Spinal Stenosis

When one or more of the bony opening in the spine become narrowing, this might put the pressure on the nerves and spinal cord. This condition is called spinal stenosis, which occurs most often in the lower back and neck.

Signs and symptoms of spinal stenosis may not be detected in some people. Some people may have pain, have a slight pickling or stinging feeling, and lose sensation or feeling in a part of the body along with muscle weakness. Worse symptoms can occur over time.

The condition mostly occurs due to the degeneration of the spine in association with osteoarthritis, which is the state or process of loss of joint cartilages and underlying bones. In severe cases, patients may be recommended to have some surgeries to create spaces for the spinal cord or nerves.

What are the types of spinal stenosis?

Your doctor can determine the type of spinal stenosis from where it begins. You may have more than one type of spinal stenosis. There are two main types of spinal stenosis, such as:

• Cervical stenosis: This condition is also called cervical spinal stenosis, which the protective spinal canal in the neck is narrow.
• Lumbar stenosis: This condition is also called lumbar spinal stenosis, which is the most common form of spinal stenosis. The narrowing takes place in the part of the spine in your lower back.

What are the signs and symptoms of spinal stenosis?

Spinal stenosis can be detected by Magnetic Resonance Imaging (MRI) and Computerized Tomography (CT) scan although you don’t have symptoms. When it occurs, it often starts slow and gets worse over time. Symptoms can vary, which depends on where the stenosis is located and which nerves are involved.

When it occurs in your cervical spine:

• You have numbness or experience slight pickling or stinging sensation.
• Your hand, arm, feet and leg feel weak.
• You have problems with walking and balance.
• You have neck pain.
• In severe cases, you will have bowel or bladder dysfunctions. A patient may be urged to urine

When it occurs in the lumbar spine:

• You experience the loss of sensation and feelings or slight pickling or stinging sensation.
• Your foot or leg feels weakness.
• You feel the pain or cramping in one or both legs when standing in longer hours or walking. This pain or cramping can be gone when walking and then bend over.
• You have back pain.
• You can walk only a short distance, e.g. 50-150 meter. And you have to sit and rest for a while before you can start to walk again.

When to see a doctor:

If signs and symptoms above occur to you, you are advised to meet your doctor.

What are the causes of spinal stenosis?

Causes of spinal stenosis can vary, including:

• Overgrowth of bone: Damages from the loss of joint cartilages and underlying bones cause the formation of bony projections that are developed along with bone edges. They can grow into the spinal canal. Bone overgrowth in the spine mostly occurs in the old people.
• Herniated discs: The discs that cushion between your vertebrae gradually dry out when you get older. Cracks in the exterior of these soft cushions cause the escape of soft materials inside them and then press on the spinal cord or nerves.
• Ligaments that become thicker: These tough cords can become thickened and stiff overtime after serving their purposes of holding the bones of your spine together for years. They can bulge into the spinal canal.
• Tumours: Tumors can form inside the spinal cord, especially in the membranes that cover the cord. The abnormal growths can also form in the space between the spinal cord and vertebrae. These growths are uncommon, and they can be detected with an MRI or CT scan.
• Spinal injuries: Accidents, as well as other trauma, can result in either dislocation or fractures of vertebrae. The dislocated bone may cause damages to the contents of the spinal canal. Swelling of adjacent tissue following back surgery can also press the spinal cord or nerves.

What are the risk factors of having spinal stenosis?

Spinal stenosis occurs mostly with those who are over 50 years of age. The condition can occur in younger people, largely due to degenerative changes. More causes need to be considered. More causes include trauma, deformity of the spine since birth such as scoliosis, and a genetic disease that affects bones as well as muscle development of the body. Spinal imaging studies such as MRI or CT scan can discriminate these causes.

What are the complications of having spinal stenosis? 

If you have spinal stenosis and you do not treat it, the condition can be progressive and get severe. Without treatment in time:

• You may have permanent numbness.
• Your body may be permanently weak.
• You may have balance problems permanently.
• You may have permanent incontinence.
• You may have permanent paralysis.

How do your doctors diagnose your condition?

During the diagnosis, your doctor may ask a series of question to find out signs and symptoms of spinal stenosis. Your doctor may also discuss your medical history as well as conducting a physical examination. Various imaging tests may be selected to identify the cause of those signs and symptoms.

