Spinal Stenosis (Narrowing of the Spine)
Spinal stenosis is the narrowing of the spinal column, which leads to the compression of the spinal cord and spinal nerves. Spinal stenosis can occur in the cervical, lumbar or thoracic region of the spine, and often results in chronic back and neck pain.
The vertebral column contains components critical to the stable functioning of the back and neck including the spinal cord, nerve roots, and vertebrae. Thirty-three vertebrae make up the cervical, thoracic and lumbar spine, as well as the coccyx and sacral, whose vertebrae are fused together.
Each vertebra has three functional parts, the posterior, anterior and spinal canal. The vertebral canal protects the spinal cord and also contains fat, ligaments and blood vessels. Vertebrae also have four facet joints, which connect each vertebra at the top and bottom.
On the back of each vertebra are bony projections that form the vertebral arch. The arch has two supported pedicles and two laminae. Under each pedicle, a pair of spinal nerves exits the spinal cord.
What is Spinal Stenosis?
Spinal stenosis is a medical term derived from the ancient Greek word stenosis, meaning a narrowing of a passage in the body. Spinal stenosis is a disease of the spinal column that often leads to chronic back or neck pain.
In simple terms, spinal stenosis refers to the compression of the nerve roots or spinal cord compression due to the narrowing or impingement of the spinal canal.
When spinal stenosis compresses on the spinal cord, it may be referred to as myelopathy. Thus, patients may have spinal stenosis with myelopathy. If the narrowing of the spine only affects the spinal nerve roots, the patient will experience radiculopathy, which is the radiation of pain down through the back and into the extremities.
Lumbar Spinal Stenosis
Lumbar spinal stenosis is caused by the compression of nerve roots in the lower back and often manifests as tingling, numbness or pain that radiates from the lower back and down to the buttocks or legs, also known as radicular pain or radiculitis. Neurogenic claudication is also a symptom of lumbar spinal stenosis and causes cramping or pain in the legs due to a nerve problem.
When the spinal canal or vertebral foramina narrow due to disease, degenerative arthritis, degenerative disc disease, or the degenerative aging process, lumbar spinal stenosis is usually diagnosed and subjected to applicable treatment methods. Spinal osteoarthritis destroys cartilage between vertebrae, promotes bone spur formation (osteophytes) and excessive growth of ligamentous structures. This is a result of the degenerative aging process. Also, while generally benign, synovial cysts may develop as a result of spine degeneration.
Lumbar spinal stenosis may also result from spondylolisthesis. This is when a vertebra slips forward onto the vertebra below. As the vertebral foramina narrows and spinal cord nerves suffer pressure from being compressed and restricted, lumbar spinal stenosis symptoms emerge and gradually worsen unless spine surgery is performed to remove pressure on nerves.
In addition to arthritis and spondylolisthesis, lumbar spinal stenosis may also be caused by tumors, infection or metabolic bone disorders associated with overgrowth of bone.
Delaying treatment for lumbar spinal stenosis may result in worsening symptoms, nerve damage, loss of function, myelopathy, urinary incontinence or loss of normal bowel functioning, etc.
Cervical Spinal Stenosis
Cervical or neck spinal stenosis occurs in the upper region of the spine and neck, leading to a wide range of painful and dangerous symptoms for those who suffer from this condition.
The condition is characterized by a narrowing of the spinal canal in the cervical region often caused by an impingement such as bone spurs, a herniated disc or bulging disc. Cervical spinal stenosis may occur with age and is sometimes a side effect of degenerative disc disease, osteoarthritis and rheumatoid arthritis.
Thoracic Spinal Stenosis
Thoracic spinal stenosis occurs in the middle portion of the spine caused by a narrowing of the spinal canal in the thoracic region of the back, often limiting a patient’s ability to move laterally or rotate. Stenosis of the thoracic spine is rare.
Who is Susceptible?
Though spinal stenosis can be a congenital condition or caused by injury or simply age, there are several other factors that could put you more at risk.
