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Spinal Stenosis: Causes, Symptoms, Diagnosis And Treatment

Your backbone (spine) protects your spinal cord and lets you stand and bend. However, a condition known as spinal stenosis can narrow your spine causing pressure on the nerves and spinal cord leading to extreme pain [1] .

Usually, this condition is seen in people who are older than 50 years of age [2] . Young people who have had a spine injury or have a narrow spinal canal are also at risk of spinal stenosis. This condition can also result from diseases such as arthritis and scoliosis [1] . The symptoms of this ailment can begin to appear gradually, while in some cases it might not show up at all. Read on to know more about this condition.

What Is Spinal Stenosis?

The narrowing of the spaces within your spine can lead to a condition known as spinal stenosis. The narrowing effect leads to pressure build-up on the nerves that travel through the spine [3]. This condition ideally occurs in the lower back and the neck [2] . When the nerve roots and spinal cord become compressed, it causes a pinching of the spinal cord and nerve roots leading to cramping, pain, numbness and weakness [4] . Depending on the location of the narrowing, the symptoms can be felt in the lower back and legs, neck, shoulder or arms.

While some patients with this condition might not experience any symptoms, others might experience tingling, pain, numbness and muscle weakness [4] . The symptoms can get worse with time.

The primary cause behind this condition is the wear-and-tear changes in the spine that occur as a result of osteoarthritis. When this condition turns severe, doctors might recommend surgery such that additional space can be created for the spinal cord or nerves [4] .

The pain associated with spinal stenosis is felt more often when walking up or down a hill, ramp or steps. Such kind of pain is usually relieved by sitting down.

Types Of Spinal Stenosis

The type of spinal stenosis is decided based on the affected region of the spine. The following are the two main types of spinal stenosis:

  • Cervical stenosis: In this, the narrowing occurs in the cervical part of the spine in your neck [5] .
  • Lumbar stenosis: In this, the narrowing occurs in the lower back region of the spine [6] .

Causes Of Spinal Stenosis

Some people have a small spinal canal from birth [7] . This condition is called congenital stenosis. However, the primary cause of this condition is age-related. This kind is called acquired spinal stenosis.

The following medical conditions can cause spinal stenosis [8] :

  • Paget's disease
  • Inflammatory spondyloarthritis
  • Spinal tumours
  • Osteoarthritis and bony spurs

The following increases the risk of developing spinal stenosis [8] :

  • If you are above 50 years of age
  • If you are born with a narrow spinal canal
  • If you are a female
  • If you have had a previous injury or surgery of the spine

Symptoms Of Spinal Stenosis

For people who experience symptoms with this condition, they usually begin to show gradually while worsening over time. Symptoms vary depending on the location of the stenosis and the nerves that are affected.

The following are the symptoms of the cervical spinal stenosis [9] :

  • Neck pain
  • Problems with walking and balancing
  • Bowel or bladder dysfunction in severe cases
  • Weakness in hand, arm, foot or leg
  • Numbness or tingling in the hand, arm, foot or leg

The following are the symptoms of the lumbar spinal stenosis [8] :

  • Weakness in foot
  • Numbness or tingling in a foot
  • Back pain
  • Pain or cramping in one or both the legs when standing for long periods

Complications Associated With Spinal Stenosis

Untreated spinal stenosis can lead to the following complications [9] :

  • Weakness
  • Numbness
  • Paralysis
  • Incontinence
  • Balance problems

Diagnosis Of Spinal Stenosis

Your doctor may first ask you about the signs and symptoms, followed by a general idea about your medical history. You would be examined physically depending on which the following imaging tests might be recommended:

  • X-rays: An X-ray of your spine can reveal bony changes that might be the reason behind narrowing the space within the spinal canal.
    • Magnetic resonance imaging (MRI): A powerful magnet and radio waves are used to produce cross-sectional images of the spine. This test is capable of detecting damages to the disks and ligaments [10] . It also detects the presence of tumours. Further, it can show the nerves in the spinal cord that are under pressure.
    • CT scan: A computerized tomography might be suggested instead of an MRI. This test combines X-ray images taken from different angles to give a detailed, cross-sectional image of the affected region. In the case of CT myelogram [11] , the CT scan is done after injecting a contrast dye. This dye outlines the spinal cord and nerves and is capable of revealing herniated disks, tumours and bone spurs.

    In some cases, an EMG (electromyogram) might be done to check the nerves that go to your legs.

    Treatment For Spinal Stenosis

    A doctor might design the treatment based on the patient's situation that is dependent on the location of the stenosis.

    Your doctor may prescribe the following medications:

    Pain relievers: To temporarily reduce the discomfort, your doctor might prescribe ibuprofen, naproxen or acetaminophen. However, these medicines are recommended only for a short time.

    Antidepressants: Night-time doses of tricyclic antidepressants can help in easing chronic pain [12] .

    Opioids: Drugs containing oxycodone and hydrocodone may prove to be useful in relieving short-term pain. However, these might have side effects [13] .

    Anti-seizure drugs: Drugs such as gabapentin and pregabalin are used to reduce pain caused due to damaged nerves.

