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Spinal Stenosis is a narrowing of the spaces in the spinal column
that causes compression of the spinal cord and/or nerve roots.
There are many causes. Any condition that involves structural
changes or inflammation of the spine may cause compression of the
spinal cord or nerve roots. *Compression of a nerve is often referred to
as a "pinched nerve."
The spinal cord (a bundle of nerves) is protected
by the vertebral column (spinal column). The spinal canal refers
to the space in the vertebral column for the spinal cord and its
nerve roots. Nerve roots exit the spinal cord through small openings
between each vertebra.
More than one area on the spine may be affected. Symptoms depend
upon what area or areas of the spine are affected. There may be
back pain and/or there may be pain, numbness, weakness, and cramping
in the legs (when the lower spine is affected) or arms (when the
neck area is affected). Symptoms often develop gradually.
Causes
Though the causes vary, this condition is most commonly
caused by gradual degenerative changes in the spine that occur
with aging. Spinal stenosis is most common in people over age
50. With age, bones and ligaments may thicken and disks between
the vertebrae become thinner and may bulge. These structural changes
may result in a narrowing of the spinal canal.
A major cause of progressive degenerative changes in the spine
is osteoarthritis. In advanced
osteoarthritis, bone spurs (bony growths) may form on the spinal
joints and compress nerve roots. There may be inflammation in advanced
osteoarthritis of the spine, narrowing the spinal canal.
An injury, scoliosis, a congenital narrow spinal canal, and a
host of other conditions may also result in spinal stenosis. Scoliosis, an
abnormal side-to-side curvature of the back, may cause compression
of the spinal cord or nerve roots if the curve is severe.
A fracture of a vertebra can cause a piece of bone to chip off
and protrude into the spinal canal. A vertebral fracture or vertebral
degeneration may also result in one vertebra slipping over another
(spondylolisthesis) and the misaligned vertebrae may protrude into
the spinal canal.
Symptoms
The lower back (lumbar spine) is the area of the spine most commonly
affected by spinal stenosis. Pressure on a nerve root (a "pinched
nerve") in the lower spine may result in sciatica.
Sciatica refers to pain along the sciatic nerve - pain that often
radiates from the back, hip, or buttocks down the back of the leg
and is often accompanied by numbness, tingling, or weakness in the
leg and sometimes the foot.
People with spinal stenosis in the lower spine often find that
leaning forward while walking or lying with knees drawn up relieves
the symptoms. This is because bending forward enlarges the spaces
between the vertebrae and relieves pressure on the nerve roots.
If stenosis occurs in the neck area, there may be neck and shoulder
pain. It may cause headaches - usually at the back of the head.
There may also be numbness, weakness and tingling in the arms or
hands and sometimes legs. It can also affect balance and cause
an unsteady gait.
In severe cases, nerves to the bladder or bowel may be affected.
A loss of bladder or bowel control warrants immediate
medical attention.
Because the symptoms of spinal stenosis can be caused by other
conditions, an MRI, CAT scan, or special x-ray may be required for
a diagnosis.
Treatment
Treatment involves treating the pain, any inflammation, and
the condition that is causing the stenosis. If conservative treatment
does not bring relief or there is severe neurological impairment
surgery may be necessary.
If symptoms are mild, over-the-counter pain and anti-inflammatory
medications may help relieve the pain. In cases of severe pain,
a physician may prescribe stronger pain medications.
Back Exercises are
usually recommended. A physician should always
be consulted before staring an exercise program. Activities
may have to be restricted if there is severe neurological impairment.
Do not do too much too soon to avoid injury.
Exercises
to strengthen the muscles that support the spine (back and abdominal
muscles) and stretch back muscles help to keep the spine
in good alignment. Shortened muscles in the lower back increase
the curve in the lower back and decrease space between the vertebrae,
causing more pressure on the nerve roots.
Aerobic exercises increase
circulation and help keep the spine healthy. Low-impact
aerobic exercises such as swimming, walking, using elliptical
trainers or stationary exercise bikes are easy on the joints.
Riding a stationary exercise bike may be preferable to walking
as the bent over position increases the space between the vertebrae
in the lower back to take pressure off nerve roots.
Some people find pain relief using complementary
treatments for pain
such as acupuncture, hydrotherapy, and TENS.
An epidural steroid injection, an injection of corticosteroids (powerful anti-inflammatory medication) and a local anesthetic into the epidural space (the space between the membranes covering the spinal cord and the wall of the spinal canal) may provide weeks to months of relief. The number of injections is limited due to potential side effects. Many people are frightened of corticosteroids, as they know of people who have had serious side effects from the long-term use of oral steroids such as prednisone. A local injection ensures a high dose of steroids are received where most needed while only a small amount of medication is absorbed into the blood stream. There are rare but serious risks involved with the injection itself.
The symptoms of spinal stenosis may worsen over time. If the pain
becomes severe and chronic and conservative treatment does not provide
relief, surgery may be recommended. Most surgery for spinal stenosis
is elective surgery.
*If there great difficulty in walking or there is a sudden loss
of bladder or bowel function, emergency surgery may be necessary
to relieve the pressure on the spinal cord or nerves and avoid permanent
nerve damage. Fortunately, this is a rare occurrence.
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