Imaging tests:

Your doctor may advise you to undergo the following imaging tests:

• X-ray: This imaging study can show if there are changes on bones; for instance, bone spurs may narrow the space in the spinal canal. In this test, you have to be exposed to radiation.
• MRI: This test utilizes a powerful magnet and radio waves to manufacture images of your spine. They are cross-functional ones. From the test, damages of your discs and ligaments can be detected if any. It can detect tumours as well. Moreover, the spinal cord that is being pressured can be shown through this test results.
• CT scan or CT myelogram: If an MRI does not work for you, computerized tomography (CT) may be recommended. It is the test that combines X-ray images that are taken from various angles to manufacture detailed and cross-sectional images of your body. Within the CT myelogram, the CT scan is operated following the injection of a contrast dye. The dye maps the spinal cord as well as nerves. The test can also show herniated discs, bone spurs and abnormal growths of cells.

What are the treatments for spinal stenosis?

Spinal stenosis surgery:

Your doctor will suggest which treatments are the best for you after determining where the stenosis occurs and what the severity of the stenosis is.

Medications:
The following medicines may be described by your doctor is you have the stenosis:

• Pain relievers: Ibuprofen, naproxen, and acetaminophen are the pain medications that doctors may temporarily use to alleviate the discomfort of spinal stenosis. There is not enough research to confirm the benefit of the long-term use of these medicines.
• Anti-depressants: Anti-depressants such as amitriptyline may be prescribed to ease chronic pain.
• Anti-seizure drugs: Some medicines that are used against seizure such as gabapentin and pregabalin are sometimes prescribed to alleviate the pain that is caused by the damaged nerves.
• Opioids: Oxycodone and hydrocodone that contain codeine may be described as temporary and short-term pain. At the same, your doctor may cautiously consider using them for long-term treatment as they carry the risk of serious side effects.

Physical therapy: 
If you have spinal stenosis, you will become less active as well, because you do not want to feel some pain. If this becomes a long-term habit, your muscles will get weak, which can result in more pain. To improve the health of your muscles, your therapist will teach you to do some exercises, which may help:

• Strengthen your muscles and build up endurance.
• Keep your spine flexible and stable.
• Boost your balance

Steroid injections:
When being pinched, your nerve roots may be irritated and swollen. However, steroid medication or corticosteroid in the space around impingement can help alleviate inflammation and reduce some pain. Bear in mind that steroid injection does not always work for everyone. The injection can only be done a few times a year as it can weaken bones and tissues nearby.

Decompression procedure:
Your doctor uses needle-like instruments to get rid of a portion of the dense ligament of the spinal column, especially in the back of it. This procedure helps increase the space in the spinal canal as well as removing nerve root impingement. If you have lumbar spinal stenosis and thickened ligament, your doctor will advise you to opt for this method. This procedure for lumbar spinal stenosis is also called percutaneous image-guided lumbar decompression (PILD) or minimally invasive lumbar decompression (MILD). However, doctors often adopt terms PILD to avoid confusion with MILD. Doctors may also use PILD as an option for patients with high surgical risks due to other medical problems. Doctors also perform this procedure with no general anesthesia.

Surgery:

If other treatments do not work for you and they cause the loss of your ability to carry on your activities, your doctor may advise you to undergo surgery. The purpose of having a surgery is to alleviate the pressure on your spinal cord or nerve roots by freeing more space in the spinal canal. Surgery seems to be used in a defined way that doctors use to alleviate to resolve the symptoms of the stenosis. In this connection, surgical procedure is also one of those surgeries that your doctor will use to treat your stenosis:

• Laminectomy: Your doctor may use laminectomy to remove the lamina, which is the back part of the affected vertebra. This procedure is sometimes called decompression surgery as it alleviates the pressure on the nerves through the more space that is created around them. Some cases require vertebra to be connected with adjoining vertebrae with the utilization of metal hardware and bone graft, which is also called spinal fusion, to maintain the strength in the spine.
• Laminotomy: Your doctor may use this procedure to remove a portion of the lamina. Your doctor carves a hole that is big enough to alleviate the pressure in a spot.
• Laminoplasty: Your doctor performs this procedure on the cervical spine or the vertebrae in the neck. The space within the spinal canal will be created with a hinge on the lamina. Your doctor then uses metal hardware to bridge the gap in the section that is opened in the spine.
• Minimally invasive surgery: Your doctor may use this approach to remove bone or lamina to reduce the damage to healthy tissue nearby. With this procedure, there is no need to do fusions. Fusions help stabilize the spine as well as reducing pain. However, the risks of having post-surgical pain and inflammation as well as diseases in sections of the spine nearby can be reduced by avoiding the fusions. Also, patients who opt for a minimally invasive approach to surgery is likely to get better faster.

These operations to create spaces in the spine help most cases to reduce the symptoms of spinal stenosis. However, some cases may get worst or remain the same after the surgery. Moreover, infections, a torn membrane that covers the spinal cord, a clot in the blood in a leg vein as well as the deterioration or death of the neurons, which is also called nerve damage.

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