    A person with spinal stenosis might become weak due to being less active. Approaching a physical therapist can be helpful in terms of learning exercises that can do the following:

    • Improve your balance
    • Maintain the flexibility and stability of the spine
    • Building up your strength and endurance

    Few doctors prefer the use of steroid injections. Although this cannot fix stenosis, injecting a steroid medication into the irritated and swollen spot can reduce inflammation and relieve some part of the pain.

    Another procedure used by doctors to address the treatment of spinal stenosis is known as decompression procedure. Here, needle-like instruments are used to remove a part of the thickened ligament in the back of the spinal column. This would increase the spinal canal space and remove nerve root impingement.

    Surgery might be considered when other forms of treatment do not seem to work. The following are some of the surgical procedures used to treat spinal stenosis [14] :

    • Laminotomy: A portion of the lamina is removed. This includes carving a hole that is big enough to relieve the pressure in a particular spot.
    • Laminectomy: The back part of the affected vertebra is removed.
    • Laminoplasty: This works only for the cervical spine condition. It creates a hinge on the lamina and opens up space within the spinal canal.
    • Minimally invasive surgery: This approach focuses on the removal of bone or lamina in a way that reduces the damage to other neighbouring healthy tissues.

    Living With Spinal Stenosis And Its Prevention

    Although there is no cure for this condition, incorporating the following in your lifestyle can make you feel better:

    • Exercise regularly. Ensure that you indulge in a good exercise regime at least three times in a week for about 30 minutes.
    • Do not do anything that can trigger or worsen the pain, such as lifting heavy objects.
    • Check with your physician about alternative therapies such as acupuncture.
    • Maintain a healthy weight.
    • Maintain a good posture while sitting.
    View Article References
    1. [1] Lee, S. Y., Kim, T. H., Oh, J. K., Lee, S. J., & Park, M. S. (2015). Lumbar Stenosis: A Recent Update by Review of Literature.Asian spine journal,9(5), 818–828.
    2. [2] Amundsen, T., Weber, H., Lilleås, F., Nordal, H. J., Abdelnoor, M., & Magnaes, B. (1995). Lumbar spinal stenosis. Clinical and radiologic features.Spine,20(10), 1178-1186.
    3. [3] Turner, J. A., Ersek, M. A. R. Y., Herron, L. A. R. R. Y., & Deyo, R. I. C. H. A. R. D. (1992). Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature.
    4. [4] Weinstein, J. N., Tosteson, T. D., Lurie, J. D., Tosteson, A. N., Blood, E., Hanscom, B., ... & Hilibrand, A. (2008). Surgical versus nonsurgical therapy for lumbar spinal stenosis.New England Journal of Medicine,358(8), 794-810.
    5. [5] Meyer, F., Börm, W., & Thomé, C. (2008). Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment.Deutsches Arzteblatt international,105(20), 366–372.
    6. [6] Genevay, S., & Atlas, S. J. (2010). Lumbar spinal stenosis.Best practice & research. Clinical rheumatology,24(2), 253–265.
    7. [7] Papp, T., Porter, R. W., Craig, C. E., Aspden, R. M., & Campbell, D. M. (1997). Significant antenatal factors in the development of lumbar spinal stenosis.Spine,22(16), 1805-1810.
    8. [8] Atlas, S. J., Keller, R. B., Robson, D., Deyo, R. A., & Singer, D. E. (2000). Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study.Spine,25(5), 556-562.
    9. [9] Pavlov, H., Torg, J. S., Robie, B., & Jahre, C. (1987). Cervical spinal stenosis: determination with vertebral body ratio method.Radiology,164(3), 771-775.
    10. [10] Hong, J. H., Lee, M. Y., Jung, S. W., & Lee, S. Y. (2015). Does spinal stenosis correlate with MRI findings and pain, psychologic factor and quality of life?.Korean journal of anesthesiology,68(5), 481–487.
    11. [11] Song, K. J., Choi, B. W., Kim, G. H., & Kim, J. R. (2009). Clinical usefulness of CT-myelogram comparing with the MRI in degenerative cervical spinal disorders: is CTM still useful for primary diagnostic tool?.Clinical Spine Surgery,22(5), 353-357.
    12. [12] Orbai, A. M., & Meyerhoff, J. O. (2010). The effectiveness of tricyclic antidepressants on lumbar spinal stenosis.Bulletin of the NYU hospital for joint diseases,68(1), 22.
    13. [13] Nunley, P. D., Deer, T. R., Benyamin, R. M., Staats, P. S., & Block, J. E. (2018). Interspinous process decompression is associated with a reduction in opioid analgesia in patients with lumbar spinal stenosis.Journal of pain research,11, 2943–2948.
    14. [14] Machado, G. C., Ferreira, P. H., Harris, I. A., Pinheiro, M. B., Koes, B. W., van Tulder, M., … Ferreira, M. L. (2015). Effectiveness of surgery for lumbar spinal stenosis: a systematic review and meta-analysis.PloS one,10(3), e0122800.

    Read more about: pain
    Story first published: Monday, July 8, 2019, 9:00 [IST]
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