...less medical jargon in a 'Quick Glance' format!
Spinal Stenosis is a narrowing of one or more areas in your spine — most often in your upper or lower back. This narrowing can put pressure on your spinal cord or on the nerves that branch out from the compressed areas.
This disease can cause cramping, pain or numbness in your legs, back, neck, shoulders or arms; a loss of sensation in your extremities; and sometimes problems with bladder or bowel function. Spinal stenosis is most commonly caused by osteoarthritis-related bone damage.
Mild symptoms of spinal stenosis are often helped by pain relievers, physical therapy or a supportive brace. In more serious cases of spinal stenosis, doctors may recommend surgery.
Symptoms:
Spinal narrowing doesn't always cause problems. But if the narrowed areas compress the spinal cord or spinal nerves, you're likely to develop signs and symptoms. These often start gradually and grow worse over time. The most common spinal stenosis symptoms include:
Pain or cramping in your legsCompressed nerves in your lower (lumbar) spine can lead to a condition called pseudoclaudication, false claudication or neurogenic intermittent claudication, which causes pain or cramping in your legs when you stand for long periods of time or when you walk. The discomfort usually eases when you bend forward or sit down, but it persists if you continue to stand upright.
Another type of intermittent claudication occurs when there's a narrowing or blockage in the arteries in your legs.
Although both types of claudication cause similar symptoms, they differ in two important ways: Vascular claudication becomes worse when you walk uphill and improves when you stand still. Pseudoclaudication is usually worse when going downhill and gets better when you lean forward or sit down.
Radiating back and hip painA herniated disk can narrow your spinal canal and compress nerves in your lumbar spine, leading to pain that starts in your hip or buttocks and extends down the back of your leg. The pain is worse when you're sitting and generally affects only one side.
You may also experience numbness, weakness or tingling in your leg or foot. For some people, the radiating pain is a minor annoyance, but for others, it can be debilitating.
Pain in your neck and shouldersThis is likely to occur when the nerves in your neck are compressed. The pain may occur only occasionally or it may be chronic, and it sometimes can extend into your arm or hand. In addition, the spinal cord is sometimes compressed, which can result in lower extremity weakness and difficulty walking. You also may experience headaches, a loss of sensation or muscle weakness.
Loss of balance Pressure on the cervical spinal cord can affect the nerves that control your balance, resulting in clumsiness or a tendency to fall.
Loss of bowel or bladder function In severe cases, nerves to your bladder or bowel may be affected, leading to partial or complete urinary or fecal incontinence. If you experience either of these problems, seek medical care right away.
Causes:
Knowing more about the anatomy of your spine makes it easier to understand how spinal stenosis develops and how it can lead to various problems. The main parts of your spine include:
Vertebrae Your spine is made up of 24 bones stacked on top of one another, plus the sacrum and tailbone. Most adults have seven vertebrae in the neck, 12 at the back wall of the chest and five vertebrae at the inward curve of the lower back. The sacrum consists of five fused vertebrae between the hip bones. The tailbone is composed of three to five fused bones at the very end of the spine.
Ligaments These tough, elastic bands of tissue help keep the vertebrae in place when you move.
Intervertebral disks These elastic pads of cartilage separate the vertebrae. They keep your spine flexible and act as shock absorbers to cushion the vertebrae when you move. Each disk consists of a ring of tough fibrous tissue surrounding a jelly-like center.
Facet joints Located on the sides, top and bottom of each vertebra, these joints connect the vertebrae to one another and stabilize the spine while still allowing flexibility. The joints are coated with a lubricant so that they slide smoothly.
Spinal cord This long bundle of nerves extends from the brainstem at the base of your skull to the second lumbar vertebra in your lower back. When the spinal cord ends, another group of nerves continues down the spinal canal. The nerves within the spinal cord carry messages between your brain and the nerves that go to all the parts of your body below your head. Two spinal nerves — one leading to the right side of your body and one to the left side — extend out from the spinal cord between each vertebra. The nerves exit through openings on each side of the vertebrae. In all, there are 31 pairs of spinal nerves in your neck and back. Some transmit information from your body to your brain, and others send messages from your brain to your muscles, skin and other organs.