• Participating in high-impact sports
• A history of injuries
• Previous spine surgery
• Infections, diseases or tumors
Spinal stenosis is not only more common in those over the age of 50, gender could also be a risk factor as post-menopausal women are more susceptible due to osteoporosis.
Causes of Spinal Stenosis
Patients who suffer from the causes of spinal stenosis can be separated into those who inherit the condition and those who have acquired it over time.
Inherited Spinal Stenosis
Patients who have inherited spinal stenosis are often born with a spinal canal that is narrower than the average person’s and often suffer the negative effects of the condition earlier in life.
Acquired Spinal Stenosis
Most patients seeking treatment for spinal stenosis suffer from the acquired version of the condition, as the narrowing of the spinal canal is a natural part of the aging process. Degeneration of the cartilage that provides a cushion for spinal joints exposes bone to friction and may result in bone spurs. As this bone on bone friction continues, the symptoms of spinal stenosis become more pronounced and the condition worsens.
In addition to the aging process, spinal stenosis is often induced by trauma to the back or neck that causes damage to the anatomy of the spine.
In general, the following may cause nerve compression or spinal cord compression and result in spinal stenosis:
• Trauma and injuries
All spinal stenosis causes share the onset of osteoarthritis later in life.
Symptoms of Spinal Stenosis
Symptoms of spinal stenosis may appear in the lumbar, thoracic and cervical parts of the spine. Depending on the location of the condition, patients may experience different symptoms.
Symptoms of Spinal Stenosis in the Lumbar Spine
• Chronic lower back pain accompanied by increased pain and weakness in the legs when walking (possible sign of cauda equine syndrome)
• Pain that is relieved by sitting but returns when the patient stands or tries to walk
• General leg pain, tingling, weakness and numbness that radiates from the lower back into the buttocks and legs
• Lower back pain
• Lessening of discomfort when patient is leaning forward or sitting
• Worsening of pain when bending backward or standing
• Inability to walk moderate distances without experiencing pain
Symptoms of Spinal Stenosis in the Cervical Spine
Cervical spinal stenosis is far less common than lumbar spinal stenosis but can be more dangerous as the symptoms of the condition worsen. The compression of the spinal cord in the neck region often leads to painful symptoms across the entire body and can have a long-lasting negative impact on a patient’s quality of life.
The most common symptom reported by patients suffering from cervical stenosis is chronic neck pain. Neck pain is often accompanied by:
• Numbness or pain in the shoulders, arms or hands.
Symptoms of Spinal Stenosis in the Thoracic Spine
• Pain in the rib cage or internal organs
• Pain that radiates down the back of the legs
• Aching in the legs that leads to difficulty walking
• Problems with balance and coordination
• Problems with bowel or bladder function
Diagnosing Spinal Stenosis
Spinal stenosis may develop over time, which means many will not have any present symptoms until the condition is well developed. If the stenosis is caused by an injury, the symptoms may come on suddenly. If you are experiencing any symptoms of spinal stenosis, a physical exam and imaging studies can provide a correct diagnosis.
During the physical exam, the doctor may test your muscle strength, reflexes, and balance. They will also ask questions about the location of your pain, what makes it better or worse, and about any remedies you are using that have helped.
Exams & Tests
After a complete summary of your medical history and physical examination, imaging studies, such as an x-ray, CAT scan, or MRI can help identify if the spinal cord or a nerve is being compressed.
A myelogram, which uses dye to provide a high contrast image, may also be requested to provide a diagnosis.
Treatment for Spinal Stenosis
Treatment options for spinal stenosis range from conservative to the more aggressive and depends on the severity of the symptoms.
It is important to remember that although these conservative remedies may be helpful in alleviating some of the symptoms of spinal stenosis, they do not address the underlying pathology driving the symptoms and are not curative.
In the event that the symptoms have reached a level where the condition is debilitating and non-surgical treatments have failed to alleviate pain, surgery for spinal stenosis treatment may be required for long-term relief.
