Lumbar and Cervical Spinal Stenosis

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Lumbar and Cervical Spinal Stenosis - What Is It?

Spinal stenosis is a general term referring to the narrowing of spaces in the vertebral column.

Anatomically, individual vertebra interconnect in several places, making canals and holes through which nerves and the spinal cord pass. In spinal stenosis, pressure is put on the nervous tissue that traverses these openings. This pressure causes pain. It can also cause neurological problems, such as muscle weakness, numbness, or even loss of bowel, bladder and sexual function.

Spinal stenosis might also be found along the spinal canal, which is the passageway through which the highly sensitive spinal cord passes.

While spinal stenosis can be caused by many things, most cases are due to aging and the related presence of osteoarthritis. When osteoarthritis of the spine develops to the point where the intervertebral disk has worn away and bone rubs against bone, the body attempts to remedy this painful condition by forming bone spurs. Depending upon their location, these bones spurs may compress the spinal cord and/or nerve roots.

Also, degenerative changes in spinal ligaments can lead to stenosis. Spinal ligaments stiffen and thicken over time in many people. This, in turn, compresses and shortens the spine. The compression will put pressure on the nerve roots, and will likely cause pain or neurological problems.

About 75% of spinal stenosis cases are lumbar spinal stenosis (LSS), in the lower back.

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Symptoms of Spinal Stenosis

The signs and symptoms of lumbar spinal stenosis include:

  • leg and foot pain brought about by certain postures. This is called neurogenic claudication.
  • Sciatica pain
  • radiating pain, with numbness, tingling and weakness of one or both legs
  • Foot or gait problems, especially a slapping foot during walking. This is known as "foot-drop".
  • Loss of balance.
  • An extreme form of LSS – called cauda equina – interrupts bowel, bladder and sexual function and the weakness of the legs is severe. Cauda equina is a very serious form of lumbar spinal stenosis, and is a medical and surgical emergency.

In 25% of cases, stenosis affects the cervical area of the spine. Symptoms for cervical spinal stenosis include:

  • Pain in neck, back, shoulders and arms
  • pain, numbness, weakness, cramping in the arms.
  • Because stenosis in the neck area can exert pressure on the spinal cord, symptoms also may include weakness, and numbness in the legs and feet, and even bowel or bladder incontinence.

Sometimes diagnosing spinal stenosis is difficult, because the signs and symptoms are shared with other conditions. In these cases, medical imaging can be helpful.

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Causes of Spinal Stenosis

Most of the time spinal stenosis is caused by the degenerative changes associated with aging. Spinal stenosis can be categorized as primary, which is basically genetic. Other causes of spinal stenosis are:

  • Tumors, which press on the spinal cord and nerve roots. Most spinal tumors are found between the vertebrae and the spinal cord, but there may be in other areas, as well. Tumors can occur anywhere in the spine. They are usually from cancers that have migrated from another part of the body.
  • Injury from car accidents and other kinds of trauma pulls the spine out of alignment, putting pressure in abnormal places in the spine, including nervous tissue. In this case, the spinal cord and/or nerve roots can be affected.
  • Heredity, (including achondroplasia), or a small spinal canal present at birth will cause symptoms in younger people.
  • Paget's Disease, a bone disease in which bones enlarge and become deformed, can encroach on the spaces in the spine.
  • Flurosis, or an excess of fluoride in the body, can calcify spinal ligaments, which will compress and shorten the spine. This is not typically a cause of stenosis in the United States.
  • Ankylosing spondylitis
  • Ossification of the posterior longitudinal Ligament (OPLL)
  • Diffuse idiopathic skeletal hyperostosis (DISH)

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Diagnosis of Spinal Stenosis

Several forms of medical imaging can be used to diagnose spinal stenosis. They are:

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Spinal Stenosis Treatment

Of course, it's best to initially use a non-surgical approach to treating and managing spinal stenosis. The following may be helpful:

  • NSAIDS will reduce pain and inflammation. However, NSAIDS have side effects, and taking increasing doses will not treat the pain better. For this reason, it is best to carefully consider the use of NSAIDS in cases of severe pain. Also, overuse of NSAIDs can cause kidney damage.
  • Analgesics such as Tylenol can reduce pain but not inflammation. Overuse of analgesics can cause liver damage and drinking alcohol while taking analgesics can amplify these side effects.
  • Supplements such as chondroitin and glucosamine, may be helpful, but the jury is still out on how these affect spinal arthritis.
  • Rest and restricted activity with a gradual return is a common sense way to improve symptoms. Walking and biking are good bets for workouts.
  • Physical therapy that builds the strength and endurance of spinal muscles.
  • Back support belts may help.
  • Epidural injections might reduce inflammation and pain. Over the long term, injections have strong side effects.
  • The X-Stop is a new device that can be implanted into the spine of certain types of spinal stenosis patients. It helps to relieve symptoms by limiting how far back you are able to arch. Recent research show, however, that the X-Stop is not for everyone. In particular, if you have spondylolisthesis, you should not try the X-Stop.

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Surgical Treatment of Spinal Stenosis

The purpose of surgery for spinal stenosis is to relieve pressure on the spinal cord and/or nerves, and also to provide spinal stability.

The most common surgery performed for spinal stenosis cases is the decompressive lumbar laminectomy. In this procedure, the lamina and spinous process of the vertebra are removed. See pictures of the parts of a vertebra, if you need a reference. Other areas encroached upon by bone are trimmed down. Sometimes this procedure is accompanied by a spinal fusion.

Surgery is not a cure-all, so the decision to use it is a serious one, requiring careful consideration. Additionally, there are risks associated with surgery including but not limited to infection, damage to the nerves, deep vein thrombosis and a tear in the meninges at the place of surgery. If this occurs, a major complication may develop if cerebrospinal fluid (CSF) leaks through the skin, possibly leading to a meningitis infection. A tear in the meninges can also lead to arachnoiditis.

Most of the time surgery for spinal stenosis is performed on older people, so other complications may arise, depending on the patient's condition.

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Can your Prevent Spinal Stenosis?

Stretch your hip abductors while sitting.
Stretch your hip abductors while sitting.

While technically speaking it's not possible to prevent arthritis (and spinal stenosis is a potential consequence of arthritis,) employing a few common sense measures help you avoid - or at least minimize - the development of this condition.  Here are a few tips:

  • Maintain an ideal weight to avoid placing extra compressive stress on the spinal bones.
  • Stretch and develop your range of motion.
  • Use good body mechanics when lifting.
  • Exercise regularly. Developing core strength will help support your back during activities of daily living. Pilates is a good core strength workout - by placing emphasis on the eccentric phase of muscle contraction, it provides traction to the spine, having a space increasing effect.
  • If you smoke, stop.

Related:  Smoking's Effect on the Spine

Sources

American Association of Neurological Surgeons "Your Aging Back: Understanding Lumbar Spinal Stenosis" Medem Medical Library. 2000. http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZ40VRYX6C&sub_cat=178 (December 18, 2005)

The Cleveland Clinic Health Information Center. "Spinal Stenosis". The Cleveland Clinic. 1995-2005. http://www.clevelandclinic.org/health/health-info/docs/3600/3698.asp?index=12096 (December 18, 2005)

The Mayo Clinic Tools for Healthier Lives - Pain. "Spinal Stenosis". The Mayo Clinic. April 19, 2004. http://www.mayoclinic.com/health/spinal-stenosis/DS00515/DSECTION=1 (December 18, 2004)

National Institute of Arthritis and Musculoskeletal and Skin Diseases - Health Topics. "What Is Spinal Stenosis? Fast Facts: An Easy-to-Read Series of Publications for the Public" The National Institutes of Health. September 2005. http://www.niams.nih.gov/hi/topics/spinalstenosis/ff_spinal_stenosis.htm

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