Spinal canal The spinal cord passes through this channel in your spine. Normally, the spinal canal is spacious enough to accommodate the spinal cord, but degenerative changes in the spine can narrow the channel.
. . . How spinal stenosis develops
Doctors categorize spinal stenosis as either primary or acquired:
Primary spinal stenosis which is relatively uncommon, is present at birth.
Acquired spinal stenosis which is the type that most people have, develops later in life. It's usually a result of degenerative changes in the spine that occur with aging.
The main cause of spinal stenosis is the degeneration of the spine due to osteoarthritis, an arthritic condition that affects the cartilage that cushions the ends of bones in your joints. With time, the cartilage begins to deteriorate and its smooth surface becomes rough. If it wears down completely, bone may rub painfully on bone. In an attempt to repair the damage, your body may produce bony growths called bone spurs. When these form on the facet joints in the spine, they narrow the spinal canal.
Other factors that can cause a narrowing of the spinal canal include:
Herniated disk By the time you're 30, your disks may start to show signs of deterioration. They begin to lose their water content, becoming flatter and more brittle. Eventually, the tough, fibrous outer covering of the disk may develop tiny tears, causing the jelly-like substance in the disk's center to seep out. The herniated disk presses on the surrounding nerves, causing pain in your back, leg or both. Sometimes you may also have numbness, tingling or weakness in the buttock, leg or foot on the affected side.
Ligament changes Ligaments in your back can undergo degenerative changes, becoming stiff and thick over time. This loss of elasticity may shorten your spine, narrowing the spinal canal and compressing the nerve roots. Sometimes wear and tear on the disks and ligaments cause one lumbar vertebra to slip over another — a condition called spondylolisthesis. This often compresses the spinal nerves, leading to numbness, tingling and weakness in your legs, especially when you stand for long periods or when you walk.
Spinal tumors In the spine, abnormal growths can form inside your spinal cord, within the membranes that cover your spinal cord, or in the space between your spinal cord and the vertebrae — the most common site. Tumors may also spread to your spine or your spinal cord from other parts of your body. Primary or metastastic tumors can occur anywhere along your spine, including the sacrum and thoracic spine, where osteoarthritis is rare. Growing tumors may compress your spinal cord and nerve roots. This can cause severe back pain that may extend to your hips, legs or feet; muscle weakness and a loss of sensation — especially in your legs; difficulty walking or even paralysis; and sometimes loss of bladder or bowel function.
Injury Car accidents and other trauma can profoundly affect your spine and spinal cord. Sometimes your spine or spinal canal may be dislocated, putting pressure on the cord and lower motor neurons. In other cases, fragments of bone from a spinal fracture may penetrate your spinal canal. Swelling of tissue after back surgery also can put pressure on your spinal cord or nerves.
Paget disease of bone Bone is living tissue engaged in a continuous process of renewal. During this remodeling process, old bone is removed and replaced by new bone. In Paget disease, your body generates new bone at a faster than normal rate. This produces soft, weak bones that are prone to fractures. It can also create bones that are deformed or abnormally large. When these unusually large bones develop in your spine, they compress the spinal cord or the nerves exiting your brain and spinal cord. The resulting pain is often severe and may radiate from your lower back into your legs. You may also experience numbness, tingling or weakness in the legs or, in some cases, double vision.
Achondroplasia This genetic disorder slows the rate at which bone forms during fetal development and in early childhood. As a result, people with achondroplasia are of short stature — often no more than 4 feet tall when fully grown. They often have small hands and fingers and unusually short upper arms and thighs. They also have a narrow spinal canal, which puts pressure on the spinal cord.
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Treatment:
Many people with spinal stenosis are effectively treated with conservative measures. But if you have disabling pain or your ability to walk is severely impaired, your doctor may recommend spinal surgery. Acute loss of bowel or bladder function is usually considered a medical emergency and requires immediate surgical intervention.
