Spinal stenosis : Causes-Symptoms-Diagnosis-Treatment

 What Is Spinal stenosis?

Spinal stricture is the narrowing of 1 or a lot of areas inside your spine. Less area inside your spine reduces the quantity of area on the market for your medulla spinalis and nerves that branch off your medulla spinalis. A tightened area will cause the medulla spinalis or nerves to become irritated, compressed or pinched, which may result in back pain and neuralgia.

Spinal stricture sometimes develops slowly over time. It's most ordinarily caused by degenerative joint disease or “wear-and-tear” changes that naturally occur in your spine as you age. For this reason, you will not have any symptoms for an extended time albeit some changes could be seen on X-rays or alternative imaging tests if taken for an additional reason. reckoning on wherever and the way severe your spinal stricture is, you may feel pain, numbing, tingling and/or weakness in your neck, back, arms, legs, hands or feet.

Spinal stenosis

The most frequent occurrence of spinal stenosis is the narrowing of a main canal in the spine This condition can have disabling effects but it doesn't necessarily mean that the person suffering from it has to suffer in silence A lumbar surgical procedure called decompression can be performed which helps patients with a spinal canal narrowing deal with the pain and other symptoms associated with this condition.

1. Musculoskeletal system

Medical terms

• Spinal stenosis is a narrowing of the spaces within your spine that can put pressure on the nerves that travel through the spine Spinal stenosis occurs most often in lower back and neck

• Some people with spinal stenosis may not have symptoms while others may experience pain and numbness or weakness in the arms and legs Symptoms can sometimes worsen over time

• Spinal stenosis is most commonly caused by wear-and-tear changes in the spine In severe cases of spinal stenosis doctors may recommend surgery to create additional space for the spinal cord or nerves

Types of spinal stenosis

The types of spinal stenosis are classified according to the part of the spine on which the condition occurs It is possible to have more than one type The two main types are: (1) cervical and (2) lumbar

• Cervical stenosis.Cervical stenosis is a narrowing of the spinal canal in the neck The condition may be caused by arthritis a tumor or another disease

• Lumbar stenosis.This condition is a narrowing in the lower part of the spine It is called spinal stenosis It may occur in one or more of your vertebrae (bones)

Where does spinal stenosis occur?

Spinal stenosis can occur anywhere along the spine but most commonly occurs in two areas:

• Lower back (lumbar canal stenosis).

• Neck (cervical spinal stenosis).

What is lumbar canal stenosis?

Lumbar canal pathology is the narrowing of the canal or the tunnels through which nerves and different structures communicate the canal. Narrowing of the canal sometimes happens thanks to changes related to aging that decrease the dimensions of the canal, as well as the movement of 1 of the vertebrae out of alignment.

The narrowing of the canal or the aspect canals that defend the nerves usually ends up in a pinching of the nerve root of the medulla spinalis. The nerves become progressively irritated because the diameter of the canal becomes narrower.

Symptoms of body part canal pathology embody pain, symptom or weakness within the legs, groin, hips, buttocks, and lower back. Symptoms sometimes worsen once walking or standing and would possibly decrease once lying down, sitting, or leaning slightly forward.

Who gets spinal stenosis?

Spinal structure will develop in anyone however is most typical in men and ladies over the age of fifty. Younger ones that are square measure born with a slim canal can even have spinal stricture. different conditions that have an effect on the spine, like spinal curvature, or injury to the spine will place you in danger for developing spinal stricture.

What are the parts of the spine?

Your spine (or backbone) could be a stack or column of twenty four bones (vertebrae) and the united bones of the os and bone. It begins at the bottom of your bone and ends at your pelvis. Your spine supports your body’s weight and protects your funiculus. every vertebrae encompasses a spherical front portion (the body), a central annulated gap (the spinal canal), flat bony areas (facet joints) wherever one vertebrae comes into contact with others on top of and below it, and bone sections on the perimeters (transverse processes) and back (laminae). a part of the plate referred to as the acanthoid method is that the ridge you're feeling after you run your pass on your back. Between every vertebrae body could be a flat, spherical pad referred to as Associate in Nursing disk that is a cushion or muffler. Ligaments square measure sturdy fiber bands that hold the vertebrae along, keep the spine stable and shield the disks.

