Spinal stenosis is a common condition that involves a narrowing in one or more areas of the spine as a result of injury or deterioration to the discs, joints or bones within the spinal canal.
While some patients may be born with a somewhat narrowed spinal canal, this seldom causes symptoms for the first several decades of life. This is referred to as congenital spinal stenosis. Once patients have reached the fourth or fifth decade of life however, degenerative conditions such as bone spurs or ligament thickening can occur that exacerbates the already present congenital spinal stenosis. This type of spinal stenosis is frequently present at multiple levels, usually necessitating a multilevel surgical approach. More focal spinal stenosis, at one or two spinal levels, can also be caused by a herniated disc or discs that project into the spinal canal and compromise the space usually reserved for the spinal cord and nerve roots. This type of stenosis can occur with or without the presence of congenital stenosis.
Symptoms
Some patients may not experience any symptoms from this condition. It is only when the narrowed area of the spine compresses the spinal cord or nerves that symptoms arise. Patients with symptomatic spinal stenosis may experience cramping, pain and numbness in the legs, back, neck, shoulders or arms, depending on which part of the spine is affected. When stenosis occurs in the lumbar spine (lower back) area, patients typically have pain and cramping, numbness, or weakness in the legs that is worse with prolonged walking or standing. This is referred to as neurogenic claudication. In cases of stenosis that affects the cervical spine (neck) area, patients can often experience an impairment of balance as well as numbness and tingling in the hands and fingers. In more advanced cases, patients can have deterioration of hand and leg function that can make even every day tasks, such as buttoning a shirt, using a fork and knife, and walking, very difficult. When this stage is reached immediate intervention is critical to minimize the permanent neurologic impairment that can occur.
Diagnosing Spinal Stenosis
Spinal stenosis is often difficult to diagnose because its symptoms can come and go and may resemble the symptoms of many other conditions. A diagnosis of spinal stenosis is often achieved after ruling out other conditions and performing imaging exams such as a spinal X-ray, MRI, and CT scan. Your doctor will also ask you several questions about your symptoms and overall health to correctly diagnose your condition and provide an adequate treatment solution.
Treatment
Most cases of spinal stenosis can be effectively treated through conservative methods such as physical therapy, nonsteroidal anti-inflammatory drugs, rest and a back brace. These treatments are usually administered for at least six weeks in order to fully assess whether or not a patient can be treated non-operatively for their symptoms. For more persistent symptoms, patients are usually then referred to pain management to undergo a series of epidural steroid injections to allow targeted delivery of a high dose of anti-inflammatory medication directly to the site of the problem. The specific treatment for your individual condition may vary.
For more severe cases, surgery may be required to relieve pressure on the spinal cord and nerves This may be achieved in the lumbar spine (lower back) through procedures such as a decompressive laminectomy or laminotomy. Depending on the severity of the degeneration or disc herniation necessitating the surgery, spinal fusion may also be needed at the same time. In the cervical spine (neck), multilevel decompression for degeneration is usually accomplished via a posterior cervical laminectomy and fusion, while disc herniations are usually addressed by an anterior approach via an anterior cervical decompression and fusion (ACDF).