Spinal Stenosis

27th November 2006 at 10:54 GMT by Dr.C.A.Jenner MB BS, FRCA. Permalink.

Article on the clinical features and treatment of Spinal Stenosis

Introduction

Spinal stenosis is a medical condition characterized by the narrowing of the spinal canal that occurs when excessive growth of bone and/or tissue reduces the size of the openings in the spinal bones. The process eventually leads to the compression of the nerve roots.

This condition occurs mostly in the lower back (lumbar) area. Spinal stenosis commonly affects middle-aged or elderly people. Younger people born with a narrow spinal canal or who damage their spines may also get spinal stenosis.

Symptoms

The main symptoms of spinals stenosis include:

• Pain in the buttocks, thighs or calves that worsens with walking or exercise
• Numbness in the buttocks, thighs or calves that worsens with standing
• Radiating back and hip pain
• Cramping and weakness in the legs
• Neck and shoulder pain
• Foot and leg pain
• Difficulty or imbalance when walking
• Loss of bowel or bladder function (cauda equine syndrome)

Causative Factors

Spinal stenosis most often occurs because of the natural process of spinal degeneration that occurs with aging. Here we list some of the other main causes that might lead to spinal stenosis:

• Herniated disk
• Ligament changes
• Spinal tumors
• Injury (such as from car accidents)
• Paget’s disease of bone
• Achondroplasia

Arthritis is also considered as one of the frequent causes of spinal stenosis.

Diagnosis

Spinal stenosis is usually diagnosed by a combination of interview about the medical history and a physical examination along with some essential tests. Here we list some of the main tests involved:

• X rays
• Spinal magnetic resonance imaging (MRI)
• Computerized axial tomography (CAT)
• Bone scan

Treatment Modalities

There are two major lines of treatment followed for relief from spinal stenosis, including conservative treatment and surgical remedies. Here we briefly explain each one of them:

1. Conservative Treatment

   • Non-steroidal anti-inflammatory drugs (NSAIDs)
   • Analgesics (Tylenol)
   • Epidural steroid injections
   • Physical therapy
   • Restricted therapy
   • Support devices

2. Surgical Options

   Before understanding the different surgical procedures available, it is important to know that surgery is considered only if the patient meets the following conditions:

   • There is weakness or numbness in the legs
   • It is difficult to stand or walk
   • Medication and physical therapy have not produced the desired effect
   • The patient’s health is stable
   • Leg pain limits normal activity, affecting quality of life

   Various surgical options include:

   • Laminectomy
   • Laminotomy
   • Foraminotomy
   • Spinal Fusion

   If left untreated the infections may progress because the pain related to them may not be felt. The changes caused by the nerve compression can also be permanent, even if the pressure is relieved.