First, doctors may pursue non-surgical treatments to help the patient find pain relief. This can include:
• Physical therapy to strengthen the neck and back
• Pain management, with over-the-counter or prescribed medications
• Massage therapy
• Epidural steroid injections
• Lifestyle changes
• Hot/cold therapy
However, in some patients, the pressure on the spinal cord creates symptoms far too painful and debilitating to lead a productive life. In these cases, a surgical procedure is necessary to correct the underlying pathology and relieve the patient from pain.
Exercises for Spinal Stenosis
Physical therapists often direct patients to engage in back exercises developed to alleviate these symptoms. These back exercises commonly include a combination of specific stretching and strengthening routines. Forward bending exercises increase the size of the compressed passageways providing temporary relief from pain and strengthening the surrounding muscles to improve stability.
Some other forms of exercise spinal stenosis patients may engage in include:
• Stationary biking
• Tai Chi
Before beginning any new exercise routine, speak with your doctor about what is safe if you’re suffering from spinal stenosis.
Treatment & Self-Care
Along with conservative treatment, you may also complete some self-care at home to alleviate your pain. Some self-care methods may include:
• Topical pain relievers (i.e. Icy Hot or Biofreeze)
• At-home massage therapy
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Correct your posture when sitting and standing
• Stay hydrated
• Eat a nutritious diet
• Stop smoking and reduce alcohol consumption
• Maintain a healthy weight
Although each if these self-care methods will not take away your stenosis, it could reduce your symptoms.
Since spinal stenosis is at its core a condition that compresses the spinal canal, any surgery for spinal stenosis would have to relieve that compression in order to alleviate the symptoms associated with it.
The primary goal of any decompression surgery of the spine is to provide additional space for the constricted spinal cord, nerve roots or nerves to pass through. Once this space has been opened up, the pain, inflammation, and numbness associated with spinal stenosis should subside. A decompression surgery for spinal stenosis is performed in order to return any lost mobility or motor skills associated with the condition as well.
Our surgeons may perform an array of procedures to decompress the affected area and treat spinal stenosis. These procedures may include:
A foraminotomy/foraminectomy is a decompression surgery performed in order to increase the space of the foramen and hollow out the passageway where the nerve roots exit the spinal canal. The procedure involves the removal of bone or tissue that obstructs the neuroforamen and compresses the nerve roots leading to inflammation and radiating pain. The removal of part of the lamina is often necessary for the surgeon to gain access to the affected nerve roots in the neuroforamen. For this reason, the foraminotomy is often performed in conjunction with a laminectomy or laminotomy.
A laminectomy/laminotomy is a surgical procedure performed to treat spinal stenosis. The surgery is designed to relieve pressure on (decompress) the spinal cord or spinal nerve roots through the widening of the spinal canal. The procedure is carried out by removing or trimming part of the lamina (roof) of the vertebrae in the compressed area. The removal of part of the lamina creates an opening for the compressed nerves, relieving pressure on the nerve roots and reducing inflammation. The partial removal of the lamina may also allow the surgeon to remove any bone spurs or damaged tissue causing pain and inflammation in the patient.
A discectomy involves the removal of a portion of the intervertebral disc that is putting pressure on the spinal cord or radiating nerves. A discectomy may be performed as part of the treatment for spinal stenosis if the disc at the affected level is herniated.
Facets are joints in your spine that help stabilize your spine. However, misaligned facet joints can put pressure on a nerve. In many cases, growth called bone spurs can develop. A facetectomy involves removing part of the facet joint to reduce that pressure.
FACET THERMAL ABLATION
A Facet Thermal Ablation is a laser eradication of sensory nerves causing pain. During a Bonati Facet Thermal Ablation (Rhizolysis), surgeons vaporize irritated and painful nerves around the facets of the vertebrae.
We encourage you to contact us to request a no-obligation MRI review or discussion with one of our medical professionals. Find out why The Bonati Spine Procedures are considered to be among the world’s best solutions for spine problems..