Spinal stenosis is a compression of spinal canal in several major areas of the spine, mostly in the upper or lower sections. Compressed spinal canal can cause spinal cord narrowing or even narrowing of nerve roots, which are growing from the spinal cord. Spinal stenosis may manifest itself in cramps, leg pain or toes numbness, certain unpleasant sensations in the neck, shoulders and forearms. Patients can also experience tingling in the limbs and problems emptying the bladder or bowel. As a matter of fact, spinal stenosis is caused by osteoarthritis. Some of the symptoms of narrowed spinal canal can be alleviated by certain pain relief pills, physical therapy or corset. In more severe cases patients with narrowed spinal canal are required to undergo surgery. Depending on the location, there are such types of spinal stenosis as lumbar spinal stenosis and cervical spinal stenosis.
To understand and grasp the nature of compressed spinal canal better, one certainly needs to have the basic knowledge of structure of spine. The spine of the human usually consists of:
Vertebrae. The spine consists of 24 bones, which are called academically vertebrae.
Bundles. These dense, elastic tissue (ligament) help hold the vertebrae (bones) during movement in their fixed places.
The intervertebral discs. These elastic pads of cartilage are separated by vertebrae. They give the spine the flexibility it needs for complex movements.
The facet joints. Located on both sides of each of the upper and lower vertebrae, the vertebrae joints connect with each other and give stability to the backbone at the same time making it flexible. Joints contain a lubricant that gives extra mobility to the spine.
Cord. This is an extensive bundle of nerves in the spine, which are running directly from the brain stem originating in base of the skull all the way to the lower back bones. The nerves which are located in the cord of the spine transmit information between the brain cells and the nerve endings that are located in other parts of the body.
Spine canal. The cord runs through the spine canal. Typically in the spine canal there is quite enough space for the cord, but the degenerative changes that are happening in the spine because of insufficient mobility can narrow it. This is the place where spinal canal stenosis takes place. It can develop close to any other part of the spine.
There are typically two types of narrowed spinal canal: initial and acquired. Initial spinal stenosis, which occurs relatively infrequently, is an inborn disease, which means it is congenital. Acquired spinal stenosis develops with age. Typically, this stenosis is the result of detrimental changes in the spine that occur, as it was mentioned before, because of the time and overload.
As it was mentioned above, the spinal stenosis cause is osteoarthritis. Osteoarthritis is a joint disease, which happens because of detrimental changes in cartilage. With age the cartilage begins to break down and its smooth and tender surface becomes rough. If it wears out completely, bones can rub together and cause pain. In this case a person can have bone spurs. When they begin to form on the spinal facet joints, the spinal canal narrows down and thus person develops spinal stenosis.
The main cause for such process is usually the age of person. If a person led a sedentary lifestyle, didn`t lead active lifestyle and didn`t exercise enough, he can develop narrowed spinal canal.
The narrowed spinal canal does not necessarily cause problems. But if the whole space of the spine compresses or in any way it affects the spinal cord or spinal nerve endings, a person may develop signs and symptoms of narrowed spinal canal. They usually begin gradually and have tendency to worsen over time.
The most widespread symptoms of spinal stenosis include:
Pain becomes more severe after a long standing or walking. This discomfort usually goes away when a person leans forward or sits down. Patients with narrowed spinal canal can not walk distance of 1 km. The distance which they can cross gradually decreases from 300 to 200, 100 and finally to less than 50 meters. Problems with walking clearly confirm the diagnosis and clearly indicate that surgery is necessary. It becomes difficult for a person to walk also because of the narrowing or blockage of leg arteries. Symptoms can be magnified if a person goes up the hill or when he stands for more than half an hour. A person can also experience radiating pain in the back or hip. Herniated intervertebral disc can narrow the canal of the spine and compress the nerve endings in the lower spine, which leads to pain. This pain originates in the thigh or buttocks and runs all the way down to the back of the leg. Pain can sometimes be present in the neck area or shoulders. It is felt most of all in cervical spine. The unpleasant feeling may occur from time to time or it may become chronic, sometimes it can spread to the hand or wrist. In addition, cord of the spine can get damaged, which can lead to limb weakness and problems with walking. There may be certain headaches, loss of sensations and muscle weakness. Loss of balance can also develop. It happens because the pressure on the cord of the spine can affect the nerve endings that control balance, which leads to a fall.
The loss of bowel or bladder function during narrowed spinal canal occurs because the nerves that innervate the bladder or intestines lead to full or partial fecal incontinence. Some patients may ignore the symptoms of narrowed spinal canal, believing that pain and stiffness they are experiencing are normal signs of aging. But the discomfort that prevents mobility is not normal. A person should always consult his doctor if he experiences:
Leg pain which increases and decreases as person sits or leans forward indicates developing of spinal stenosis. Hyperextension of the back brings relief.
The diagnosis of narrowed spinal canal can be a difficult process, because its signs, symptoms and other manifestations are often temporary and resemble many age-related diseases. To make a right diagnosis and identify other diseases, doctor will evaluate patient`s medical history and do usual physical examination, which may include diagnosis of the peripheral heart rate and a number of motor reflexes and leg reflexes. A person may need to have additional tests. He may require to undergo spine X-ray. Although X-ray can not confirm narrowed spinal canal, it can help identify problems that cause similar symptoms, including:
Magnetic resonance imaging (more commonly known as simply MRI) is also carried out for the diagnosis of spinal stenosis. MRI creates cross-sectional images of the back that X-ray can not show. Strong magnetic waves make images that other diagnostic tests can not create. This method may reveal damage of discs and ligaments, as well as the presence of a tumor.
