Spinal or vertebral stenosis is a common back condition. With this disease, the spaces in the spine become too narrow, which increases pressure on the spinal cord and other nerves.
Symptoms and Signs
Dr. Praveen Kadimcherla with Atlantic Spine Center discusses stenosis definition, diagnosis and treatment: The signs are hard to ignore: back pain, numbness or tingling in the arms or legs, muscle weakness, or even problems with bladder or bowel function. But what could cause such alarming symptoms? It might be lumbar spinal stenosis, a condition most common in adults over 50, according to Praveen Kadimcherla, MD, an orthopedic spine surgeon at Atlantic Spine Center. The lumbar spinal stenosis symptoms can gradually get worse and, in severe cases, there can be a partial, or complete leg paralysis.
Causes
A narrowing of the open spaces within the spine, spinal stenosis, can put pressure on the spinal cord and nerves traveling through the spine to the arms and legs. Some who are affected experience no symptoms at all, while others can't walk, sit, or do other activities for very long without feeling the effects, says Dr. Kadimcherla. "Before they're properly diagnosed, patients with spinal canal stenosis may not understand why just being in certain positions, or doing everyday things is causing so much pain or discomfort," he says. "They usually don't pinpoint what's wrong until they visit a spine specialist."
Those who develop spinal stenosis haven't done anything wrong, and the condition is seldom preventable, Dr. Kadimcherla says. But educating patients on the lower back pain causes is part of his job. These spinal stenosis causes include:
- Aging: Simply getting older is probably the biggest risk factor for developing spinal stenosis. That's because aging can cause the bands of tissue supporting the spine to get thick and hard or cause bones and joints to get bigger. "The surfaces of bones may also bulge out, which is known as bone spurs," Dr. Kadimcherla adds.
- Arthritis: In some cases, arthritis – which wears away cartilage between joints – can trigger spinal stenosis because it reduces the spaces between spinal joints where nerves come through.
- Herniated discs: When spongy spinal discs protrude from the spinal column, they can pinch nerve roots in its openings.
- Thickened ligaments: Ligaments are the tough cords that help hold the bones of the spine together. When they stiffen or thicken over time, they can push into the spinal canal and press on nerves.
- Heredity: Some people inherit a predisposition to spinal stenosis.
- Injuries: Car accidents or other trauma can dislocate or fracture spinal vertebrae, and displaced bone may damage the spinal canal.
"Less-common reasons for spinal stenosis include tumors of the spine, calcium deposits on ligaments, and other rarer occurrences," Dr. Kadimcherla says. "This is precisely why it's important to be properly diagnosed, so the problem can be addressed."
Risks of Spinal Stenosis
A patient can have spinal stenosis from birth, and this is congenital stenosis caused by a small spinal canal. An acquired spinal stenosis can develop due to several risk factors. Having scoliosis, or a sideways curvature of the spine, increases the chance of stenosis developing. Certain injuries and excess fluoride or calcium levels are also among the risk factors. The prognosis of spinal stenosis is rather good, the condition develops slowly, so a patient may not suffer from painful symptoms for a long time. Some conservative treatments such as pain-relieving drugs, anti-inflammatory medicines, ice or heat pads, spinal stenosis physical therapy can be very effective in fighting the first signs of symptoms. Surgery to correct spinal stenosis also offers pain relief, but in more severe cases.
Complications
Spinal stenosis can start rather slowly with little or no symptoms. But over time it can lead to trouble walking and a loss of bowel or bladder control. Unfortunately, in the case of mild symptoms, some traditional non-invasive treatments can help, but with severe spinal stenosis a patient may need surgery.
Duration of Spinal Stenosis
As we’ve already said, there’s currently no cure for spinal stenosis. There are certain steps to prevent such a disease, including regular exercises and a healthy diet.
The disease can last for quite a while with no visible signs. Traditional treatment options in many patients may keep the condition and its symptoms at bay for years. In the case of severe pain, a patient may need surgery. In this case, the healing and recovery process can take from six months to a year.
Diagnosis
Getting an accurate diagnosis of spinal stenosis usually involves imaging tests such as X-ray to see bone changes such as narrowing in the spinal canal, MRI scans, that help determine spinal cord nerves under pressure, or CT scans to get a cross-sectional picture of the spine. All of these diagnostic tests provide a different look at hard and soft tissues in the back.
Sometimes doctors will also use a myelogram, a test in which liquid dye is injected into the spinal column, or a bone scan that shows where bone is breaking down or forming.
A physical exam is performed to rule out other possible conditions, or confirm numbness and weakness typical for spinal stenosis. Similarly, symptoms and medical history can help rule out other diseases with similar symptoms. A doctor might also ask the patient to have other tests, such as a blood test.
Treatment
Once doctors know the root cause, spinal stenosis can often be treated with conservative, non-surgical measures, many of which can be done at home. These include taking prescribed medications to relieve pain or swelling; limiting activity temporarily; in-office epidural cortisone injections; and physical therapy and prescribed exercises.
Sometimes, however, these conservative approaches don't work. If you're becoming disabled by your symptoms or the spinal stenosis becomes severe, surgery becomes an option. Spinal stenosis requires emergency surgery if it triggers a complication known as cauda equina syndrome, which causes loss of control of the bowel or bladder, problems having sex, or loss of feeling in one or both legs. But surgery for spinal stenosis is typically done in a minimally invasive procedure using only small incisions. The same-day surgery offers less pain and blood loss than traditional "open" surgery and a quicker recovery.
"Most of the time, surgery to improve spinal stenosis is a choice that a patient and doctor make together," Dr. Kadimcherla says. "If a patient is coping with severe limitations – such as the inability to walk for significant periods without sitting to relieve pain – they're probably at a point where surgery is a reasonable option."
Prevention
To prevent such a condition, you should mind your general health and pay attention to back health. Try to incorporate exercise to strengthen the muscles that support the spine and strengthen back muscles. Gentle stretching can help prevent some back injuries. Walking, swimming and yoga are among healthy physical activities to add to your daily life. A healthy diet with balanced levels of vitamins C, D and calcium improves bone health.
Watch our 3D animated video on Spinal Stenosis here https://www.youtube.com/watch?v=kr8DV1zdB7c
