Spinal stenosis is a condition in which there is narrowing of the spinal cord causing nerve pinching which leads to persistent pain in the buttocks, limping, lack of feeling in the lower extremities, and decreased physical activity. As the age increases, these conditions can develop due to the drying out and shrinking of the disc spaces between the bones (80% of the disc is made up of water).
Anatomy of Spinal Stenosis
The spine consists of a series of bone blocks (vertebral bodies) which are separated from one another by discs of soft tissue. Within the structure of the spine sits a tunnel called the spinal canal. This tunnel contains the neurological structures including the spinal cord and nerve roots. Although there is some free space between the neurological structures and the edges of the spinal canal, this space can be reduced by many different conditions including injury to the spine.
The canal is surrounded by bone and ligaments and therefore can not expand if the spinal cord or nerves require more room. Therefore, if anything begins to narrow the spinal canal, there is risk for irritation or injury of the spinal cord or nerves. Conditions which can lead to narrowing of the spinal canal include infection, tumors, trauma, herniated disc, arthritis and degeneration.
Causes of Spinal Stenosis
The cause of Spinal Stenosis is often linked to aging, osteoarthritis, rheumatoid arthritis, or inherited conditions.
Changes that occur in the spine as people age are the most common cause of this condition.
However, the cause of spinal Stenosis can also be linked to tumors of the spine, injuries, Paget's disease, too much fluoride in the body, and calcium deposits on the ligaments that run along the spine
Symptoms of Spinal Stenosis
People can have significant stenosis that they are unaware of until tests are done. It is most common in women over the age of 50-men are less prone to this condition.
The following are possible evidence of spinal stenosis : -
Pain or numbness in the back, legs, and/or buttocks
Cramping in the legs
Weakness in the legs
Bowel and/or bladder problems in some cases
Prolonged standing or walking makes the pain worse
Symptoms may come and go, and may vary in severity when present
Bending forward or sitting increases the room in the spinal canal and may reduce the pain or give complete relief from pain
Diagnosis of Spinal Stenosis
Finding the cause of your neck problem begins with a complete history and physical examination. After the history and physical exam, your doctor will have a good idea of the cause of your pain. To make sure of the exact cause of your neck pain, your doctor can use several diagnostic tests. These tests are used to find the cause of your pain, not make your pain better. Regular X-rays, taken in the doctor's office, are usually a first step in looking into any neck problem and will help determine if more tests are needed.
Once most of the information is gathered, your doctor will give you a thorough physical exam. During the exam, your doctor will look at your neck to find out how well your neck is functioning.
This includes : -
How well you can bend your neck and roll your head in all directions
How well you can twist your neck
If there is tenderness around the neck
If there are muscle spasms around the neck and shoulders
Tests that examine the nerves that leave the spine are also important.
These include : -
Testing for numbness in the arms and hands
Testing the reflexes
Testing the strength of the muscles in the arms, hands, and legs
Testing for signs of nerve irritation
Treatment of Spinal Stenosis
Non Surgical Treatment of Spinal Stenosis
Preventing Falls. Falling is a risk for patients with spinal stenosis. They should avoid alcohol and sedatives. Leg strengthening exercises (walking, cycling) may be helpful, with brief resting if pain occurs.
The use of common pain relievers, such as NSAIDs, physical therapy, and steroid or other spinal injections may be helpful for some patients.
Surgical Treatment of Spinal Stenosis
Surgery. If pain is persistent, patients may require surgery, most often a procedure called decompressive laminectomy. Some patients may require spinal fusion as well. Studies suggest that surgery reduces back pain in many patients, at least for a few years. By four years after surgery, however, 30% of patients have severe pain again and 10% have had another operation.
It should be noted that surgery does not always improve outcome and in some cases can even make it worse. Surgery can be an extremely effective approach, however, for certain patients with severe back pain that does not respond to conservative measures.
Decompressive Laminectomy
Decompressive laminectomy is the most common surgery performed in order to correct lumbar spinal stenosis. The goal of this operation is to create more room for the nerve root that has been encroached upon by the facet joints of the vertebra. Because the LSS symptoms are created by the compression of the nerve root, uncompressing the root relieves the symptoms.
The procedure is performed under general anesthesia : -
A midline incision in the lower back is centered over the affected area.
Dissection through the back muscles provides access to the spine. The portion of the vertebra known as the lamina is removed along with any thickened ligaments to release the nerves traveling down the center of the spinal canal.
Individual nerves are released as they exit the spinal canal by shaving a portion of the degenerative facet joint.
The soft tissues are then closed in multiple layers with absorbable sutures. Following the operation, the patient stays in the hospital for one to three days.
Normally it takes several weeks to recover from this operation
Spinal fusion
Spinal fusion to fuse two vertebrae together to provide stronger support for the spine almost always follows a decompression laminectomy. A surgical procedure to weld together vertebrae, bones of the spine. Read More.
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