Spinal Stenosis

Spinal Stenosis

Spinal stenosis occurs when spaces in the spine narrow and put pressure on the spinal cord and nearby nerves. The narrowing can happen in the spinal canal, in the spaces between the vertebrae, or at points where the nerves from the spine branch out to other parts of the body. As the spaces get smaller, the tightness can pinch the spinal cord or the nerves around it causing pain, tingling or numbness in the arms, legs or torso. Spinal stenosis is most common in people over 50 years and is commonly caused by age related changes such as bone overgrowth or thickened ligaments.

There are two main types of spinal stenosis and one or both types can be diagnosed. Cervical Spinal Stenosis occurs when the spinal canal in the neck area becomes narrowed.

Lumbar spinal stenosis is the most common type, and it occurs when there is narrowing in the spinal canal in the lower back.

Causes

Stenosis often results from wear and tear on the spine due to arthritis. Arthritis can also cause the ligaments in the spine to get thicker, which can make the spinal canal narrower. With osteoarthritis, the cartilage between the joints breaks down. The vertebrae rub together and this can cause bone spurs (extra bone growth) which narrows the space within the spinal canal.

Symptoms

The most common symptoms are pain, numbness, weakness and stiffness.

Other spinal stenosis symptoms may include:

• Numbness, tingling and weakness in the arms and legs, caused by stenosis pressing on the spinal nerves
• Sciatica - shooting pain down the leg that starts as an ache in the lower back or buttocks
• Trouble standing or walking in the upright position due to compressed vertebrae causing pain
• Myelopathy - numbness, tingling or weakness in the arms and legs that results when spinal stenosis squeezes the spinal cord.
• Slapping the foot on the ground when walking caused by painful leg weakness
• Loss of bladder or bowel control - Spinal stenosis can weaken the nerves connected to the bladder or bowel.
• Cauda equina syndrome - when spinal stenosis compresses a section of nerves at the base of the spinal cord (the cauda equina), feeling can be lost in the pelvic area. This can cause bladder or bowel incontinence and permanent nerve damage if not treated immediately as a medical emergency.

All symptoms should be reported to a physician. Sudden loss of bowel or bladder function with back pain requires immediate attention.

Diagnosis

Spinal stenosis is diagnosed by:

• History and Physical examinations recording symptoms and motions or actions that cause pain
• Spine X-ray to show changes in bone structure like loss of disc height or bone spurs
• MRI (Magnetic Resonance Imaging) uses radio waves and magnets to create cross sectional images of the spine and detailed images of the nerves, disks and spinal cord.
• CT scan (Computed Tomography) is a combination of x rays that create cross-sectional images of the spine
• CT Myelogram uses a contrast dye to see the spinal cord and nerves clearly

Treatment

Conservative treatment options to help manage symptoms of spinal stenosis include

• Non-steroidal and inti-inflammatory medications to relieve inflammation and provide relief from pain
• Prescription medications
• Muscle Relaxants for muscle cramps and spasms
• Physical Therapy to gain strength and improve balance, flexibility and stability of the spine
• Corticosteroid injections - in the space around pinched nerves may help reduce inflammation, pain and irritation.
• Regenerative Medicine - these two procedures use the body’s own healing cells to to heal and stabilize the spine restoring spinal integrity and mobility
  Platelet Rich Plasma (PRP); uses the body’s own concentrated platelets and growth factors to repair soft tissues, reduce inflammation and improve muscle and ligament health.
  Stem Cell therapy (Bone Marrow Concentrate): can enhance regeneration of joint tissues, decrease inflammation and support long-term structural improvement.

These Regenerative treatments are most effective when combined with a targeted physical therapy program that focuses on improving spinal strength, flexibility and controlled mobility.

• Weight loss to reduce mechanical stress on the spine
• Smoking cessation to improve circulation and healing
• Anti-inflammatory nutrition emphasizing whole, nutrient-dense foods to support joint and muscle recovery

Surgery

The exact surgical treatment will depend on several factors specific to the condition. Multiple factors need to be considered when determining the best surgical treatment for any given patient. Many times, there is more than one way to treat a specific problem.

Some surgeries that might be considered for spinal stenosis if conservative treatment does not work include:

• Laminectomy decompression surgery. This most common type of surgery for spinal stenosis involves removing the lamina, which is a part of the vertebra. The surgeon may also remove some ligaments and bone spurs to make more room for the spinal cord and nerves
• Laminotomy - a small part of the lamina that is causing the most pressure on the nerve, is removed. This is a partial laminectomy.
• Laminoplasty - Surgery for cervical spinal stenosis (in the neck) that removes part of the lamina to provide more space.
• Foraminotomy - this procedure involves removing bone or tissue around the nerve roots to provide more room for the nerve roots.
• Interspinous Process Spacers - Spacers are inserted between the bones that extend off the back of each vertebra to keep vertebra apart and create more space for nerves. This is a minimally invasive procedure for lumbar spinal stenosis.
• Spinal Fusion - this procedure permanently fuses two vertebrae together when other treatments haven’t helped.