The funiculus – the body’s “master cable cord” that sends and receives messages between the body (including muscles and organs) and also the brain – runs through the middle of the duct. it's utterly encircled by the bony components of the spine. Nerves roots square measure the initial phase of a bundle of nerve fibers that return off the funiculus and exit the back through aspect areas between the vertebrae referred to as the neural opening. The nerve fibers or “nerves” (the “mini cable network”) then withdraw to any or all components of the body

Symptoms Spinal stenosis

Many people have evidence of spinal stenosis on an MRI or CT scan but may not have symptoms When they do occur they often start gradually and worsen over time Symptoms vary depending on the location of the stenosis and which nerves are affected

In the neck (cervical spine)

• Numbness or tingling in the hands arms and legs

• Weakness in a hand, arm, foot or leg

• Problems with walking and balance

• Neck pain

• Pregnancy-related diarrhea can be very difficult to deal with

In the lower back (lumbar spine)

• Numbness or tingling in a foot or leg

• Weakness in a foot or leg

• Cramps and pain in your legs when you stand or walk long periods usually ease as you bend over or sit

• Back pain

When to see a doctor

See your doctor if you have any of the symptoms listed.

Causes Spinal stenosis

The backbone runs from your neck to your lower back The bones in the spine form a spinal canal which protects the spinal cord (the nerves)

• Overgrowth of bone.Damage to the spinal bones and osteoarthritis can cause bone spurs to develop in the spine These bone spurs grow into the spinal canal causing Paget's disease (bone overgrowth in the spine)

• Herniated disks.The soft cushions that act as shock absorbers between your vertebrae tend to dry out with age Cracks in a disk's exterior may allow some of the soft inner material to escape and press on the spinal cord or nerves

• Thickened ligaments.The tough cords that help hold the bones of your spine together can become stiff and thickened over time These thickened ligaments can bulge into the spinal canal

• Tumors. Abnormal growths will type within the funiculus, within the membranes that cowl the funiculus or within the area between the funiculus and vertebrae. These square measure uncommon Associate in Nursing classifiable on spine imaging with an magnetic resonance imaging or CT

• Spinal injuries.Traumatic injuries such as automobile accidents and other trauma can cause dislocations or fractures of one or more vertebrae The bone displaced from a spinal fracture may damage the contents of the spinal canal Swelling of nearby tissue immediately after back surgery also can put pressure on the spinal cord or nerves

Risk factors Spinal stenosis

Most people with spinal stenosis are over 50. Degenerative changes can cause spinal stenosis in younger people and other causes need to be considered These include trauma to the spine such as a fall and congenital conditions that affect bone and muscle growth Spinal imaging can differentiate these causes and symptoms

Spinal stenosis and walking problems

Spinal stenosis or Narrowing of the spinal canal is a condition that causes severe back pain This problem occurs when bones grow together and narrow the bony channel in your spine through which nerves pass to get out to the rest of your body When this happens you can't move as well often because there isn't enough room for nerves between the moving vertebrae Osteoarthritis is one of several conditions that can cause spinal stenosis Others include: Osteoporotic compression fractures Slipped discs (which themselves are caused by wear and tear on cartilage) and other types.

Spinal stenosis with neurogenic claudication

symptoms The symptoms of spinal stenosis depend on the location of the narrowing or blockage If the spinal cord is compressed it can cause weakness in a leg or both legs resulting in foot drop and difficulty walking Other possible symptoms include muscle pain and tenderness in the lower back and buttocks area Spinal stenosis causes compression of nerves exiting from the spinal cord at different levels from C2 to L5/S1 in adults If a nerve root is compressed this can cause shooting pains down an arm (radiculopathy) or leg (peripheral neuropathy).

Sciatica is a condition in which the sciatic nerve the spinal cord's largest nerve becomes pinched or irritated When this happens pain often shoots down into one hip or buttocks and can sometimes extend to the leg The pain's severity makes it hard for many people with sciatica to sleep through the night In most cases sciatica resolves on its own within six weeks Even so if symptoms last longer than three months without getting better or worse that means it might be something other than a musculo-ligamentary disorder In such cases you should contact your doctor as.

