Stenosis is a condition that can develop as a person ages, particularly in those over 50. It is characterized by a narrowing of the spinal canal, which places pressure on the spinal cord and nerves, because there is not enough room for them. It resembles placing a ring on your finger. If the finger becomes injured or inflamed, the ring constricts and causes pain. The pain caused by stenosis is typically focused in the low back area and can shoot down the legs and flare up after walking or exercising.
Narrowing of the spinal canal may be genetic. However, the primary contributing factor to the development of stenosis is degenerative disc disease. As the spine undergoes changes in stability, density and size, this can result in less space for and more pressure on the spinal structures.
When one area of the spine is injured, it is more likely that spinal health in other areas will fail. Conditions that may encourage the development of stenosis include scoliosis, osteoarthritis, rheumatoid arthritis, spinal tumors and trauma.
Symptoms of stenosis include a deep aching in the low back, buttocks and thigh, and intense numbness or pain in the legs and sometimes the shoulders. Symptoms can be brought on by walking and exercise. If you have stenosis, you may notice that pain is sometimes relieved by sitting or by a position in which the spine is flexed forward and bending over. Consequently, people with stenosis may walk with a hunched over posture and find that their pain worsens when bending backward. Severe cases of stenosis will display more serious symptoms such as loss of bowel and bladder function and loss of feeling in an arm/leg.
Outlined below are some of the diagnostic tools that your physician may use to gain insight into your condition and determine the best treatment plan for your condition.
In many cases, changing posture and using spinal injections can control the symptoms for a long period of time. Stenosis can be treated nonsurgically, but some cases require surgery in order to create more space around the nerves.
Pain can be relieved by flexing forward and bending over. Taking anti-inflammatories may be beneficial, especially ibuprofen products like Advil or Nuprin. Acetominophen (Tylenol) can be taken for pain, if you are allergic to ibuprofen. A physical therapy program can be followed that incorporates stretches and movements that extend the spine. Injections may be used to reduce inflammation and control pain symptoms. Try our home remedy exercises provided. Stop if they cause an increase in pain or symptoms.
The most common surgery to treat stenosis is called a laminectomy, which helps create more space for the surrounding spinal nerves.
The foramen is the natural passage or tunnel between the vertebrae of the spine through which a nerve root exits from the spinal canal on its path to a specific tissue or organ. When this foramen becomes narrowed, the nerve can become irritated or dysfunctional.
Removing bone and soft tissues to enlarge the passage for the nerve is called a foraminotomy. A foraminotomy is commonly performed as part of a decompression of the spinal canal itself. In some cases a foraminotomy may be performed from outside the canal and not involve any direct decompression of the central canal if the pressure is strictly on the nerve root. To perform this operation, specialized instruments are used to remove portions of bone from the laminae, facets and facet capsules.
This refers to any surgical technique which aims to free the space for the nerves in the spinal canal or foramena. A spinal decompression for stenosis can be performed in the cervical spine (neck), the thoracic spine, and in the lumbar spine. A decompression involves removing tissue which is constricting or compressing nerve structures. In some cases the spine becomes unstable and a spinal fusion is performed at the time of surgery.
A number of different surgical methods are commonly used to achieve a decompression, including: laminectomy, laminotomy, laminoplasty, foramenotomy, anterior discectomy. The ideal technique to use will depend largely upon the level of the spine that must be decompressed, the elements which are causing the compression (bone, disc, ligaments or other), the stability of the spine, and the surgeon's experience. Dr. John Regan is renowned as a physician who combines leading edge clinical practice with compassionate care to deliver the best patient outcomes.
In the laminectomy procedure, the spine is approached through a two-inch to five-inch incision in the midline of the back, and the left and right back muscles are detached from the lamina on both sides. The lamina is removed (laminectomy), which allows the doctor to see the nerve roots. The facet joints, which are directly over the nerve roots, may then be trimmed to give the nerve roots more room.
When the spinal canal becomes narrowed and the spinal cord and nerves are compressed, surgery may become necessary. One type of surgical procedure is called a laminoplasty, which refers to opening up the space of the spinal canal by splitting the laminae. The laminae, which, in simple terms are like a set of double doors over the spinal canal, are "swung open". First the spinous process (the "bump" you feel at the back of the spine) is removed. Then the central portion of the laminae is split and each lamina (right and left) is hinged open. The hinged laminae are kept open through bone struts, sutures, or other techniques. A laminoplasty can lead to marked enlargement of the space available for nerves and the spinal cord.
When the spinal canal becomes narrowed or the nerves compressed, a laminotomy can be performed to free up the space of the spinal canal by removing a portion of the lamina. The procedure involves making an incision into the layer of muscles and ligaments that sits on either side of the spine, and freeing up the attachments to the spinous process and lamina to expose the laminae to full view. Using a special instrument that removes little bites of bone, the lamina is gradually trimmed until sufficient bone is removed to free the compressed nerve This "unroofs" a portion of the spinal canal and resulting in enlargement of the space available for the nerves.
Although degenerating discs are the most common cause of spinal stenosis, spinal tumors, injury, bone disease and other conditions can lead to stenosis as well. For example, primary stenosis results from diseases that are present at birth, while acquired stenosis is typically the result of degeneration in the spine.
If pain interferes with your daily activities, you should consult a spine specialist to treat your stenosis. Leg pain that worsens is especially an indicator of spinal stenosis. This type of pain is not a normal part of the aging process.
Treatment for spinal stenosis aims at minimizing the effects and symptoms of the stenosis but does not stop the progression of degenerative changes. Adopting a healthy lifestyle that includes exercise can help prevent disc degeneration. Click here to learn more about degenerative disc disease.
If your pain is severe enough or if walking has become difficult, your physician may consider surgery as an option for you. However, nonsurgical, conservative treatments are usually effective at treating spinal stenosis.
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