Spinal Stenosis

Definition
Spinal stenosis is a narrowing of the lumbar (back) or cervical (neck) spinal canal, which causes compression of the nerve roots.This can cause weakness in your extremities as narrowing often results in pressure on the spinal cord and/or nerves. Spinal stenosis can occur in a variety of ways in the spine. Most cases of spinal stenosis occur in the lower back (lumbar spine) and will affect the sciatic nerve, which runs along the back of the leg.

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The most commonly referred to types of this condition are: lumbar spinal stenosis, occurring in the lower back, and cervical spinal stenosis which occurs in the neck. As mentioned previously, the condition more commonly occurs in the lower back.

Causes
Spinal stenosis mainly affects middle-aged or elderly people. It may be caused by osteoarthritis or Paget’s disease or by an injury that causes pressure on the nerve roots or the spinal cord itself.

The three major causes of spinal stenosis are:

Aging – With age, the body’s ligaments (tough connective tissues between the bones in the spine) can thicken. Spurs (small growths) may develop on the bones and into the spinal canal. The cushioning discs between the vertebrae may begin to deteriorate. The facet joints (flat surfaces on each vertebra that form the spinal column) also may begin to thicken. Aging, coupled with secondary changes, is the most common cause of spinal stenosis. Heredity – if the spinal canal is too small at birth, symptoms of spinal stenosis may show in a relatively young person. Structural deformities of the involved vertebrae can cause narrowing of the spinal canal.

Tumors of the spine – Abnormal growths of soft tissue that may affect the spinal canal directly by inflammation or by growth of tissue into the canal. Tissue growth may lead to bone resorption (bone loss due to over activity of certain bone cells) or displacement of bone and the eventual collapse of the supporting framework of the spinal column.

Trauma – accidents and injuries may either dislocate the spine and the spinal canal or cause burst fractures that produce fragments of bone that penetrate the canal.

Paget’s disease of bone – This chronic (long-term) disorder usually results in enlarged and deformed bones. The disease can affect any bone of the body, but is often found in the spine.
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Blood supply – The blood supply that feeds healthy nerve tissue may be diverted to the area of involved bone.

Fluorosis – An excessive level of fluoride in the body. It may result from chronic inhalation of industrial dusts or gases contaminated with fluorides, prolonged ingestion of water containing large amounts of fluorides, or accidental ingestion of fluoride-containing insecticides. The condition may lead to calcified spinal ligaments or softened bones and to degenerative conditions like spinal stenosis.

Symptoms

* Back pain that spreads to the legs
* Difficulty or imbalance when walking
* Leg pain
* Neck pain
* Numbness in the buttocks, thighs, or calves that is worse with standing, walking, or exercise
* Pain in the buttocks, thighs, or calves that is worse with walking or exercise
* Weakness of the legs

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 legs. Compressed 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 (vascular 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 pain. A 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 shoulders. This is likely to occur when the nerves in your neck (cervical spine) 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 (cauda equina syndrome). 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.

Risk factors

Age is the main known risk factor for spinal stenosis. Your risk of this condition increases after age 50.

Also at risk are people with skeletal fluorosis, a sometimes crippling bone disease caused by high levels of fluoride in the body. Although the disease is rare in the United States, several million people worldwide have severe skeletal fluorosis.

Diagnosis
Spinal stenosis can be difficult to diagnose because its signs and symptoms are often intermittent and because they resemble those of many age-related conditions. To help diagnose spinal stenosis and rule out other disorders, your doctor will ask about your medical history and perform a physical exam that may include checking your peripheral pulses, range of motion and leg reflexes.

You’re also likely to have one or more of the following tests:

* Spinal X-ray. Although an X-ray isn’t likely to confirm that you have spinal stenosis, it can help rule out problems that cause similar symptoms, including a fracture, bone tumor or inherited defect.
* Magnetic resonance imaging (MRI). In many cases, this is the imaging test of choice for diagnosing spinal stenosis. Instead of X-rays, an MRI uses a powerful magnet and radio waves to produce cross-sectional images of your back. The test can detect damage to your disks and ligaments, as well as the presence of tumors.
* Computerized tomography (CT) scan. This test uses a narrow beam of radiation to produce detailed, cross-sectional images of your body, including the shape and size of your spinal canal. Because you receive more radiation from a CT scan than from a regular X-ray, you should avoid this test if you’re pregnant.
* CT myelogram. This may be the most sensitive test for detecting spinal stenosis, but because it poses more risks than either MRI or CT, it may not be your doctor’s first choice. If you’re contemplating surgery, however, your doctor may recommend a CT myelogram to assess the severity of the stenosis. In a myelogram, a contrast dye is injected in your spinal column. The dye then circulates around your spinal cord and spinal nerves. A myelogram can show herniated disks, bone spurs and tumors.
* Bone scan. In this test, a small amount of a radioactive material that attaches to bone is injected into a vein in your arm. The material emits waves of radiation that are detected by a gamma camera. The camera then produces images of your bones. In a sense, a bone scan is the opposite of a standard X-ray, in which radiation passes through your body to create an image on film. A bone scan can detect a number of bone disorders, but often can’t distinguish among them. For that reason, it’s usually performed with other tests.
* Other diagnostic procedures. Sometimes your doctor may inject you with a spinal nerve block or epidural steroids. If your symptoms improve after the injection, spinal stenosis is likely the cause of your discomfort. The problem with this approach is that a negative finding doesn’t mean you don’t have spinal stenosis.

Treatment
Generally, conservative management is encouraged. This involves the use of anti-inflammatory medications, other pain relievers, and possibly steroid injections. If the pain is persistent and does not respond to these measures, surgery is considered to relieve the pressure on the nerves.

Surgery is performed on the neck or lower back, depending on the site of the nerve compression.

The recommended treatment for spinal stenosis is generally open back surgery with high risks, hospital stays and lengthy recuperation time. Laser-assisted surgical procedures can correct the causes of spinal stenosis and relieve painful symptoms. These procedures are called a Foraminotomy or a Laminotomy. These laser spine procedures will remove the portion of the disc or bone spur that is pressing against a nerve causing the symptoms of spinal stenosis. By removing or shrinking the disc with the laser and removing any bone spurs, we can decompress the spinal cord or nerve root that is being impinged. At this point, excess disc material is removed and the symptoms of spinal stenosis typically disappear

Complications of spinal stenosis may include:

* Loss of feeling. Depending on which nerves are compressed, spinal stenosis may cause a loss of feeling in your arms, hands, feet or legs. As a result, cuts or wounds may become seriously infected because you’re not aware of them.
* Loss of bladder or bowel control. In addition, spinal stenosis sometimes interferes with bowel or bladder function — a problem that can affect your quality of life.
* Degenerative changes. Although treatment can relieve symptoms of spinal stenosis, it doesn’t stop degenerative changes. Some of these changes, such as muscle atrophy, may be permanent, even after the pressure is relieved.

Other Complications:Injury can occur to the legs or feet due to lack of sensation. Infections may get worse because pain related to them may not be felt. Changes caused by nerve compression may be permanent, even if the pressure is relieved.

When to Contact a Medical Professional

Call your health care provider if you have symptoms of spinal stenosis.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000441.htm#Definition
http://www.laserspineinstitute.com/back_problems/spinal_stenosis/
http://www.mayoclinic.com/health/spinal-stenosis/