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.
Medical history: Conducting a detailed medical history
helps the doctor better understand the possible causes of your back
and neck pain which can help outline the most appropriate treatment.
Physical exam: During the physical exam, your physician
will try to pinpoint the source of pain. Simple tests for flexibility
and muscle strength may also be conducted.
X-rays are usually the first step in diagnostic testing
methods. X-rays show bones and the space between bones. They are of
limited value, however, since they do not show muscles and ligaments.
MRI (magnetic resonance imaging) uses a magnetic field
and radio waves to generate highly detailed pictures of the inside of
your body. Since X-rays only show bones, MRIs are needed to visualize
soft tissues like discs in the spine. This type of imaging is very safe
and usually pain-free.
CT scan/myelogram: A CT scan is similar to an MRI in
that it provides diagnostic information about the internal structures
of the spine. A myelogram is used to diagnose a bulging disc, tumor,
or changes in the bones surrounding the spinal cord or nerves. A local
anesthetic is injected into the low back to numb the area. A lumbar
puncture (spinal tap) is then performed. A dye is injected into the
spinal canal to reveal where problems lie.
Electrodiagnostics: Electrical testing of the nerves
and spinal cord may be performed as part of a diagnostic workup. These
tests, called electromyography (EMG) or somato sensory evoked potentials
(SSEP), assist your doctor in understanding how your nerves or spinal
cord are affected by your condition.
Bone scan: Bone imaging is used to detect infection,
malignancy, fractures and arthritis in any part of the skeleton. Bone
scans are also used for finding lesions for biopsy or excision.
Discography is used to determine the internal structure
of a disc. It is performed by using a local anesthetic and injecting
a dye into the disc under X-ray guidance. An X-ray and CT scan are performed
to view the disc composition to determine if its structure is normal
or abnormal. In addition to the disc appearance, your doctor will note
any pain associated with this injection. The benefit of a discogram
is that it enables the physician to confirm the disc level that is causing
your pain. This ensures that surgery will be more successful and reduces
the risk of operating on the wrong disc.
Injections: Pain-relieving injections can relieve back
pain and give the physician important information about your problem,
as well as provide a bridge therapy.
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Treatment
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.
What treatment options exist for spinal stensois?
1. Foraminotomy
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.
2. Surgical decompression
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.
3. Laminectomy
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.
4. Laminoplasty
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.
5. Laminotomy
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.
FAQs
What causes spinal stenosis?
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.
When should I see a doctor?
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.
What should I expect from treatment?
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.
When is surgery seriously considered?
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.
Click here for narrated videos of spine surgeries, procedures and what causes various symptoms. Click here to see medical illustrations that help you understand back and neck problems. Click here to see an exercise library that has special stretches that can relieve pain symptoms.
John J. Regan, MD is the author of the First Chapter of Minimally Invasive Spine Surgery: Clinical Examples of Anatomy, Indications, and Surgical Techniques.
Our spine Internet site acts as on-line spine encyclopedia. In addition, as a free community service, Spine Group Beverly Hills mails out Home Remedy Books on a limited basis to residents in Southern California. Click here to learn more.
We understand that traveling with a back problem can be difficult and unsettling. That’s why we enable you to set up a telephone consultation with Spine Group Beverly HIlls in advance, to determine if a trip would be worthwhile. Because this involves significant time for our practice to receive your information and diagnostics, and for Dr. Regan to review your case in advance of your call, there is a fee for this consultation. Click here to learn more.
The vast majority of back problems improve on their own or with nonsurgical treatment. There are a few warning signs, however, that may indicate serious spinal problems. If you experience any of these symptoms, seek medical attention immediately. Click here to learn more.
Want to tackle back or neck pain? Dr. Regan has developed an educational journal to help patients get Back to Life. Click here to download our latest Back to Life Journal.
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Recognize emergency symptoms
for back and neck pain Do you have weakness or numbness in a hand or foot?
Are you unable to raise your toe as you walk?
Do you have any loss of bowel or bladder control?
If you answered yes to any of these questions, click here.
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.