Is spinal stenosis a serious condition?

Spinal stenosis is serious when not treated In fact some patients with spinal stenosis experience such severe pain that they are unable to get out of bed However this is a rare occurrence for most people who have the condition.

Spinal stenosis is a condition that causes pressure on the nerves going to the legs arms and torso The spinal canal can become narrow due to bone spurs or other calcified tissues compressing it Signs of spinal stenosis may include burning pain in the legs weakness in the limbs and bowel or bladder incontinence Spinal stenosis treatment usually begins with non-surgical treatments like physical therapy and medication About half of people with mild to moderate spinal stenosis will see an improvement after these treatment options Some patients are candidates for surgery while others are not eligible due to other conditions such as arthritis or tumors.

Complications Spinal stenosis

Severe spinal stenosis may cause permanent damage if it is not treated

• Numbness

• Weakness

• Balance problems

• Incontinence

• Paralysis

Diagnosis Spinal stenosis

Your doctor will ask you about signs and symptoms discuss your medical history and conduct a physical examination Your doctor may order several imaging tests to help pinpoint the cause of your signs and symptoms

Imaging tests

These tests may include:

1. Myelography

• X-rays.An X-ray of your back can reveal bony changes that may be narrowing the space within the spinal canal Each X-ray involves a small exposure to radiation

• Magnetic resonance imaging (MRI).An MRI uses a powerful magnet and radio waves to produce cross-sectional images of your spine The test can detect damage to the disks and ligaments as well as the presence of tumors It can also show where the nerves in the spinal cord are being compressed by pressure

• CT or CT myelogram. If you cannot have an MRI your doctor may recommend computerized tomography (CT) This is a test that combines X-ray images taken from many different angles to produce detailed cross-sectional images of your body In a CT myelogram the CT scan is conducted after a contrast dye is injected The dye helps doctors see through bones and tissue The spine is outlined and the spinal cord and nerves can be revealed It can reveal herniated discs bone spurs and tumors

Treatment Spinal stenosis

 Spinal stenosis surgery

Treatment for spinal stenosis depends on the location of the stenosis and your symptoms

Talk to your doctor about the best treatment for your condition If your symptoms are mild or you aren't experiencing any your doctor may monitor them with regular follow-up appointments He or she may give you some home care suggestions that you can do yourself If these don’t work then he or she may prescribe medication to help ease the symptoms I recommend medications physical therapy and surgery If none of these treatments are helping perhaps you should consider other options

Medications

Your doctor may prescribe:

• Pain relievers.Pain medications such as ibuprofen (Advil Motrin IB others) naproxen (Aleve others) and acetaminophen (Tylenol others) may be used temporarily to ease the discomfort of spinal stenosis These painkillers are typically recommended for a short time only as there is little evidence that they have benefit from long-term use

• Antidepressants.Tricyclic antidepressants such as amitriptyline can help relieve chronic pain

• Anti-seizure drugs.Some anti-seizure drugs such as gabapentin (Neurontin) and pregabalin (Lyrica) are used to relieve pain caused by damaged nerves

• Opioids. Certain drugs that contain codeine-related drugs such as oxycodone (Oxycontin Roxicodone) and hydrocodone (Norco Vicodin) as well as drugs that contain morphine are useful for pain relief Opioids may also be considered cautiously for long-term treatment of chronic pain But they carry the risk of serious side effects including becoming addicting forming

Physical therapy

It's common for people who have spinal stenosis to become less active in an effort to reduce pain But this can lead to muscle weakness which can cause more pain A physical therapist can teach you exercises that may help

• Build up your strength and endurance

• Your spine should be flexible and stable when you are standing

• Improve your balance

Steroid injections

You may feel pain in the nerve roots where they are pinched when injecting a steroid medication (corticosteroid) into the space around impingement will not fix the stenosis but it can help relieve some of the pain

Steroid injections sometimes don't work for everyone Repeated steroid injections can weaken nearby bones and connective tissue so you can only get these injections once a year

