Spinal Stenosis

 

Spinal Stenosis: Definition

What Is Spinal Stenosis?

Spinal stenosis is a condition that occurs when the spaces in your backbone (spine) become narrow. When this happens, your spinal cord and its nerves can become compressed or pinched. More than half the time, spinal stenosis occurs in the lumbar spine, which is the lower portion of the back, and the narrowing of the spine that goes along with this condition causes pain that travels down the back of the leg.

In general, there are 3 major classifications of spinal stenosis.

  • Foraminal spinal stenosis is the most common type of lumbar spinal stenosis, may also be referred to as lateral spinal stenosis. As the nerve root is about to leave the canal through a side hole at the back of the spine, called the neuro-foramen, a bone spur (osteophyte) that has already developed from bone degeneration or arthritis, can press on that nerve root.
  • Central spinal stenosis occurs when the central spinal canal is constricted with enlarged ligament and bony overgrowth, causing compression of the spinal cord and cauda. This narrowing can cause pressure on the nerve bundle at the end of the spinal cord (cauda equina) or the nerve bundle within the thecal sac.  Stenosis can occur along any area of the spines, but most common in the lumbar area
  • Far lateral spinal stenosis is the narrowing of the area lateral, or to the side of the neuro-foramen. The narrowing is secondary to the development of bone spurs from the facet joints, bulging discs, herniated discs, and ligament hypertrophy. 

Spinal Stenosis Causes

Reasons Why Spinal Stenosis Happens 

Some people are born with an unusually small spinal canal. In other cases, spinal stenosis comes about when another condition or disorder occurs that reduces the amount of space in the canal.

Spinal stenosis may be caused by:

  • Bone Spurs: Bone spurs are one of the common spinal stenosis causes. They form when wear and tear damage causes extra bone tissue to form. If these develop in the spinal canal, they can cause spinal stenosis. Paget's disease is a bone disorder that typically occurs in adults that can also cause the overgrowth of bone material. 
  • Herniated Discs: Spinal stenosis can also be caused by ruptured or herniated intervertebral discs and are common spinal stenosis causes. These are the soft cushions between your vertebrae that serve as shock absorbers. As the body ages, these discs dry out. If the outer rim cracks or tears, some of the soft gel-like material from the inside can leak out, causing spinal stenosis by pressing on the spinal cord and nerves inside the spinal canal.
  • Stiff and Thickened Ligaments: Ligaments are tough fibers that help add stability to the spine by binding the vertebrae together. Over time, these ligaments get hard and thicken. As this happens, they can sometimes bulge and decrease the amount of space in the spinal canal, leading to spinal stenosis.
  • Tumors: Abnormal tissues or masses sometimes grow inside the membranes of the spinal cord, or in the space between the spinal cord and the vertebrae, taking up room in the spinal canal. This causes spinal stenosis.
  • Injuries or Trauma: Falls, motor vehicle accidents or other injuries and trauma can cause serious dislocations or fractures of one or more backbones. These fractures or dislocations can be one of the common spinal stenosis caused by damaging the spinal canal. Sometimes surgery on the spine can cause swelling in tissues near the spinal canal that compress the spinal nerves and the spinal cord.
  • Malignancy or cancer is abnormal growth of the spinal cord or within the membranes covering the cord and the vertebrae. It's one of the rare spinal stenosis causes
  • Spinal ligament changes such as inflammation and scarring can result in thickened ligaments. These thickened ligaments can impinge the spinal canal over time.
  • Spinal cord abscess is a collection of pus from an infection. This swollen area can cause permanent damage to the spinal cord
  • Spondylolisthesis is a condition when a vertebra slides forward on the vertebra below it, commonly seen in the lumbar spine.

Prevalence

Who Is At Risk? 

Spinal stenosis occurs most often in people who are older than 50 years of age. People who develop the condition at a younger age most often have a genetic disease that has affected the development of their bones and muscles.

Risk Factors

The main risk factor for spinal stenosis is the age over 50 years. Other predisposing factors are the following:

  • Genetically abnormal narrowing of the spinal canal
  • Developmental problems in the spine prior to birth
  • Poor posture and body mechanics
  • Degenerative disc disease
  • Obesity
  • Smoking
  • Diseases such as arthritis, scoliosis, osteoporosis, and lordosis.

Complications

Spinal stenosis causes incontinence and weakening which are common complications, and can often be very severe. In worst cases, spinal stenosis causes patients to not be able to control their bladder and experience paralysis. Cauda equine syndrome is a rare but serious complication that requires immediate surgical intervention to reduce pressure on a bundle of nerves near the end of the spinal cord

 

Spinal Stenosis: Symptoms and Diagnostic Procedures

What Are the Symptoms of Spinal Stenosis? 

