About the disease
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.
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.
The main cause of this condition 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:
- Leg pain
- Compression of nerve endings in the lower (also known as lumbar) spine
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:
- Numbness or weakness in the back, legs, neck or shoulders that are not related to over exercising or stress
- 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.
- 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.
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. A surgeon can perform decompression on the first, second, third, fourth segments, depending which of them was affected. Decompression can be combined with discotomy, which is a removal of the intravertebral disc.
- Laminotomy is another surgical option, during which 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 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.