Spinal stenosis indicates a pathological condition causing the compression of the contents of canal especially neural structures.The term stenosis means a narrowing of the calibre of an orifice or a tube which causes a decrease in flow of fluids or within the tube or compression of solid content.
This is usually due to the common occurrence of spinal degeneration that occurs with aging. It can also sometimes be caused by spinal disc herniation, osteoporosis or a tumor. Presence of congenital anomaly or a deformity may contribute towards spinal stenosis.
Spinal stenosis may affect the cervical, thoracic or lumbar spine. In some cases, it may be present in all three places in the same patient.
Causes of Spinal Stenosis
- Degenerative arthritis
- Tumors of the spine
- Infections of the spine like tuberculosis
- Paget’s disease
- Deposition on ligaments or ligamentous hypertrophy
- Congenital anomalies
- Disc Herniation
Spinal stenosis associated with degenerative arthritis is usually seen in patients over 50 years of age, and becomes progressively more severe with increased age. The normal “wear and tear” of ageing can cause arthritis in the spine that leads to spinal stenosis. This can be from bone spurs (osteophytes) forming, bulging and wear of the intervertebral discs, and thickening of the ligaments between the vertebrae.
Certain people are more likely to develop degenerative spinal stenosis than others. People that have a family history of spinal stenosis , chronic back problems,who are heavy laborers or athletes are at an increased risk.The symptoms of spinal stenosis depend on where the stenosis occurs in the spinal canal and how severe it is.
Symptoms of Spinal Stenosis
The symptoms would depend on the region involved in stenosis and structures under stress.
In cervical region, the degenrative stenosis typically causes myelopathy which presents with progressive weakness of upper limbs and lower limbs and spasticity. Loss of balance, frequent falling, inability to perform fine movements like buttoning buttons or picking up small coins. Loss of control of the bowel and/or bladder may occur at later stages.
Other kinds of stenosis may cause radiculopathy i.e. pain, numbness, tingling, or weakness along the path of the nerve being compressed.
In thoraccic spine would mainly present with weakness of lower limbs only. Bladder/bowel control may be lost in severe stages.
In lumbar spine the the symptoms caused by compression of the nerves are of radiculopathy. These can include pain, numbness, tingling, or weakness or cramping in the legs and feet, particularly progressively with walking and being relieved with resting.
The diagnosis is based on clinical history, detailed examination including regional examination and the investigations.
Xray, CT and MRI are the usual investigations that help in making a diagnosis. Magnetic resonance imaging or MRI is especially helpful in assessing adequacy of spinal canal.
Treatment of Spinal Stenosis
There are various treatments available for spinal stenosis depending on how severe the patient symptoms.
- Anti-inflammatory medications
- Oral steroids
- Epidural steroid injections
- Physical therapy
Surgery is used in patients who do not have enough relief from these nonsurgical measures. Goal of surgery is to relieve the neural structure of compression caused by stenosis.
In the lumbar spine, this is most commonly treated with a laminectomy. This surgery removes a portion of the vertebra (lamina) to create additional space for the nerve.
In the cervical spine, the most common treatment is an anterior cervical discectomy and fusion. If multiple levels are involved in the neck, one of more vertebrae can be removed. replaced by a bone graft replaces them along with a plate.
Laminectomy and laminoplasty are other procedures for cervical spine stenosis.
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