. . . Nonsurgical treatments
Before considering surgery for spinal stenosis, your doctor is likely to recommend trying one or more of the following for at least three months:
Physical therapy Working with a physical therapist can build up your strength and endurance and help maintain the flexibility and stability of your spine.
Nonsteroidal anti-inflammatory drugs (NSAIDs) These include over-the-counter and prescription medications, such as aspirin, ibuprofen (Advil, Motrin, others) or indomethacin (Indocin), to reduce inflammation and pain. Although they can provide real relief, NSAIDs have a "ceiling effect" — that is, there's a limit to how much pain they can control. If you have moderate to severe pain from spinal stenosis, exceeding the recommended dosage won't provide additional benefits. What's more, NSAIDs can cause serious side effects, including stomach ulcers that may bleed. If you take these medications, talk to your doctor so that you can be monitored for problems.
Analgesics This group of pain relievers includes acetaminophen (Tylenol, others). Analgesics don't reduce inflammation, but they can effectively treat pain. Yet chronic overuse of acetaminophen can cause kidney and liver damage. Drinking alcohol increases your risk of serious side effects.
Chondroitin sulfate and glucosamine These nonprescription supplements, used either alone or in combination, have shown positive effects on osteoarthritis. But it's not yet known whether they're effective at treating or preventing osteoarthritis of the spine. Talk to your doctor if you're interested in these supplements — they may interfere with other medications you're taking, especially warfarin (Coumadin).
Rest or restricted activity Moderate rest followed by a gradual return to activity may improve symptoms. Walking is usually the best exercise, especially for people with neurogenic claudication, but biking also is recommended because it keeps your back in a flexed position rather than in an extended one.
A back brace or corset This helps provide support and may especially benefit people who have weak abdominal muscles or degeneration in more than one area of the spine.
Epidural steroid injections In some cases, your doctor may inject a corticosteroid medication into the spinal fluid around your spinal cord and nerve roots. Corticosteroids suppress inflammation and can be especially helpful in treating pain that radiates down the back of your leg — in fact, a single dose may provide significant relief. But because corticosteroids can cause a number of serious side effects, the number of injections you can receive is limited, usually to no more than three in one year.
. . . Surgery
The goal of surgery for spinal stenosis is twofold: to relieve pressure on the spinal cord or nerves and to maintain the integrity and strength of your spine. This can be accomplished in several ways, depending on the cause of the problem. The most common surgical procedures include:
Decompressive laminectomy In this procedure, your surgeon removes all of the lamina — the back part of the bone over the spinal canal — to create more space for the nerves and to allow access to bone spurs or ruptured disks that may also be removed. A laminectomy is often performed through a single incision in your back, although in some cases, your surgeon may use a laparoscopic technique. In that case, a tiny camera and surgical instruments are inserted through several small incisions, and your surgeon views the operation on a video monitor. Laparoscopic back surgery is complex and requires great skill and is not appropriate for many people with spinal stenosis. When done properly, however, you're likely to have less pain and to recover from surgery more quickly with this technique. Risks of laminectomy include infection, a tear in the membrane that covers the spinal cord at the site of the surgery, bleeding, a blood clot in a leg vein, decreased intestinal function and neurological deterioration.
Laminotomy In this procedure, just a portion of the lamina is removed to relieve pressure or to allow access to a disk or bone spur that's pressing on a nerve. The risks are the same as for laminectomy.
Fusion This procedure may be performed on its own or at the same time as laminectomy. It's used to permanently connect two or more vertebral bones in your spine and may be especially indicated when one vertebra slips over another. To fuse the spine, small pieces of extra bone are needed to fill the space between two vertebrae. This may come from a bone bank or from your own body, usually your pelvic bone. Wires, rods, screws, metal cages or plates also may be used, especially if your spine is unstable or the operation takes place to correct a deformity.
Back surgery can relieve pressure in your spine, but it's not a cure-all spinal stenosis treatment. You may have considerable pain immediately after the operation, and you might continue to have pain for a period of time. For some people, recovery can take weeks or months and may require long-term physical therapy. What's more, surgery won't stop the degenerative process of spinal stenosis, and symptoms may return — sometimes within just a few years.
