Spinal Stenosis: Causes, risk factors & treatment!

Spinal stenosis involves the condition in which abnormal narrowing of the spinal cavity & neural foramen occurs, which leads to development of pressure on the spinal cords & roots of the nerve.

TYPES

  • Cervical Spinal Stenosis
  • Lumbar Spinal Stenosis
  • Thoracic Spinal Stenosis

SIGNS & SYMPTOMS OF SPINAL STENOSIS

  • Standing discomfort 
  • Discomfort/pain, in shoulder, arm, hand
  • Unexplained weight loss
  • Gait disturbance
  • Bilateral symptoms 
  • Numbness at or below the level of involvement
  • Weakness at or below the level of involvement 
  • Pain or weakness in buttock / thigh only 
  • Radiating pain
  • Pain or weakness below the knee
  • Pinched nerve.

COMPLICATIONS

  • Cervical myelopathy
  • Clumsy & numb hands
  • Loss of bladder control
  • Loss of bowel control
  • Imbalance
  • Sexual dysfunction
  • Weakness that can progress to paralysis
  • Claudication, impairment in the legs
  • Paresthesia
  • Radiculopathy
  • Cauda equina syndrome
  • Degenerative disc.

CAUSES LEADING TO SPINAL STENOSIS

  • Thickening of the spinal ligament
  • Formation of bone spurs
  • Herniation of discs into the spinal canal
  • Breakdown of facet joints
  • Hypertrophy of facet joints
  • Compression fractures of the joints
  • Formation of cysts on the facet joints
  • Compression of the spinal sacs.

RISK FACTORS 

  • Degenerative disc disease
  • Osteoporosis
  • Osteoarthritis
  • Rheumatoid arthritis
  • Congenital defects in spinal cord, like narrowing of the spinal cord at birth.
  • Structural defects of the vertebra
  • Spondylolisthesis
  • Accidents & injury
  • Irregular growth of soft tissue
  • Spinal tumors
  • Paget’s Disease of the bone
  • Scoliosis
  • Achondroplasia.

DIAGNOSIS

  1. Medical history of patients are noted first, past incidence of cancer, trauma, accident, neurological damage, fever, night time disturbance and unexplained weight loss are potential red flags.
  2. Physical examination of areas where sensory abnormality, numbness, muscle weakness & radicular pain are seen.
  3. MRI is done for the accurate diagnosis & knowing the cause of spinal stenosis. Images are produced where nerve compression & muscle damage are seen.
  4. A radioactive dye is injected in the spinal cavity through a spinal tap, subsequently X-ray or CT scan are performed for detecting the narrowing of the spinal canal & diagnosis of spinal stenosis.

TREATMENT FOR SPINAL STENOSIS

Non-surgical treatment

  • Medications to relieve pain as inflammation, NSAIDs.
  • Severe pain can be treated with opioid medications.
  • Steroid injections in the spine for treatment of severe inflammation.
  • Physiotherapy

Surgical treatment

  • Lumbar decompressive laminectomy: Involves removing the top of the bone overlying the spinal canal and thickened ligaments in order to decompress the nerves and sac of nerves.
  • Interlaminar implant:  A non-fusion U-shaped device which is placed between two bones in the lower back to maintain motion in the spine and keep it stable after a lumbar decompressive surgery.
  • Surgery for cervical myelopathy
  • Anterior cervical discectomy and fusion:  Decompressing the spinal cord and nerve roots of the cervical spine by discectomy.
  • Laminoplasty, removal of the posterior parts of the spine to generate space in the spinal canal.

PREVENTION & MANAGEMENT

  • Weight loss & maintaining a healthy weight
  • Calcium & multivitamin rich foods & supplements
  • Aerobic exercises like riding a stationary bicycle & walking
  • Swimming.