To conceptualize spinal stenosis a very basic understanding of spine anatomy is helpful.
Two key components of the spine are the individual vertebrae and the spinal cord. Vertebrae are the interlocking bony structures of the spine. The shape of vertebrae varies depending on which section of the back is being inspected. A common feature of vertebrae is a central canal, called the vertebral foramen. This is the area in which the spinal cord travels through. Lateral canals, or foramen, allow spinal nerves to branch out from the spinal cord and travel to various areas of the body. By surrounding the spinal cord, vertebrae provide physical protection to the spinal cord and serve the important function of transferring weight down the axis of the spine.
Intervertebral discs separate vertebrae from one another. These jelly like structures allow the spine to withstand trauma, and permit a limited range of motion. The intervertebral discs have a tough cartilaginous annulus fibrosus, and a jelly-like interior named the nucleus pulposus. The nucleus gives the intervertebral disc a shock absorbing capacity, while the annulus maintains the structural shape.
Vertebrae articulate with neighboring vertebrae through synovial joints (similar to joints in the knee or shoulder) called facet joints. The synovial joints reduce friction during movement and help to maintain vertebrae orientation to some degree.
Arthritic bone spurs narrow the spinal canal.
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There are a few types of spinal stenosis, but all stem from the narrowing of a canal that a nerve root or the spinal cord travel through. By narrowing the opening, increased pressure is put upon the nerve, resulting in pain, numbness, or weakness of muscle groups.
The primary forms of spinal stenosis are central stenosis, foraminal stenosis, and far lateral stenosis. Central stenosis is narrowing of the vertebral foramen, the central canal in which the spinal cord travels. Foraminal stenosis is a narrowing of the windows in the vertebrae that the spinal nerves travel through. Foraminal stenosis can also be caused by reactive bone formations in the spine, which are frequently caused by degenerative disc disease. Finally, far lateral stenosis is the compression of spinal nerves after they have passed through the spinal foramen. This may be caused by a herniated disc, or the formation of a reactive bone spur.
Spinal stenosis can happen in the neck (which contains cervical vertebrae) or the lower back (lumbar vertebrae). The location of the stenosis, including the type of stenosis, will dictate the symptoms.
As one ages the development of spinal stenosis is more common. Degenerative disc disease, which causes a thinning of the intervertebral discs, will narrow the foramen that spinal nerves exit through. Furthermore, higher stress will be placed upon the facet joints, causing bone spurs. Arthritis of the facet joints will also contribute to the formation of bone spurs.
Osteoporosis may contribute to the formation of spinal stenosis, as micro-fracturing of the vertebral bodies (large part of vertebrae that provides the platform for the intervertebral discs) can change the orientation of the vertebrae relative to one another. Instability of the spine, often caused by a lack of core muscle strength, also leaves patients at risk. Spondylolisthesis is the slipping of a vertebral body forward, which often constricts spinal foramen.
More macro-derived spinal stenosis is also possible. Risk factors include being overweight, smoking, maintaining poor posture, or suffering from arthritis. Hereditary factors can increase likelihood of suffering from spinal stenosis, as can repeated or acute trauma to the spine.
Symptoms of spinal stenosis usually have a gradual onset. Lumbar spinal stenosis often causes diffuse back pain, and pain in the buttocks and leg. Symptoms are similar to sciatica pains, which can be derived from spinal stenosis. Pain will often be triggered by certain movements or postures, and relieved by others. This is a good indication of pressure being exerted on spinal nerves.
Pain in the legs and buttocks is often accompanied by numbness and/or tingling sensations. In more extreme cases, foot drop and muscle weakness may be observed. In the event of symptoms of muscle weakness and foot drop, consult your physician immediately.
A cervical spinal stenosis is often characterized by more severe symptoms, and may include neck pain, arm pain and numbness, and occasionally difficulties controlling balance and bowel activities.
Spinal stenosis can be diagnosed by a physician through a few methods. A physical examination will often display acute pain during certain movements, and sensations will frequently be different in areas supplied by nerves that are affected by spinal stenosis.
If spinal stenosis is suspected, an X-Ray, MRI, or CAT scan will show definitively. All imaging at DISC is performed in house, providing patients a fast and accurate diagnosis with minimal stress or run around. In some circumstances a small amount of dye will be injected to show the exact location of stenosis. This procedure is called a myelopathy.
There are a variety of treatments for spinal stenosis. Therapies are tailored to the source of pain.
Many symptoms are manageable using non-surgical strategies. Physical therapy, such as soft tissue and chiropractic treatment and targeted strengthening provided by Med-X conditioning has been shown to alleviate symptoms in the majority of patients. A focus on core strength and stabilizing muscles may help to take some of the pressure off of spinal nerves. Pain may be managed by traditional methods of icing and aspirin. If pain is chronic and prohibitive, an injection of corticosteroids may be recommended to allow physical therapy to continue. Pain management injections are performed in the DISC surgery center. These relatively painless procedures are conducted with the strictest protocol for cleanliness, accuracy and efficacy. Most patients are able to avoid surgery through a combination of physical therapy and pain management. Less severe inflammation and pain due to inflammatory signals can be managed using over the counter medication such as ibuprofen.
Some patients find relief using alternative strategies. Traction of the spine, specific stretching and yoga and acupuncture have been shown to provide relief.
If non-surgical methods are insufficient, many surgical options are available. The type of surgery will depend upon the source of the spinal stenosis. For the majority of conditions, minimally invasive procedures offer patients lasting relief from symptoms. Microdiscectomy, foraminectomy, different types of vertebral fusion or disc replacement are all valid options. Most minimally invasive surgeries have a recovery time of 6-8 weeks before normal activity may be resumed. DISC surgeons routinely treat spinal stenosis on an outpatient basis using minimally invasive techniques. Most patients return home the same day of surgery. DISC offers comprehensive physical rehabilitation and follow up care through The Soft Tissue Center. With over 7,000 surgical cases performed to date and zero MRSA infections, DISC maintains a 97% excellent patient satisfaction rating. From conservative care to minimally invasive surgery, DISC’s team of physicians for individualized treatment plans to meet each patient’s unique needs.
Spinal nerves relay sensation in specific parts of your body. Pressure on the nerves can cause pain in the areas that the nerves supply. Pain in the buttocks that radiates down the leg — called sciatica — is caused by this pressure.