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Spinal Stenosis
Spinal Stenosis is a general term denoting narrowing of the spinal canal in the lumbar area leading to nerve root compromise. The term is often used to describe a developmental abnormality that leaves a narrow, bony canal. Spinal stenosis usually develops gradually over years, and is the most common spinal condition leading to surgery in people over the age of 60. Some patients are predisposed to problems as they are born with a relatively small spinal canal. This is referred to as congenital spinal stenosis.
Causes
The pressure on the nerves can be caused by gradual wear and tear changes about the spine, including:
- Disc degeneration and bulging
- Thickening of the surrounding ligaments and joints called the facet joints, called the ligamentum flavum
- Osteoarthritis
- Hypertrophy or enlargement of the facet joints
- Bone spurs
- Disc herniations
- Tumors
- Buckling of ligaments inside the spinal canal
- Fractures, when a piece of bone displaces into the spinal canal
Symptoms
- Symptoms can include
- Back pain sometimes radiating to the legs
- Numbness
- Weakness and
- Difficulty walking
- If severe enough can result potentially in bowel or bladder dysfunction as well as sexual dysfunction in males
Diagnosis
The diagnosis of spinal stenosis begins with a complete history and physical examination. The doctor will determine what symptoms are present, what makes them better or worse, and how long they have been present. A physical examination is essential for determining how severe the condition is, and whether or not it is causing weakness or numbness in certain parts of the body. Abnormalities in the strength and sensation of particular parts of the body that are found with a neurological examination provide the most objective evidence of chronic nerve root compression caused by spinal stenosis.
There are no laboratory tests that can detect the presence or absence of a stenosis, but they may be helpful in the diagnosis of unusual causes of nerve root and spinal cord dysfunction.
Additional diagnostics include:
Routine radiographs of the lumbar spine are very helpful in determining the amount of degeneration that is present in the spine, which gives an indirect indication of whether or not spinal stenosis is present. These x-rays are also used to determine if certain parts of the spine are unstable, which may be contributing to the symptoms of stenosis.
A CT scan (CAT scan) provides excellent visualization of the bony anatomy of the spinal column and is an indispensable tool for determining where the stenosis is located. This test is often performed in conjunction with a myelogram, which involves injecting dye into the space occupied by the spinal cord and nerve roots, in order to determine how well the cerebrospinal fluid is able to travel along the nerve roots.
An EMG or electromyographic test may help to determine which nerve root in particular is not working normally in the situation where several nerve roots may be involved.
Treatment
For treatment, the initial non-operative approach may be physical therapy; most back problems respond to nonsurgical treatments, such as anti-inflammatory medication, ice, heat, gentle massage or physical therapy.
When non-operative treatments don't help, surgery may offer relief, but it doesn't help every type of back pain. In fact, back surgery is needed only a small percentage of the time.
For patients with persistent pain, a decompressive lumbar laminectomy may be recommended to remove portions of the damaged bone, joints, and ligaments that are pressing on nerve roots. Many people can leave the hospital the day after the procedure.
