Spinal Stenosis

Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. This narrowing occurs most often in the lower back and the neck.

Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves.

Symptoms of Spinal Stenosis

Some people with spinal stenosis may not have symptoms while others may experience pain, tingling, numbness and muscle weakness.

Common symptoms of spinal stenosis include radiculopathy, myelopathy and cauda equina syndrome.

Radiculopathy, involves neurological deficits and pain the stems from the compression of spinal nerve root, such as tingling, numbness, or weakness that goes into an arm or leg. This pain can range from a dull ache or tenderness to an electric-like pain or burning sensation.

Myelopathy, also involves neurological deficits such as tingling, numbness, or weakness that goes into both arms and legs. However, myelopathy could also involve dysfunction elsewhere in the body, such as problems with bladder and bowel control.

Cauda equina syndrome, results from the compression of the spinal nerve roots that continue below the spinal cord. Many issues may develop in the lower extremities, including loss of sensation in the thighs, buttocks and legs and even bowel or bladder incontinence. This condition requires immediate medical attention to avoid permanent nerve damage.

Causes of Spinal Stenosis

The bones of your spine form a spinal canal, which protects your spinal cord. The spinal cord is an extension of your brain responsible to conveying movement and sensory signals to and from the brain. For most individuals spinal stenosis occurs when something happens to narrow the open space within the spine. This can include overgrowth of bone, wear and tear due to daily activity, damaged or bulging intervertebral discs, thickened ligaments of the spine, growth of tumours and cysts into the spinal canal, or spinal injuries as a result of trauma. Most people with spinal stenosis are over the age of 50.

Diagnosis of Spinal Stenosis

Spinal stenosis is diagnosed based on a thorough assessment of medical history, physical examination and diagnostic imaging scans.

Physical examination: Physical examination involves gauging the degree of motion, site of pain and evaluation of nerve and muscle using specific movements. Typically, in order to find the specific site of spinal stenosis, imaging studies may be required.

Diagnostic imaging: Radiological studies such as X-rays, CT scans and MRIs may be ordered to investigate extent of degenerative changes and helps visualise all involved tissues like bone, muscles, nerves, ligaments and cartilage. Once the extent and site of spinal stenosis is identified, your doctor may be able to create a suitable course of treatment for your condition. Imaging studies also help rule out any other hip and spine conditions with overlapping symptoms.

Treatment for Spinal Stenosis:

Non-surgical treatments are usually preferred as the first course of action for spinal stenosis. This includes physiotherapy, pain medication, activity modification, or steroid injections around the affected area. Only when there is severe pain and reduced neurological function that continues to worsen, surgery is considered a viable option.

There are several surgical options for spinal stenosis, such as:

Laminectomy: This surgery involves the removal of a portion of the bone of the vertebra.  The goal here is to decompress (relieve pressure) the spinal cord and nerve roots that were being pinched or inflamed by spinal stenosis. Laminectomy is the most common surgery for spinal stenosis.

Foraminotomy: This surgery removes a small part of the bony opening where the spinal nerve exits the spinal canal. This includes removal of bone spurs, partial removal of the disc or other soft tissues that were compressing the spinal nerve in or near the foramen. This is less invasive procedure than laminectomy.

Discectomy: Degeneration of the intervertebral disc can also play role in narrowing the intervertebral foramen and causing spinal stenosis. In such cases, the collapsing disc may be removed and the necessary space for the nerves is created by fusing the adjacent vertebrae.

There are lot of different procedures that can be done for spinal stenosis depending on the cause and area where it must be performed.


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