Spinal Stenosis

Spinal_Stenosis

The term “Stenosis” comes from the Greek word meaning “Choking” and is known as degenerative conditions such as Osteoarthritis and/or degenerative Spondylolisthesis. Spinal Stenosis is a narrowing of the spaces within spine. It increases the pressure on the nerves that travel through the spine. Spinal stenosis occurs mostly in the lower back and the neck, it also causes restrictions to the spinal canal.

Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. In severe cases of spinal stenosis, doctors can recommend surgery to create additional space for the spinal cord or nerves.

Types of spinal stenosis:

The types of spinal stenosis are classified according to where on the spine the condition occurs. It’s possible to have more than one type. The two main types of spinal stenosis are as below:

• Cervical Stenosis-

Cervical Spine Stenosis also known as Cervical Stenosis. It occurs due to narrowing of neck’s protective spinal canal. The spinal canal of neck narrows because of degenerative changes. If the space within the spinal canal is reduced too much, neurologic deficits can result from spinal cord compression. This condition is called Myelopathy. Cervical stenosis with myelopathy is known as a cervical Spondylosis with Myelopathy or Cervical Spondylotic Myelopathy.

• Lumbar Stenosis.

In this condition, the narrowing occurs in the part of the spine in your lower back. It’s the most common form of Spinal Stenosis. Spine changes as our age increases. Spinal column in the combination of vertebrae, discs, muscles and ligaments. The degeneration of spinal column leads to Lumbar Stenosis.

Symptoms of Spinal Stenosis:

Many people have evidence of spinal stenosis on an MRI or CT scan but symptoms are not easily detected. When they do occur, they often start gradually and worsen over time. Symptoms vary depending on the location of the Stenosis and which nerves are affected. The normal symptoms are as below. Many people with Spinal stenosis do not show symptoms in early stage. Symptoms can become worst after a long time. Hence it is very necessary to start treatments as soon as possible.

In the neck (cervical spine):

• Numbness or tingling in a hand, arm, foot or leg

• Weakness in a hand, arm, foot or leg

• Problems with walking and balance

• Neck pain

• In severe cases, bowel or bladder dysfunction (urinary urgency and incontinence)

In the lower back (lumbar spine):

• Numbness or tingling in a foot or leg

• Weakness in a foot or leg

• Pain or cramping in one or both legs when you stand for long periods of time or when you walk, which usually eases when you bend forward or sit

• Back pain

Causes of Spinal Stenosis:

The backbone (spine) runs from neck to lower back. The bones of spine form a spinal canal, which protects your spinal cord (nerves).

Some people are born with a small spinal canal. But most spinal stenosis occurs when something happens to narrow the open space within the spine. Causes of spinal stenosis may include following things:

• Overgrowth of bone: Wear and tear damage from osteoarthritis on spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal. Paget’s disease, a bone disease that usually affects adults, also can cause bone overgrowth in the spine.

• Herniated disks: The soft cushions that act as shock absorbers between your vertebrae tend to dry out with age. It increases friction between two bones leading to degeneration of cracks in bones. Cracks in a disk’s exterior can cause the soft inner material to escape and press on the spinal cord or nerves. Due to extreme pressure on nerves, it starts malfunctioning and blocks the blood flows.

• Thickened ligaments: The tough cords help to hold bones of spine together. But as age increases, cords become stiff and thick day by day. This thickened ligaments can bulge in the spinal canal causing spinal stenosis.

• Spinal injuries: This is very common cause for Spinal Stenosis in human. Accidents causes damage to spinal cord leading to dislocation and fracture to vertebrae. The displaced bones from spinal fracture damage the parts of spinal canal. Swelling of nearby tissue immediately after back surgery also can put high pressure on the spinal cord or nerves finally leading to spinal stenosis.

• Tumors: Tumors are the collection of unwanted and abnormal cells. Abnormal growths can form inside the spinal cord, within the membranes that cover the spinal cord or in the space between the spinal cord and vertebrae. These are uncommon and identifiable on spine imaging with an MRI or CT. The doctors can easily find the tumor in spinal cord with the help of advanced technology.

Tests for spinal Stenosis:

• EMG: This machine is very useful in detecting Spinal stenosis. Electromyography ( EMG ) test helps to verify the health of muscles and nerves that control the muscles. This is one of the most advanced and successful test for detecting spinal stenosis.

• Spinal MRI:  This machine uses magnetic field and radio waves. MRI test is used to create pictures of the spine with the help of pulses of radio wave energy and magnetic field. In most of cases, MRI offers different information than X-rays, an ultrasound or CT Scan.

• Spinal CT scan: This is very common method of detecting spinal stenosis. Computed Tomography ( CT ) is a imaging method that uses X-rays to create cross sectional picture of the lower back.

• X-rays of the Spine: This is very common but not very effective method to find out spinal stenosis. This test is useful to take pictures of the spine to find injuries or diseases that have adverse effect on the discs or joints in your spine. X-rays method is very effective to find spinal fractures, tumors, infections, disc problems and bone spurs.

Treatments for Spinal Stenosis:

• Foraminotomy:

This surgery is very useful to widen opening in the back where nerve roots leave spinal canal. It reduces narrowing of the nerve opening.

• Laminectomy:

This surgery is used to take away the lamina, part of the bones that make up vertebrae or bone spurs in back. This process reduces pressure of spinal canal.

• Spinal Fusion:

This surgery is useful to join together two or more bones in the spine, so there is no movements between them.

Physical therapy:

It’s common for people who have spinal stenosis to become less active, in an effort to reduce pain. But that can lead to muscle weakness, which can result in more pain. A physical therapist can teach exercises that will be very useful after surgery as below.

• To build up strength and endurance.

• To maintain the flexibility and stability of spine.

• To improve balance while walking.