Definition Spinal stenosis is a narrowing of the open spaces within your spine, which can put pressure on your spinal cord and the nerves that travel through the spine. Spinal stenosis occurs most often in the neck and lower back.
While some people have no signs or symptoms, spinal stenosis can cause pain, numbness, muscle weakness, and problems with bladder or bowel function.
Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to aging. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves.
Spinal stenosis symptoms Many people have evidence of spinal stenosis on X-rays, but have no signs or symptoms. When symptoms do occur, they often start gradually and worsen over time. Symptoms vary, depending on the location of the stenosis:
In the neck - Narrowing in the upper (cervical) spine can cause numbness, weakness or tingling in a leg, foot, arm or hand. In severe cases, nerves to the bladder or bowel may be affected, leading to incontinence.
In the lower back - Compressed nerves in your lower (lumbar) spine can cause pain or cramping in your legs when you stand for long periods of time or when you walk. The discomfort usually eases when you bend forward or sit down.
When to see a doctor Make an appointment with your doctor if you have persistent pain, numbness or weakness in your back, legs or arms.
While some people are born with a small spinal canal, most spinal stenosis occurs when something happens to reduce the amount of space available within the spine. Causes of spinal stenosis may include:
Overgrowth of bone - Wear and tear on your spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal. Paget's disease, a bone disease that usually affects adults, also can cause bone overgrowth in the spine.
Herniated disks - The soft cushions that act as shock absorbers between your vertebrae tend to dry out with age. Cracks in a disk's exterior may allow some of the soft inner material to escape and press on the spinal cord or nerves.
Thickened ligaments - The tough cords that help hold the bones of your spine together can become stiff and thick over time. These thicker ligaments can bulge into the spinal canal.
Tumors - Abnormal growths can form inside the spinal cord, within the membranes that cover the spinal cord or in the space between the spinal cord and vertebrae.
Spinal injuries - Car accidents and other major trauma can cause dislocations or fractures of one or more vertebrae. Displaced bone from a spinal fracture may damage the contents of the spinal canal. Swelling of adjacent tissue immediately following back surgery also can put pressure on the spinal cord or nerves.
What are the risk factors? Most people with spinal stenosis have passed the age of 50. When younger people develop spinal stenosis, the cause is typically a genetic disease affecting bone and muscle development throughout the body.
What are some complications associated with spinal stenosis?
Severe cases of spinal stenosis may cause: - Numbness - Weakness - Incontinence - Paralysis
Spinal stenosis can be difficult to diagnose because its signs and symptoms resemble those of many age-related conditions. Imaging tests may be needed to help pinpoint the true cause of your signs and symptoms.
Imaging tests These tests may include:
X-rays - Although an X-ray isn't likely to confirm that you have spinal stenosis, it can help rule out other problems that cause similar symptoms.
Magnetic resonance imaging (MRI) - In most cases, this is the imaging test of choice for diagnosing spinal stenosis. Instead of X-rays, an MRI uses a powerful magnet and radio waves to produce cross-sectional images of your spine. The test can detect damage to your disks and ligaments, as well as the presence of tumors. Most important, it can show pressure on the spinal cord or spinal nerves.
CT myelogram - Computerized tomography (CT) combines X-ray images taken from many different angles to produce detailed, cross-sectional images of your body — including the shape and size of your spinal canal. In a CT myelogram, the CT scan is conducted after a contrast dye is injected. The dye outlines the spinal cord and nerves, and it can reveal herniated disks, bone spurs and tumors.
The type of treatment you receive for spinal stenosis may vary, depending on the location of the stenosis and the severity of your signs and symptoms.
Medications To control pain associated with spinal stenosis, your doctor may prescribe:
NSAIDs - Nonsteroidal anti-inflammatory drugs (NSAIDs) help relieve pain and reduce inflammation. Some NSAIDs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve), are available without prescription.
Muscle relaxants - Medications such as cyclobenzaprine (Amrix, Flexeril) can calm the muscle spasms that sometimes occur with spinal stenosis.
Antidepressants - Nightly doses of tricyclic antidepressants, such as amitriptyline, can help ease chronic pain.
Anti-seizure drugs - Some anti-seizure drugs, such as gabapentin (Neurontin, Gralise) and pregabalin (Lyrica), are used to reduce pain caused by damaged nerves.
Opioids - Drugs such as oxycodone (Oxycontin, Percocet, others) and hydrocodone (Lortab, Vicodin, others) contain substances related to codeine and can be habit-forming.
Therapy A physical therapist can teach you exercises that may help:
- Build up your strength and endurance - Maintain the flexibility and stability of your spine - Improve your balance
Steroid injections Your nerve roots may become irritated and swollen at the spots where they are being pinched. Injecting a corticosteroid into the space around that constriction can help reduce the inflammation and relieve some of the pressure. However, repeated steroid injections can weaken nearby bones and connective tissue, so only a few injections a year are allowed.
Surgery Surgery may be considered if:
- More conservative treatments haven't helped - You're disabled by your symptoms - You're in good health otherwise
The goal is to relieve the pressure on your spinal cord or nerve roots. For example, a laminectomy removes the back part (lamina) of the affected vertebra to create more room within the spinal canal. In some cases, vertebrae also may need to be fused together to maintain the spine's strength.
In most cases, surgery helps reduce spinal stenosis symptoms. But some people's symptoms stay the same or get worse after surgery. Surgical risks include infection, a tear in the membrane that covers the spinal cord, a blood clot in a leg vein and neurological deterioration.
Post by petelanddownunder on Jun 2, 2015 4:55:46 GMT -8
I have an extreme stenosis in my lumbar region and not sure if at the same site but recent X-rays have identified a new spinal break in the lumbar region. I had to confirm with the surgeon that my spine has actually broken again as he was referring to my recently broken spine as "unstable spine". I am still uncertain what the cause for the recent break in my spine was although last year possible spinal osteo myelitis was identified and later discounted in my lumbar region. An mri approx. one year ago identified all sorts of spinal degeneration and the Brisbane spinal unit has made no attempt to offer me any treatment. My original diagnosis was extreme "pelvic anterior tilt" and all these other issues have been identified since further exploring the pelvic anterior tilt diagnosis... I finally asked for and received a referral to a private spinal surgeon a few moths ago who identified the new lumbar break "unstable between L1 and L5". Approx a month ago the private spinal surgeon telephoned to suggest that he is considering to perform a bone graft/fusion of my spine at the lumbar region and I am currently waiting for more news...
PS Anyone with a similar diagnosis please do not be concerned as we are all very different and I am currently 60years of age and have been a para for more than 35years. Just because you may have a stenosis or have been in a chair for an extended time, or may be a similar age to me does not mean that you may suffer a similar experience as my current circumstances.
Post by davincidanes on Jun 3, 2015 4:51:01 GMT -8
petelanddownunder, I can certainly see where that would be quite concerning. I'm sure that you will weigh the risks of surgery very carefully as compared to what the potential benefit may be. Good luck to you.