significant spinal stenosis, they will begin to notice pain in the buttocks, thigh or leg that develops with standing or walking, and improves with rest. In some cases, a patient will complain of leg pain and weakness without having any back pain. More severe symptoms of the disorder include numbness, paresthesias and weakness in the lower extremities. Certain positions can alleviate the symptoms of spinal stenosis by increasing the amount of space available for the nerves, sitting with your legs wide open an help give more room for the nerves.

These positions usually involve flexion of the lumbar spine and bending forward. "Any positions that flex the lumbar spine are associated with resolution of symptoms." * For instance, patients with spinal stenosis can ride a bike and walk up an incline or flight of stairs without any pain. They can often walk for extended distances if they have something to lean on, like a shopping cart. However, if they are walking down an incline or flight of stairs, or if they have to give up the shopping cart, their symptoms will often reappear.

The presentation and severity of the symptoms of spinal stenosis depends on the several factors, including the original width of the spinal canal, the susceptibility of the nerves involved, and the unique functional demands of the patient and the pain tolerance of each individual patient.

Diagnosis
The diagnosis of spinal stenosis begins with a complete history and physical examination. The doctor will determine what symptoms are present, what makes them better or worse, and how long they have been present for. A physical examination is essential for determining how severe the condition is, and whether or not it is causing weakness or numbness in certain parts of the body. Abnormalities in the strength and sensation of particular parts of the body that are found with a neurological examination provide the most objective evidence of chronic nerve root compression caused by spinal stenosis. There are no laboratory tests that can detect the presence or absence of a stenosis, but they may be helpful in the diagnosis of unusual causes of nerve root and spinal cord dysfunction. Routine radiographs of the lumbar spine are very helpful in determining the amount of degeneration that is present in the spine, which gives an indirect indication of whether or not spinal stenosis is present. These x-rays are also used to determine if certain parts of the spine are unstable, which may be contributing to the symptoms of stenosis.

A CT scan (CAT scan) provides excellent visualization of the bony anatomy of the spinal column and is an indispensable tool for determining where the stenosis is located. This test is often performed in conjunction with a myelogram, which involves injecting dye into the space occupied by the spinal cord and nerve roots, in order to determine how well the cerebrospinal fluid is able to travel along the nerve roots. An EMG or electromyographic test may help to determine which nerve root in particular is not working normally in the situation where several nerve roots may be involved.

Most individuals with spinal stenosis live normal lives. It is only those patients who have intractable symptoms that have treatment. The usual treatment is activity modification, anti-inflammatory drugs, and pain medications. If the pain is intractable, epidural steroids are frequently used and finally, surgery.

Surgical treatment involves making the spinal canal bigger by removing the bony elements that are compressing the nerves. Fusion is frequently added during surgery in the patients that have significant longevity. This is a controversial issue as there is a strong difference of opinion. The reason for the fusion would be for the instability that is part of the genesis of the arthritic changes and it is found that surgery without fusion, done on the people with significant stenosis, adds to the instability problem by removing a portion of the spinal joints. Lastly, it is found that in the long-term follow-ups of greater than three years, the patients do better. In general, patients with severe stenosis say the postoperative pain is not a whole lot worse than the preoperative pain.

Recovery period depends on the extent of the procedure and the status of the patient preoperatively. For patients who are in good cardiovascular condition, the recovery is relatively brief. Typically, hospitalisation for decompression and fusion procedure would be four to five days with the patient independent for self care but limited in endurance at the time of discharge. Before the patient gets as good as he/she will get is a period of discharge. Before the patient gets as good as he/she will get is a period of four to six months. The answers to these questions will vary from surgeon to surgeon.