The primary clinical symptoms of spinal stenosis are chronic pain. In patients with severe stenosis, weakness and regional anesthesia may result. Patients with spinal stenosis become symptomatic when pain, motor weakness, paresthesia, or another neurologic compromise causes distress. Spinal stenosis of the thoracic spine is more likely to directly affect the spinal cord because of the relatively narrow thoracic spinal canal.

Spinal stenosis of the cervical and thoracic regions may contribute to neurologic injuries, such as the development of a central spinal cord syndrome following spinal trauma. Spinal stenosis of the lumbar spine is associated most commonly with midline back pain and radiculopathy. In cases of severe lumbar stenosis, innervation of the urinary bladder and the rectum may be affected, but lumbar stenosis most often results in back pain with lower extremity weakness and numbness along the distribution of nerve roots of the lumbar plexus.

Spinal canal size is not always predictive of clinical symptoms of spinal stenosis, and some evidence suggests that body mass may play a role in limitations of function in this population. Severe radiologic stenosis in otherwise asymptomatic individuals suggests inflammation, not just mechanical nerve root compression. Specific inflammation generators may include herniated nucleus pulposus (HNP), ligamentum, flavum, and facet joint capsule.

Sometimes, people who have spinal stenosis have no symptoms of the condition. When symptoms do start to appear, they usually come on gradually and slowly get more severe. The symptoms of spinal stenosis vary and depend on what part of the spine is affected. Evidence of spinal stenosis is usually apparent on X-ray.

  • Symptoms in the Neck: If spinal stenosis is present in the neck (cervical area of the spine), it can cause pain and possibly tingling or numbness in the arms or the legs. If it is very severe, incontinence of bowel and/or bladder may result due to compression of the nerves that control these functions.
  • Symptoms in the Lower Back: If spinal stenosis leads to nerve compression in the lumbar area (lower spine), symptoms of spinal stenosis might be muscle spasms and cramping and leg pain with standing and walking. The pain is relieved by bending forward or sitting because this removes the pressure from the pinched nerves.
Lumbar spinal stenosis is strongly associated advanced age, severe lower extremity pain, and absence of pain when the patient is in a flexed position.  The most important elements involve the postural nature of the patient's pain, stating that absence of pain or improvement of symptoms of spinal stenosis when seated assists in ruling in lumbar spinal stenosis. However, lumbar spinal stenosis cannot be ruled out when sitting is the most comfortable position for the patient and standing/walking is the least comfortable. Patients with LSS compensate for symptoms by flexing forward, slowing their gait, leaning onto objects (eg, over a shopping cart) and limiting distance of ambulation. Unfortunately, such compensatory measures, particularly in elderly osteoporotic females, promote disease progression and vertebral fracture. Lumbar spine stenosis results in pain, numbness, or weakness, most often in legs, feet, and buttocks.
Other symptoms of spinal stenosis are the following
  • Leg  or buttocks  pain and  cramping which gets worse on walking, standing straight or leaning backward
  • Stiffness in the leg and thighs
  • Low back pain
  • Loss of bladder and bowel control in severe cases

When Should I See a Doctor?

If you have pain that lasts more than a few days, or if you have numbness or weakness in your legs or arms, or bowel or bladder incontinence, notify your physician. These could be signs of spinal stenosis or a more serious medical condition.

Diagnostic Procedures

How is Spinal Stenosis Diagnosed?  

Since the symptoms of spinal stenosis mimic those of many other conditions common to aging, it is not always easy to diagnose. In order to diagnose the particular cause of your pain and other symptoms of spinal stenosis, your doctor may recommend several imaging tests. Recommended tests for spinal stenosis may include:

X-rays: Standard X-ray films usually don't provide doctors with enough information to give a definitive diagnosis of the symptoms of spinal stenosis, but they do help to rule out other reasons for your symptoms.

Magnetic Resonance Imaging (MRI): An MRI uses a strong magnetic field and radio waves to obtain images that a doctor can use to evaluate the condition of your spine and also the soft tissues of the body to locate the area where physical symptoms of spinal stenosis are occurring. An MRI provides much more information than an X-ray and many physicians recommend this test if they suspect spinal stenosis.

CT Myelogram: A Computerized Tomography (CT) uses X-rays taken from many angles and combines them to provide images that are very detailed. A myelogram involves the injection of dye which helps certain structures to appear even more clearly. This is very useful in cases of suspected spinal stenosis because it can show the spinal canal's size and shape, and can reveal bone spurs, herniated discs, and abnormal growths and masses.

Spinal Stenosis Treatment Options

How Is Spinal Stenosis Treated? 

These diagnostic studies are usually performed if symptoms do not subside after a period of 3 to 6 months of therapy such as rest, anti-inflammatory medications, and physical therapy.

