What is Spinal Stenosis?
Spinal stenosis is a disorder that develops when the spinal canal becomes narrow. This happens as the facet joints and the intervertebral discs begin to degenerate over time. In this condition, osteophytes or better know as bone spurs grow into the spinal canal area. The facet joints also increase in size due to arthritis, which reduces the space available for the nerve roots. This condition is commonly known as facet arthropathy.
Different types of spinal stenosis
The spinal column ligaments such as the ligamentum flavum, become rigid, thicker with age, and less flexible. These changes narrow the spinal canal and may begin to put pressure on the nerve roots and the delicate spinal cord, creating the symptoms for spinal stenosis.
Central Stenosis is when stenosis occurs in the central spinal canal. This where the spinal cord or cauda equina are located, in the tract where the nerve root exits the central canal (lateral recess stenosis), or in the lateral foramen (foraminal stenosis) where the individual nerve roots exit out to the body.
Almost every person as they age will have some changes to their spinal canal, but the severity of the symptoms will greatly depend on the size of a person’s spinal canal and the impingement on the nerves. The deterioration rate varies greatly for each person, and only some will feel pain or weakness.
There are a number of processes that decrease the amount of space in the spinal canal available for the nerves. Spinal Stenosis can happen in individuals who were born with a smaller than normal spinal canal, known as congenital stenosis or have rare conditions such as tumors and metabolic conditions. Degenerative causes are usually the most common.
What Are Spinal Stenosis symptoms?
There is a significant amount of debate and medical research as to reasons why stenosis causes weakness and pain. Pain in the leg or buttocks is a common symptom of lumbar spinal stenosis. This may be associated with the compression of the microvascular structures carrying blood flow to the nerve roots. The symptoms of spinal stenosis may also be the direct result of the nerve roots being compressed. This compression may disrupt the normal function of the nerve roots and decrease the effectiveness and endurance of the spinal nerves.
Degenerative disease of the spine may have no symptoms at all for some people. Some patients may complain of mild discomfort in the lower back, and in certain cases others may not even be able to walk. If you significant spinal stenosis, you may notice pain in the buttocks, thigh or leg that develops with walking or simply standing, and only improves with rest. In certain cases, a person will complain of leg pain and weakness without having any back pain.
Severe symptoms of Spinal Stenosis include:
- numbness
- tingling
- weakness in the lower extremities.
Changing positions can help alleviate the symptoms of spinal stenosis as this increases the amount of space available for the nerves. These positions usually involve bending of the lower spine and bending forward. This is known as flexion. Most people with spinal stenosis can ride a bike and walk up an incline or flight of stairs without feeling any pain. However, if they are walking down an incline or flight of stairs, the symptoms will often reappear. The severity of the symptoms of spinal stenosis depends on certain factors, including the original width of the spinal canal, the susceptibility of the nerves involved, the pain tolerance of the individual and the unique functional demands of the person.
How is Spinal Stenosis Diagnosed?
A complete medical history and physical examination initiates the diagnosis of spinal stenosis. Your physician will determine what symptoms are present, what makes these symptoms better or worse, and how long the symptoms have been present. A physical examination is critical to determine the severity of the condition and whether or not the body is suffering from weakness or numbness in certain parts of the body. A neurological examination provides the most objective evidence of chronic nerve root compression caused by spinal stenosis. The examination is also used to rule out other conditions such as diabetes or hip and knee arthritis.
There are no lab tests that will detect stenosis, but they can be helpful in the diagnosis of unusual causes of nerve root and spinal cord dysfunction. MRI or CT scanning can be used to visualize the spinal canal where the nerves live and determine the degree of narrowing as well as rule out other causes.
What treatment options are available for Spinal Stenosis?
Treatments will vary depending on the severity of your symptoms and how much they limit daily activities. Depending on your level of pain, treatment options include:
Non-surgical treatments – For mild to moderate pain, more conservative treatment methods can include OTC or prescription medications, physical therapy, and steroid injections.
Minimally invasive spine surgery – For pain that is moderate to severe, decompression can be achieved through less invasive surgical procedures like interspinous spacers.
Traditional Spine Surgery – For pain that is moderate to severe, a spinal fusion and decompression can be considered when more conservative treatments aren’t successful.
