Stenosis
What is Spinal Stenosis?
Spinal stenosis is a condition caused by narrowing of the spinal canal that leads to nerve compression.
Causes
Spinal stenosis may be due to a number of causes including disc degeneration with bulging, herniated discs, facet arthropathy/”arthritis”, malalignment such as spondylolisthesis, and several others. These conditions cause compression of nerves in or next to the spinal canal.
Symptoms
If stenosis occurs slowly and gradually over time, the body may adapt and cause no symptoms at all. Alternatively, if the body is unable to adapt or if there is an injury, symptoms may manifest. Depending on where the stenosis occurs, symptoms may affect the neck, shoulders, arms, back, or legs. If stenosis affects nerve roots, this often causes “radiculopathy” which is pain, numbness, tingling, or weakness in the extremities. If stenosis affects the spinal canal in the lumbar spine, this may cause the same symptoms mentioned above in addition to a heaviness in the legs with walking. This sense of heaviness is called “neurogenic claudication” and occurs when the spinal cord cannot receive enough blood supply to meet the demand of the nerves with activities. If stenosis affects the spinal canal in the cervical spine, nerve compression may lead to “myelopathy” which can cause gait instability, discoordination, difficulty with fine motor movements such as hand writing or buttoning buttons, and clumsiness.
Treatments
First line treatment includes physical therapy for core strengthening and lumbar stabilization. Epidural steroid injections to decrease inflammation may also be effective. If conservative treatments fail, surgical treatment may be indicated. In most cases, surgical treatment is elective, aimed at improving symptoms and functioning, rather than preventing neurologic complications. If, however, there is a progressive neurologic deficit or bladder dysfunction is present, urgent surgery is required. In the lumbar spine, usually a laminectomy without fusion is sufficient for relieving symptoms, unless an alignment abnormality such as a spondylolisthesis is present.
In the cervical spine, however, the spinal cord is much more delicate and cannot be manipulated. As such, surgical treatment takes place from the front of the spine via a discectomy and fusion (ACDF) or disc replacement.
Click here for more information on the value of exercise. Visit our YouTube Page for examples of actual surgery for stenosis of the cervical and lumbar spine. Click here for more information on minimally invasive surgery in general.
