Spinal stenosis is an abnormal narrowing (stenosis) of the spinal canal that may occur in any of the regions of the spine. This narrowing causes a restriction to the spinal canal, resulting in a neurological deficit. Symptoms include pain, numbness,paraesthesia, and loss of motor control. The location of the stenosis determines which area of the body is affected. With spinal stenosis, the spinal canal is narrowed at the vertebral canal, which is a foramen between the vertebrae where the spinal cord or nerve roots pass through. There are several types of spinal stenosis, The most common forms are cervical spinal stenosis, at the level of the neck, and lumbar spinal stenosis, at the level of the lower back. Thoracic spinal stenosis, at the level of the mid-back, is much less common. In lumbar stenosis, the spinal nerve roots in the lower back are compressed which can lead to symptoms of sciatica . Cervical spinal stenosis can be far more dangerous by compressing the spinal cord. Cervical canal stenosis may lead to serious symptoms such as major body weakness and paralysis.
Signs and symptoms
The common signs and symptoms are standing discomfort (94%), numbness (63%), weakness (43%), bilateral symptoms (68%), discomfort/pain, in shoulder, arm hand (78%), buttock / thigh only (8%) and below the knee (3%). Neurological disorders are Pinched nerve, Intermittent neurogenic claudication. Symptoms occur with extension of spine and are relieved with spine flexion. Nerve root dysfunction causes objective signs such as weakness, loss of sensation and of reflex. Other signs and symptoms may include fever, nocturnal pain, gait disturbance, structural deformity, unexplained weight loss, previous carcinoma, severe pain upon lying down, presence of severe or progressive neurologic deficit , lower back pain [due to degenerative disc or joint changes, narrowing of spinal canal, nerve root canal or intervertebral.
Can be aging, due to which body's ligaments can thicken, bone spurs develop on the bone and into the spinal canal. Arthritis( Two types), heredity, structural deformities of the vertebrae may cause narrowing of the spinal canal and instability of the spine, or spondylolisthesis. Trauma and Tumors of the spine can also cause the disease..
Making the diagnosis of spinal stenosis involves a complete evaluation of the spine. The process always begins with a medical history and physical examination. Imaging studies (x-ray, MRI, etc.) are often used to determine the extent and location of the nerve compression.
The physical examination of a patient with spinal stenosis will give the physician information about exactly where nerve compression is occurring. Some important factors that should be investigated are any areas of sensory abnormalities, numbness, irregular reflexes, and any muscular weakness. The MRI has become the most frequently used study to diagnose spinal stenosis. A spinal tap is performed in the low back with dye injected into the spinal fluid. X-Rays are performed followed by a CT scan of the spine to help see narrowing of the spinal canal. This is a very effective study in cases of lateral recess stenosis. It is also necessary in patients with a pacemaker as they cannot undergo an MRI.
- Non surgical treatment include education, Medicines to relieve pain and inflammation, exercise, weight loss, physical therapy and lumbar epidural steroid injections.
- Surgery includes Lumbar decompressive laminectomy , Interlaminar implant and Anterior cervical discectomy and fusion.