Living with Spinal Stenosis
Your spine is one of the most important structures in your body, but you may not truly appreciate it until it starts to act up. The human spine is composed of 33 separate bones that house the spinal cord, the central nerve bundle that connects nerves throughout the body to the brain. The spine serves as a protective housing for this critical neural network, but it also fulfills many other functions like supporting the rib cage and providing flexibility to the torso.
Deep within the spine is the spinal canal in which the spinal cord rests. In older people with conditions like osteoarthritis or who have injured their spine, this canal may have narrowed and put pressure on the spinal nerves. This painful condition is known as spinal stenosis.
What Causes Spinal Stenosis?
Spinal stenosis is a narrowing of the spinal canal which presses on the nerves. This condition most often occurs in the neck or lower back. There are many potential causes of spinal stenosis ranging from congenitally narrow spinal canals to a back injury or natural wear-and-tear on the spinal vertebrae.
Among the most common causes of spinal stenosis are the following.
- Herniated discs—if the spinal discs that lie between vertebrae and cushion the bones deteriorate, then some of the gel in the discs may seep out and pinch the spinal canal.
- Bone spurs—when the spinal bones are damaged, bone spurs may develop. These bone spurs may press on the spinal nerves if left untreated.
- Cancerous growths—although uncommon, it is possible for cancer to appear within the spinal column and cause a narrowing of the spinal canal.
- Spinal injuries—an injury that fractures or dislocates a vertebrae may apply pressure to the spinal cord. In some cases, it may not be a bone or ligament that shrinks the canal but inflammation from the injury.
- Thickened ligaments—if the ligaments that hold spinal bones together add mass, then this hard tissue may compress the spinal canal.
- Congenital defects—some people are born with narrower spinal canals, making them more susceptible to spinal stenosis as they age.
- Scoliosis—an abnormal curvature of the spine may produce pressure on the spinal nerve.
Diagnosing Spinal Stenosis
There are some telltale signs that you have spinal stenosis. If you experience one or more of the following symptoms, you should see a physician as soon as possible.
- Numbness or tingling in an extremity.
- Weakness in one of your limbs
- Difficulty walking or maintaining balance
- Pain in the neck or lower back
- Bowel or bladder dysfunction
- Pain in the legs that eases upon sitting.
If your doctor suspects that you have spinal stenosis, then they may order an x-ray, MRI or CT scan. An imaging test will detect the presence of bone spurs, herniated discs or tumors, and more sophisticated testing can pinpoint the exact location of the spinal stenosis.
If your doctor does confirm a diagnosis of spinal stenosis, there is no reason to initially worry. In many cases, this condition can resolve on its own or with only minor adjustments to your lifestyle. For example, if you work at a desk, then you should learn the best way to maintain body positioning to minimize strain on your spinal cord. You should also learn to be more active throughout the day to slow the progression of the condition.
Treatments for Spinal Stenosis
There are many treatment options for spinal stenosis, but which one is right for you will depend on a number of factors including the cause of the condition and its progression. You should consult with your doctor prior to using any of the following therapies, as some may aggravate your condition.
- Physical therapy—most people respond to back or neck pain by limiting their activities, but this can weaken back muscles and worsen pain symptoms. That is why your physician may recommend physical therapy to keep you active. Physical therapy should strengthen key muscles, enhance your balance and improve back flexibility.
- Steroid injections—if swelling of nerves or surrounding tissue is a major component, then steroids may help ease symptoms. Steroids are an anti-inflammatory, but they also weaken bones and tissue, so you are limited in how often they can be used.
- Decompression—for patients with thickened spinal ligaments in the lower back, decompression therapy may be a treatment option. This therapy uses a needle instrument to remove material from the problematic ligament.
- Medications—many drugs may be used to treat spinal stenosis including opioid pain relievers, NSAIDs, antidepressants, and anti-seizure drugs. These drugs primarily relieve swelling and pain without treating the underlying health condition.
- Discectomy—if the spinal stenosis is related to a bulging disc, a discectomy procedure may be used to cut away a part of the disc that is pinching the nerve. In most cases, this may be completed using arthroscopic instruments with minimal incisions.
- Laminectomy—this surgical procedure removes some of the bone encasing the spinal canal, thereby allowing the canal more room. In certain circumstances, vertebrae may be stabilized with bone grafts or metal rods.
- Laminotomy—similar to a laminectomy, a laminotomy also removes part of the surrounding bone. However, much less bone is removed in a laminotomy; this allows the spinal canal to expand without seriously destabilizing the spine.
- Laminoplasty—a laminoplasty is only used on spinal stenosis in the neck. Some of the bone is cut vertically but not removed. Metal bridges are attached to the dissected cervical vertebrae, providing more room for the spinal canal without significantly compromising neck stability.
- Minimally invasive surgery—using high-precision instruments, a surgeon may remove a minor amount of bone. This not only maintains the structural integrity of the spinal column, but it also speeds recovery following surgery as well as limiting risks like inflammation and bone loss.
- Spinal fusion—by fusing two or three bones together, pain is reduced. The fusion can be minimally invasive and involves placing spacers between the vertebrae. A more involved fusion procedure would require bone grafts or metal bracers.
Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care
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