Neuronal studies include the following:

  • Needle electromyography - Can help to diagnose lumbosacral radiculopathy with axonal loss
  • Nerve conduction studies - Can help to differentiate lumbar spinal stenosis (LSS) from other confounding neuropathic conditions (eg, lumbosacral plexopathy, generalized peripheral neuropathy, tarsal tunnel syndrome, other mononeuropathies)
  • Somatosensory evoked potentials - are useful in the diagnosis of central nervous system (CNS) pathology and are also used intraoperatively during decompressive surgery to assist the physician in dynamically identifying any iatrogenic changes to the sensory pathways

The spinal stenosis treatment options vary, depending on how severe the signs and symptoms are and where in your spine the condition has occurred. Treatment may include:

  •  Medications: The goal of medications taken for spinal stenosis is to relieve the pain caused by the condition. Several different spinal stenosis treatment options may be recommended by your physician including:
    • Non-steroidal anti-inflammatory drugs: These are also known as NSAIDs. They help ease the pain of spinal stenosis by reducing inflammation as well as by decreasing the body's response to pain. Examples are naproxen and ibuprofen. Some NSAIDs can be purchased over-the-counter. Other NSAIDs such as COX-2 inhibitors require a physician's prescription.
    • Muscle Relaxants: Muscle relaxants are effective in treating the pain of spinal stenosis because they reduce muscle spasms. Cyclobenzaprine is one example of a muscle relaxant. These medications require a doctor's prescription and one of the common spinal stenosis treatment options.
    • Anti-depressants: Some medications that are used to treat depression are also effective for relieving the pain of spinal stenosis. One example is venlafaxine. These medications require a doctor's prescription.
    • Anti-seizure drugs: Medications that are used to treat seizure disorders are also useful in controlling pain caused by nerve disorders and can help control the pain caused by spinal stenosis. One example is gabapentin. Again, a physician's order is needed for these types of drugs.
    • Opioids: These are narcotic medications. These are usually only prescribed for very severely painful spinal stenosis and they are given for limited amounts of time. An example of a narcotic is oxycodone. A doctor's written prescription is needed to obtain opioids.
  •  Therapy: Sometimes physical therapy is recommended for patients with one of the spinal stenosis treatment options. A therapist can help with an exercise program that is designed to help:
    • Improve the flexibility and stability of the spine
    • Improve overall strength
    • Improve and maintain balance
  • Epidural Injections: Your physician may recommend steroid injections given epidurally for as one of the spinal stenosis treatment options. The goal of these injections is to reduce the swelling and irritation directly in the affected area. Corticosteroids have anti-inflammatory properties and can help ease swelling and reduce the pressure caused by spinal stenosis. Because of the potential side effects of steroids, these injections can only be given a few times per year.
  • Surgery: Surgery is not usually recommended unless conservative spinal stenosis treatment options have been unsuccessful or the symptoms of spinal stenosis are so severe they are causing serious disability. The goal of surgery is to decompress or remove the pressure from the spinal cord and nerve roots. A common procedure for spinal stenosis is a laminectomy. In this operation, a part of a vertebra is removed to create more room in the spinal canal. If more stability is needed in the spine, a procedure called spinal fusion may be necessary. In this procedure for spinal stenosis, vertebrae are fused to form one solid piece of bone
Epidural Steroid Injection can be used to relieve the pain of stenosis and irritated nerve roots, as well as to decrease inflammation. Injections can also help reduce swelling from a bulging or herniated disc. The steroid injections are a combination of cortisone (a powerful anti-inflammatory steroid) and a local anesthetic that is given through the back into the epidural space. Epidural steroid injections are not always successful in relieving symptoms of inflammation. They are used only when conservative spinal stenosis treatment options have failed.

Spinal surgery usually helps to ease the symptoms of spinal stenosis, but there are risks associated with any procedure on the spine. These may include:

  • Infection
  • Blood clots
  • Neurological decline or deficit
  • Leakage of spinal fluid
  • Respiratory problems
  • Bleeding

Useful Advice

Useful Home Remedies  

There are several things you can do at home to relieve the pain of spinal stenosis:

  • Take over-the-counter pain medications to help with inflammation and discomfort
  • Try applying cold packs or mild heat to areas that are painful
  • Consider using a walker or cane to help relieve the pain of spinal stenosis. These add stability and also allow you to take pressure off your spinal cord and nerves while walking

If your pain is severe, or if you have weakness or numbness in your arms or legs, contact your doctor.  

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Questions & Answers
Q:
What is the best way to treat permanent back and neck pain and stiffness?
A:

Here are some tips:

Neck Pain Tips: Sleep with a cervical pillow

Orthopedic or cervical pillows are made with special contours to support the space beneath the neck and head. They are also more concave for the head and provide more support to the neck.

