SPINAL STENOSIS
Lumbar and Cervical
Spinal stenosis is a narrowing of the spinal canal, which places pressure on the spinal cord. If the stenosis is located on the lower part of the spinal cord it is called lumbar spinal stenosis. Stenosis in the upper part of the spinal cord is called cervical spinal stenosis. While spinal stenosis can be found in any part of the spine, the lumbar and cervical areas are the most commonly affected.
CAUSES
Some patients are born with this narrowing, but most often spinal stenosis is seen in patients over the age of 50. In these patients, stenosis is the gradual result of aging and "wear and tear" on the spine during everyday activities. There most likely is a genetic predisposition to this since only a minority of individuals develops advanced symptomatic changes. As people age, the ligaments of the spine can thicken and harden (called calcification). Bones and joints may also enlarge, and bone spurs (called osteophytes) may form. Bulging or herniated discs are also common. Spondylolisthesis (the slipping of one vertebra onto another) also occurs and leads to compression. When these conditions occur in the spinal area, they can cause the spinal canal to narrow, creating pressure on the spinal nerve.
SYMPTOMS
The narrowing of the spinal canal itself does not usually cause any symptoms. It is when inflammation of the nerves occurs at the level of increased pressure that patients begin to experience problems.
Patients with lumbar spinal stenosis may feel:
- Pain, weakness, or numbness in the legs, calves or buttocks
- In the lumbar spine, symptoms often increase when walking short distances and decrease when the patient sits, bends forward or lies down
- Cervical spinal stenosis may cause similar symptoms in the shoulders, arms, and legs; hand clumsiness and gait and balance disturbances can also occur
- In some patients the pain starts in the legs and moves upward to the buttocks
- In other patients the pain begins higher in the body and moves downward. This is referred to as a "sensory march".
- The pain may radiate like sciatica or may be a cramping pain.
- In severe cases, the pain can be constant.
- Severe cases of stenosis can also cause bladder and bowel problems, but this rarely occurs.
- Also paraplegia or significant loss of function also rarely, if ever, occurs.
NONSURGICAL TREATMENT
There are a number of ways a doctor can treat stenosis without surgery. These include:
- Medications, including nonsteroidal antiinflammatory drugs (NSAIDs) to reduce swelling and pain, and analgesics to relieve pain.
- Corticosteroid injections (epidural steroids) can help reduce swelling and treat acute pain that radiates to the hips or down the leg. This pain relief may only be temporary and patients are usually not advised to get more than 3 injections per 6 month period.
- Rest or restricted activity (this may vary depending on extent of nerve involvement).
- Physiotherapy and/or prescribed exercises to help stabilise the spine, build endurance and increase flexibility.
- See clinical pilates
SURGICAL TREATMENT
In many cases, nonsurgical treatments do not treat the conditions that cause spinal stenosis, however they might temporarily relieve pain. Severe cases of stenosis often require surgery. The goal of the surgery is to relieve pressure on the spinal cord or spinal nerve by widening the spinal canal. This is done by removing, trimming, or realigning involved parts that are contributing to the pressure.
If nerves were badly damaged before the surgery, the patient may still have some pain or numbness after the surgery. Or there may be no improvement at all. Also, the degenerative process will likely continue, and pain or limitation of activity may reappear 5 or more years after surgery.
Most doctors will not consider surgical treatment of spinal stenosis unless several months of nonsurgical treatment methods have been tried. Since all surgical procedures carry a certain amount of risk, patients are advised to discuss all treatment options with their doctor before deciding which procedure is best.
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