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Spinal Stenosis: introduction
The spinal canal is like a tunnel which runs up and down the human spine. This canal sits directly behind the bony blocks which make up the spine (vertebrae) and contains the nerves (spinal cord and nerve roots) running from the brain to all areas of the body
When something causes a narrowing of this canal then the nerves can become irritated or squeezed. This can lead to a variety of symptoms ranging from tingling, numbness, and weakness to severe pain and paralysis. Common conditions which can narrow the spinal canal include a herniated disc (often called a slipped disc), fracture of the spine, tumor, infection and degeneration. A set of symptoms related to narrowing of the spinal canal seen with aging and degeneration is called spinal stenosis. The symptoms of spinal stenosis most commonly include a sensation of heaviness, weakness and pain with walking or prolonged standing. At rest these symptoms usually disappear. These symptoms are related to the irritation of the nerves in the spinal canal which is worsened with standing or walking due to mechanical compression or stretching of the nerves. Patients often complain of a gradual decrease in their ability to walk, requiring more frequent stops to rest their legs. The treatment for spinal stenosis is dependant on the severity of symptoms. Generally, aerobic activities like walking combined with a guided exercise program and weight loss (in overweight patients) is recommended first.
When there is no relief, some specialists recommend injection treatments although the effectiveness of this is limited. Surgery is indicated when symptoms are severe, progressive and a specific area of narrowing in the spinal canal has been discovered. The surgical procedure is aimed at freeing up the nerves in the canal by removing pieces of bone and thickened tissues such as the ligaments. A spinal fusion may also be necessary to stabilize the spine
Explanation:
The spine consists of a series of bone blocks (vertebral bodies) which are separated from one another by discs of soft tissue. Within the structure of the spine sits a tunnel called the spinal canal. This tunnel contains the neurologic structures including the spinal cord and nerve roots. Although there is some free space between the neurologic structures and the edges of the spinal canal, this space can be reduced by many different conditions including injury to the spine. The canal is surrounded by bone and ligaments and therefore can not expand if the spinal cord or nerves require more room. Therefore, if anything begins to narrow the spinal canal, there is risk for irritation or injury of the spinal cord or nerves. Conditions which can lead to narrowing of the spinal canal include infection, tumors, trauma, herniated disc, arthritis and degeneration.
Spinal stenosis refers to the condition of neurologic problems associated with narrowing of the spinal canal due to degenerative changes in the spine. Arthritis of the small joints in the spine (facets) as well as thickening of ligaments and formation of bony spurs can all lead to gradual squeezing and irritation of neurologic structures. This process is usually gradual and can lead to symptoms such as pain with walking, a decreased endurance for physical activities, heaviness in the legs, tingling sensations, tightness and numbness in the legs with activity, and often associated low back pains.
Treatment for spinal stenosis ranges from physical therapy to epidural injections and finally surgery in certain cases. Since patients affected by spinal stenosis are usually elderly, treatment must carefully consider not only the disease in the spine but also the risks and benefits of treatment in each individual. Although therapy and steroid injections into the affected area of the spine can offer good relief in some patients, there are people who will only get temporary relief if at all. In patients who have failed non-operative treatment, surgery can sometimes be considered. Prior to designing a treatment plan for any individual, careful diagnosis must be made. This will often involve tests such as an MRI, CT scan, or myelogram and plain X-rays. In those patients who are candidates for surgery, the goal is to free up the constricted regions of the spinal canal to ensure freeing the affected neurologic structures. Occasionally, in order to stabilize a degenerated part of the spine, a fusion will be performed. This involves laying down of bone over an area of the spine so that a solid block is created where there was previously arthritis with pain and an unstable spine.
Surgery for spinal stenosis has a high success rate in patients carefully selected for this procedure. It remains a useful approach in treatment when other options have been exhausted and after careful review of risks and benefits with the patient.
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