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Definition
Spinal stenosis occurs when the spinal canal is narrowed or compromised, leaving inadequate room for the nerves.
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Causes and Risk Factors
The causes of stenosis vary. The condition may be either congenital or due to spinal degeneration. Anything that encroaches on the spinal canal can lead to stenosis. Examples are spur formation around the vertebral bodies, distortion around the vertebral joints or swelling of the joint's capsule; displacement of the yellow ligament or thickening of the vertebral body's lamina (thin bony plate).
A herniated disc is a type of spinal stenosis, although it is not called by that name because the clinical picture is different.
A few diseases can cause spinal stenosis. Among them are Paget's disease, a disease of unknown origin that causes abnormal growth and distortion of a number of different bones; and fluoridosis, due to excessive fluoride which can thicken bone and contribute to stenosis when there is a pre-existent narrowing of the canal.
In some cases, scarring and other postsurgical problems, like overgrowth of a spinal fusion, can lead to stenosis.
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Symptoms
Spinal stenosis usually affects the elderly. Symptoms include substantial back pain with variable leg pain and weakness associated with walking. The pain may become increasingly severe with standing and walking, and can usually be relieved by a short period of rest.
The nerve deficit symptoms - weakness, pain, pins and needles, coldness or loss of sensation in the limbs - have a more generalized and irregular pattern than in disc herniation. Coughing, sneezing or straining while defecating may aggravate the discomfort.
Unlike disc disease and other kinds of backache with an intermittent course, spinal stenosis generally becomes progressively painful over time.
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Diagnosis
After a complete medical history and physical examination, your physician may suggest radiologic studies, such as x-rays or an MRI (magnetic resonance imaging).
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Treatment
Treatment of the disease consists of rest (lying on one's side with hip and knees bent), painkillers, anti-inflammatory medications, support from a flexion corset or brace and gradual, appropriate exercise.
Conservative treatment consists of medication (aspirin and non-steroidal anti-inflammatory drugs), orthotics (an effective thoraco-lumbar spinal brace which keeps the spine in some flexion); exercise (such as a stationary bicycle); and behavior modification (a pushcart when shopping, gentle leaning forward when sitting, avoiding prolonged standing, and avoiding sleeping on the back without pillows under the knees).
If these treatments fail, surgery may be the answer. Using a procedure called decompression, the surgeon operates on the spine from the back and frees the nerve roots as they go out through their tunnel from the spinal canal through a smaller canal and into the legs. The bony parts forming the back of the spinal canal - including the spinous process, lamina and yellow ligament - must be removed to make room for the nerves. In some cases, spine fusion is necessary. Surgery can offer an 80 to 85 percent chance of improvement.
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Questions to Ask Your Doctor
Are any further tests required for a positive diagnosis?
Will you be prescribing any medication? What are the side effects?
What conservative measures can be taken to relieve the pain or prevent further deterioration?
Will surgery be necessary to relieve the pain? How is the surgery performed? What are the risks?
What results can be expected after surgery?
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