Computed tomography (CT) gives a detailed image of a certain cross-layer (slice) of the human body, including the size and shape of the spinal canal.
Many patients who are suffering from narrowed spinal canal need only conservative methods of treatment. But if the pain causes disability or significantly interferes with patient`s walking, doctor may recommend surgery for spinal stenosis. Loss of bowel and bladder control or any other important function is also a condition requiring immediate medical or surgical intervention. Overall, there are non-surgical and surgical spinal stenosis treatments of narrowed spinal canal.
Non-surgical treatment of narrowed spinal canal
Before carrying out a surgery, doctor may recommend to try non-surgical treatment of narrowed spinal canal, which should last for at least two months. It is done to be sure that a person really needs surgery, because usually spinal surgeries are very dangerous and they can have certain complications. Basically non-surgical spinal stenosis treatment includes:
Physiotherapy. During physical therapy patient is working with a professional physical therapist, which can help restore muscles strength, endurance, flexibility, and stabilize the spine mobility.
Nonsteroidal anti-inflammation drugs are also an important part for spinal stenosis treatment.
Analgesics can help alleviate the spinal pain and bring the patient joint relief.
Rest or sometimes restricted activities are also needed for this period of treatment. Moderate rest, after which there begins a gradual return to activity, can eliminate the symptoms. Walking is the best exercise in this case. Patients with neurogenic claudication are also recommended cycling.
The dorsal corset provides support to patients with weak abdominal or degeneration in several parts of the spine.
Spinal stenosis surgery
Surgery for spinal stenosis has two objectives - to remove pressure on the cord of the spine or nerve endings and ensure the integrity, mobility and strength of the spine. This can be primarily achieved by several ways, depending on the problem cause. The most common surgeries for narrowed spinal canal include:
Spinal decompression is also called laminectomy. During laminectomy surgeon removes the whole arc of the vertebral plate - back of the bones of spinal canal. This results in expanded space for the nerve endings and provides access to the spurs of the bone or destroyed disks, which can also be removed. Thus, the narrowing process is eliminated.
Laminotomy. During this laminotomy, a part of the arc of the plate is removed to relieve pressure of narrowed spinal canal and provide access to the disk or spurs that compress the nerve. The risks of laminotomy are similar to risks in laminectomy.
The gradual stabilization process of the spine. This operation can be performed separately or simultaneously with a laminectomy. It aims to find direct connection of two or more bones of the narrowed spinal canal in the spine. Such matching is necessary to fill the space between two vital vertebrae. These fragments can be taken from a patient`s body, usually the pelvis bone. Also plate metal frames can be used, especially if the spine is unstable or if surgery is performed for correcting deformity. It does not have as many possible complications as other types of surgeries. The very next day after such surgery patient can get up and walk.
A rapid stabilization of the spine. Recent research proved that at the initial stages of spinal stenosis there can be an implantation of spinal cushion that can perform several functions of the spine and relieve the pain as well as normalize the condition of the affected vertebra, thereby eliminating stenosis.
Nevertheless, surgical intervention is not a panacea for spinal stenosis, although it can relieve the initial symptoms. A patient may experience severe pain immediately after surgery and this pain may reoccur at regular intervals. For some patients, recovery may take weeks or months and they may need long-term physiotherapy. Moreover, the operation will not stop the degenerative process, the symptoms can return, sometimes after several years. Moreover, a patient should always beware of the complications that can arise after the surgery.
Complications of narrowed spinal canal include:
Limitation in walking. In the case of extreme narrowed spinal canal, patients may not be able to take more than 10 steps.
Loss of sensation. Depending on exactly which nerves were compressed, spinal stenosis can cause loss of sensation in the hands, arms, feet or legs.
Loss of bowel or bladder control. Spinal stenosis sometimes disrupt functioning of the bowel or bladder, which may affect the patient's quality of life.
Detrimental changes. Although treatment of narrowed spinal canal can relieve the symptoms of spinal stenosis, it does not stop the occurrence of degenerative changes. Some of these changes, such as muscular atrophy can be constant, even after reducing the pressure.
It is not possible to prevent the beginning of age-related changes associated with the back, but some steps can prolong the mobility of the spine. Such steps include:
Regular exercise. This will help a person maintain strength and flexibility of the spine, joints and ligaments. For best results exercise must be aligned with aerobic exercise, such as walking and cycling or stretching. The risk of injury can be significantly reduced by warming up or developing the muscles regularly and increasing flexibility. Strength training during the narrowed spinal canal can make the arms, legs and abdominal muscles stronger and remove tension from the back.
If a person is not used to doing exercise, he should gradually increase the duration and intensity of training to the extent when his stamina gets stronger. For that he needs to engage in exercising for at least 40 minutes. He should also keep track of how he is sitting, standing, lifting heavy objects. When a person sits down, he needs choose a chair on which the lower part of his back takes the minimum voltage. If necessary, he needs to place a pillow or towel twisted into a roll on the narrowest part of his back so that the bend is correct.
While driving the seat needs to be set so as it maintains the level of the knees and hips. Sometimes a person needs to move the seat forward to normally reach the pedals.Hide
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