Definition and Overview

Spinal stenosis is a condition where the spaces in the spine become narrow, causing pain, numbness, and sometimes paralysis.

The spine is one of the most important parts of the body as it provides structure and support. It allows a person to perform movements such as standing, walking, sitting, and bending, among others. In the spine is also the spinal cord, which is a bundle of nerves connected to the brain. These nerves serve as electrical pathways in which the brain, the body’s command center, sends instructions to every organ. If the spinal cord is damaged, it can lead to organ failure, paralysis, and even death.

The spine is composed of small bones called vertebrae (or vertebra in singular form). These bones are distributed into three regions, namely, cervical, thoracic, and lumbar.

The cervical spine is composed of 7 vertebrae and is the one closest to the brain and runs through the neck area. The middle section is the thoracic with 12 vertebrae. The remaining bones are part of the lumbar spine, which is connected to the sacrum, which belongs to the pelvic area.

Stenosis usually happens in only two regions: cervical and lumbar. Between the two, lumbar is the most common. However, cervical spinal stenosis is more life threatening since it’s where the spinal cord can be found. Stenosis with myelopathy is a condition characterized by the thinning of the spaces and the compression of the spinal cord. Meanwhile, in the lumbar region, only nerves are present.

Stenosis can be progressive, although in the case of lumbar, it may also fluctuate. It may also affect just one or more spaces in the spine. The most important is it’s caught and managed early to avoid severe complications.

Causes of Condition

  • Age: One of the main causes of spinal stenosis is aging. As a person grows old, the structure of the spine changes, including the open spaces becoming narrower. Age is a greater risk in cervical spine stenosis. It may lead to spurs or the enlargement of the bones of the spine, which can put significant pressure on the nerves, as well as result in herniated discs. These discs, which serve as cushions, can become “brittle” or dry as the person ages. By then, some material can go out of the disc and irritate the spinal nerves or cord.

  • Osteoarthritis: One of the most common forms of arthritis in the world, it is characterized by the gradual wearing out of the cartilage found in the discs and joints in the spine.

  • Congenital defect: Some people are already born with a narrow spinal canal.

  • Tumours: Spinal stenosis can also develop along with a mass overgrowth (tumour). This tumour can be malignant or benign, as well as primary or secondary (metastasis). As the tumour occupies the open space, it creates pressure that compresses or pinches the spinal cord and the nerves.

  • Injuries: Trauma to the back and neck may also injure the spine, especially if the impact is so strong that it fractures, displaces, or changes the bone structure.

  • Genetics: A spinal stenosis has typically a genetic component when it occurs to young people especially teens and children. During this age, the bones are still in their development stage.

Key Symptoms

  • Numbness especially in the legs and arms
  • Weakness in the extremities
  • Discomfort
  • Difficulty in doing movements including walking
  • Paralysis
  • Shooting pain in the limbs
  • Poor motor skills
  • Dysfunction of the bladder
  • Fever
  • Weight loss

There are differences in symptoms between lumbar and cervical spine stenosis. One of the major differences is the frequency of pain. When stenosis is in the lumbar spine, the pain in the legs will occur once the person begins moving such as walking. It goes away when the person is at rest. With cervical spine stenosis, the pain is more likely to be consistent and progressive.

Who to See & Types of Treatment Available

An orthopedic specialist, neurologist, and an internist are some of the doctors that can assess and treat spinal stenosis.

To diagnose the disease, different imaging tests are performed such as X-ray and MRI (magnetic resonance imaging). However, to allow the doctors to really see the shape of the spine (its curvature), CT myelogram may be used. This is a contrast dye that is injected into the body.

When it comes to treatments, they can be either surgical or non-surgical. Under non-surgical methods, doctors may recommend:

  • Modification of movement or activity – This may work for patients with lumbar spine stenosis as they tend to feel less or zero pain when they try to move their body forward. Hence, they may benefit from walking with a cane or walker.

  • Exercise – Exercises such as biking and swimming have been known to help reduce the symptoms like pain. This will also help avoid putting extra weight that may only add more pressure to the back.

  • Medications – Most of the recommended medications such as NSAIDs (non-steroidal anti-inflammatory drugs) do not necessarily treat the condition but rather relieve the symptoms.

  • Epidural injection – Some experts find the results of these injections to be poor, but overall, they’re effective in providing temporary relief. Most of those who respond positively to the injections can also benefit from a surgery.

  • Therapy – Aside from stretching and exercise, therapists can also provide instructions on how to modify certain movement or activity. They can counsel, guide, and help patients with self-care.

Surgery, meanwhile, is considered when stenosis has become more severe and life threatening, as well as when it has drastically decreased the quality of life of the patient (including the inability to move properly or has lost motor functions).

For those with cervical stenosis caused by the herniated disc, an anterior cervical discectomy with fusion may be performed, where the herniated discs are removed and a graft is used to connect the space between the upper and lower part of the disc.

For lumbar spine stenosis, the best option is decompressive laminectomy, which provides more space for the nerve roots by removing a bone or disc material or both. This is ideal if the cause of the stenosis is aging.

References:

  • Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34:1078-1093. http://www.ncbi.nlm.nih.gov/pubmed/20357643

  • Chou R, Baisden J, CarrageeEj, Resnick DK, Shaffer WO, Loeser JD. Surgery for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34:1094-1109.

  • Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis. Four-year results of the Spine Patient Outcomes Research Trial. Spine. 2010;35:1329-1338.

  • Zacharia I, Lopez E. Lumbar spinal stenosis. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 50.

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