This disorder usually involves the narrowing of one or more of three areas of the spine:
- The canal in the center of the column of bones (vertebral or spinal column) through which the spinal cord and nerve roots run
- The canals at the base or roots of nerves branching out from the spinal cord
- The openings between vertebrae through which nervs leave the spine and go to other parts of the body.
The narrowing may involve a small or large area of the spine. Pressure on the lower part of the spinal cord (back area) or on nerve roots branching out from that area may give rise to pain or numbness in the legs. Pressure on the upper part of the spinal cord (neck area) may produce similar symptoms in the shoulders, or even the legs.
Spinal stenosis is most common in men and women over 50 years of age. However, it may occur in younger people who are born with a narrowing of the spinal canal or who suffers an injury to the spine.
The normal vertebral canal provides adequate room for the spinal cord and cauda equina. Narrowing of the canal, which causes spinal stenosis, may be inherited or acquired. Some people inherit a small spinal canal or have a curvature of the spinal (scoliosis) that produces pressure on nerves and soft tissue and compresses or stretches ligaments.
Acquired conditions of Spinal stenosis
Degenerative Conditions: Spinal stenosis most often results from a preliminary, degenerative aging process. Either structural changes or inflammation can begin the process. As people age, the ligaments of the spine may thicken and calcify (harden from deposits of calcium salts). Bones and joints may also enlarge: when surfaces of the bone begin to project out from the body, these projections are called osteophytes (bone spurs).
When the health of one part of the spine fails, it usually places increased stress on other parts of the spine. For example, a herniated (bulging) disk may place pressure on the spinal cord or nerve root. When a segment of the spine becomes too mobile, the capsules of the facet joints thicken in an effort to stabilize the segment, and bone spurs may occur. This decreases the space (neural foramen) available for nerve roots leaving the spinal cord.
Spondylolisthesis, a condition in which one vertebra slips forward on another, may result from a degenerative condition or an accident, or, very rarely, may be acquainted at birth. Poor alignment of the spinal column when a vertebra slips forward onto the one below it can place pressure on the spinal cord or nerve roots at that place.
Aging with secondary changes is the most common cause of spinal stenosis. Two forms of arthritis that may affect the spinal are osteoarthritis and rheumatoid arthritis.
Osteoarthritis: Osteoarthritis is the most common form of arthritis and is more likely to occur in middle-aged and older people. It is a chronic, degenerative process that may involve multiple joints of the body.
Rheumatoid Arthritis: Rheumatoid arthritis usually affects people at an earlier age than osteoarthritis does and is associated with inflammation and enlargement of the soft tissues (the synovium) of the joints
Other Acquired Conditions
Tumors of the spine: Ossification of the posterior longitudinal ligament occurs when calcium deposits form on the ligament that runs up and down behind the spine and inside the spinal canal. These deposits turn the fibrous tissue of the ligament into bone. (Ossification means “forming bone.”) These deposits may press on the nerves in the spinal canal.
Spinal stenosis Symptoms: The space within the spinal canal may narrow without producing any symptoms. However, if narrowing places pressure on the spinal cord, cauda equina, or nerve roots, there may be a slow onset and progress of Spinal stenosis symptoms. The neck or back may or may not hurt. More often, people experience numbness, weakness, cramping, or general pain in the arms or legs. If the narrowed space within the spine is pushing on a nerve root, people may feel pain radiating down the leg (sciatica). Sitting or flexing the lower back should relieve symptoms. (The flexed position “opens up” the spinal column, enlarging the spaces between vertebrae at the back of the spine.).
People with more severe lumbar stenosis may have problems with bowel and bladder function and foot disorders. For example, cauda equina syndrome is a severe, and very rare, form of spinal stenosis. It occurs because of compression of the cauda equina, and symptoms may include loss of control of the bowel, bladder, or sexual function and / or pain, weakness, or loss of feeling in one or both legs. Cauda equina syndrome is a serious condition requiring urgent medical attention.
Spinal stenosis Diagnosis
Medical history: A complete medical background check has to be connected to rule out or identify if any other medical conditions is causing the pain. The history taking helps the treating doctor understand if the patient is suffering from any recurring health problems or has taken any past treatments and surgeries etc.
Physical examination: After taking your history, the Spine consultant will give you a physical examination to rule out possible causes of pain and try to determine the source of your back problem. A series of examinations along with a DSA test will be conducted to assess the Motion of Spine and Neck, Weakness of spinal muscles, Sensory and Motor Skills
Diagnostic Tests: After forming an opinion on the cause of the patient's pain, a diagnostic test may be required to confirm the disc problem and / or to gain additional information, such as the location of a herniated disc and impeding nerve roots. Diagnostic tests may include:
DSA: If the spinal stenosis is a soft tissue stenosis due to a slipped disc a DSA helps identify the root cause of the disc bulge causing this stenosis.
X-Ray: An X-ray helps diagnose a bony spinal stenosis and the degree to which the disc has slipped. It's not possible to diagnose a herniated disc with this test alone.
MRI: Magnetic Resonance Imaging (MRI) provides a sensitive and accurate assessment of the spinal nerves and anatomy, including disc alignment, height, hydration and configuration.
Spinal Stenosis is a back problem that progresses slowly. Here is a conservative and non-surgical treatment approach that should be the first step in treating spinal stenosis. While most back problems do not require a surgery; if the condition is acute, a surgery may be required.
Non-surgical treatment for Spinal stenosis
- Education about the course of the condition and how to relate symptoms
- Medicines to treat pain and inflammation.
- Physical therapy, to provide education, instruction, and support for self-care; physical therapy instructions on stretching and strength exercises that may lead to a decrease in pain and other symptoms.