Neck Pain Tips: Sleep on your back

The best position to lie to sleep is on your back. If you sleep on your stomach or on your side, make sure your pillow is not too thick. It should raise your head no more than 4 to 6 inches. This will keep your neck and head from turning to either side.

Neck Pain Tips: Position your computer screen at eye level

While you are working at a computer, sit comfortably in your chair with your computer in front of you. Close your eyes and then open them. When you open your eyes, you should see the middle of the computer screen. If your gaze is not in the middle of the screen, adjust the height of the screen using items like books.

To keep your head from gradually drifting forward, take frequent breaks to stretch. Getting up to walk around at least once every half-hour is one of the best neck pain tips.

Neck Pain Tips: Use a telephone headset

Never hold a phone between your shoulder and your ear. Use a headset or other hands-free system to talk on the phone and avoid abusing your neck and spine.

Neck Pain Tips: Exercise your neck muscles

One of the best neck pain tips is using the chin tuck. You can do this often throughout the day. In addition to helping strengthen the muscles that hold the head in alignment over the shoulders, it also helps strengthen the scalene and sub-occipital muscles.

Read more tips here: Neck Pain Tips: Sleeping, Posture, Exercising, Hydration & Prevention

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Temed Holdings
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Q:
What is the best treatment for neck pain and shoulder Pain?
A:

One of the best treatment for neck pain and shoulder pain is exercises:

Neck Pain Exercises: Neck Extension

  1. To begin this neck pain exercise, sit up straight in a chair with your feet flat on the floor.
  2. Looking straight ahead, tuck your chin slightly (starting position)
  3. Place the palm of your hand on the back of your neck, at the base of your head
  4. Apply slight forward pressure with your hand, while resisting the forward motion of your neck and head
  5. Hold for a count of 5 and return to the starting position and relax
  6. Repeat the neck pain exercises 5-10 times

Neck pain exercises: Side bend

  1. Sit up straight in a chair with your feet flat on the floor.
  2. Looking straight ahead, tuck your chin slightly (starting position)
  3. Place your left hand, palm down, on the left side of your head (around your ear)
  4. Slightly push your head to the right side with your hand, while resisting the sideways motion of your neck and head
  5. Hold for a count of 5 and return to the starting position and relax.
  6. Repeat 5-10 times
  7. Repeat the neck pain exercises with the other side.

Neck pain exercises: Neck flexion

  1. Sit up straight in a chair with your feet flat on the floor.
  2. Looking straight ahead, tuck your chin slightly (starting position)
  3. Place the tips of your fingers on your forehead
  4. Slightly push your head backward with your fingers, while resisting the backward motion of your neck and head
  5. Hold for a count of 5 and return to the starting position and relax.
  6. Repeat the neck pain exercises 5-10 times

More exercises here: Neck Pain Exercises

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Temed Holdings
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Q:
How do I reduce the shoulder and neck pain?
A:

Here are some tips:

Neck Pain Tips: Sleep with a cervical pillow

Orthopedic or cervical pillows are made with special contours to support the space beneath the neck and head. They are also more concave for the head and provide more support to the neck.

Neck Pain Tips: Sleep on your back

The best position to lie to sleep is on your back. If you sleep on your stomach or on your side, make sure your pillow is not too thick. It should raise your head no more than 4 to 6 inches. This will keep your neck and head from turning to either side.

Neck Pain Tips: Position your computer screen at eye level

While you are working at a computer, sit comfortably in your chair with your computer in front of you. Close your eyes and then open them. When you open your eyes, you should see the middle of the computer screen. If your gaze is not in the middle of the screen, adjust the height of the screen using items like books.

To keep your head from gradually drifting forward, take frequent breaks to stretch. Getting up to walk around at least once every half-hour is one of the best neck pain tips.

Neck Pain Tips: Carry weight evenly

Many people make the mistake of carrying a heavy briefcase or their purse on their shoulder or on one side of their body. Doing this causes strain in the muscles and leads to pain.

Remove non-essentials from your briefcase or purse. Consider using a backpack to evenly distribute the weight across your shoulders. If you choose to carry a purse or backpack, keep your shoulders level while carrying it.

Neck Pain Tips: Maintain a proper posture

The most common posture contributing to neck pain is the “head-and-shoulders-forward” posture. In this position, the neck slopes forward, putting the head in front of the shoulders.

In this position, the head pulls the upper back forward also in a slumped position. This places a strain on the entire spinal column.

More tips here: Neck Pain Tips: Sleeping, Posture, Exercising, Hydration & Prevention

Read more
Temed Holdings
4 answers