Decompression procedure

With this procedure needles are used to remove a portion of the thickened ligament in the back of the spinal column to increase spinal canal space and remove nerve root impingement Only patients with lumbar spinal stenosis and a thickened ligament are eligible for this type of surgery decompression

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PILD is performed without general anesthesia which may be an option for some people with high surgical risks from other medical problems

Surgery

Surgery may be an option if other treatments have not helped or if you are suffering from symptoms that have affected your mobility The main goal of surgery is to relieve pressure on the spinal cord or nerve roots Surgery to decompress the area of stenosis by providing more space is the most effective way to relieve pressure and pain caused by a narrowing in the spinal canal A definitive way to try to resolve symptoms of spinal stenosis is to have a massage therapist perform the treatment

Surgeries for Spinal stenosis have fewer complications when performed by highly experienced surgeons Don’t hesitate to ask if your surgeon has experience performing a spinal stenosis surgery on patients with similar symptoms or if you have any doubts about the surgery If you still have concerns get a second opinion

Examples of surgical procedures to treat spinal stenosis include:

• Laminectomy.Laminectomy removes the back part of the affected vertebra This surgery can be called decompression surgery because it reduces pressure on the nerves by creating more space around them
  Sometimes a vertebra may need to be linked to adjoining vertebrae using metal hardware and bone grafting (bone fusion) in order to maintain the spine's strength

• Laminotomy.This procedure removes only a portion of the lamina typically carving a hole just big enough to relieve pressure in a particular spot

• Laminoplasty.This procedure is performed only on the vertebrae in the neck (cervical spine) It creates a hinge to open up the space within the spinal canal by connecting that space with another area of the spinal column Afterward metal hardware bridges this gap between those two vertebrae

• Minimally invasive surgery.This type of surgery does not damage surrounding healthy tissue so there is less need for fusions
  Tylenol is shown to reduce recovery time for sore muscles

When is spinal stenosis surgery considered?

Spinal stenosis is a very complex condition and most often requires surgery. Even if non-surgical options have failed, surgical treatment may be considered when all other treatments have failed. Talk with your healthcare provider about the alternatives available for you. When is the best time to get rid of your old clothes? Before or after a major event such as Christmas

• Your symptoms are intolerable and you can’t do or enjoy daily life activities

• Your pain is caused by pressure on your spine

• Walking and maintaining balance has become difficult

• You have lost bowel or bladder control or have sexual function problems

What are the surgical treatments for spinal stenosis?

Surgical options involve removing portions of bone growths that are crowding the spinal canal and pinching spinal nerves

Types of spine surgery include:

• Laminectomy:The most common type of surgery for this condition is called a laminectomy This involves removing the lamina which are portions of the vertebra that can be removed to make room for the spinal cord and nerves Some ligaments and bone spurs may also be removed during the procedure The procedure makes you feel better by relieving your symptoms
• In a laminectomy the lamina portion of the vertebral bone is removed
• Laminotomy:In this procedure only a small part of the lamina is removed – trauma to the nerve
• Laminoplasty:In this procedure performed in the neck (cervical) area most of the lamina is removed to remove more bone and metal plates and screws are used to create a hinged bridge across the area where bone was removed
• Foraminotomy:The foramen is the area in the vertebrae where nerve roots exit This procedure involves removing bone or tissue in this area to provide more space for the nerve roots
• Interspinous process spacers: This procedure is an open (minimally invasive) surgery for some people with lumbar spinal stenosis Spacer implants are placed between the bones called the spinous processes that extend off the back of each vertebrae called the spina coppi The spacers help keep the vertebrae apart to decrease compression on nerves in order to provide more space for nerves local anesthesia is given and involves removing part of the laminal layer
• Spinal fusion: This procedure is considered if you have nerve pain radiating from a spinal stenosis or instability in your spine and you have not been helped with other methods A laminectomy is usually performed first and bone removed during this procedure Spinal fusion surgery permanently joins two vertebrae together A procedure is used to create a bridge between two vertebrae which stimulates new bone growth The vertebrae are held together with screws rods or wires until the vertebrae heal and grow together The healing process takes six months to one year and usually takes longer when there is more damage in the spine

Is surgery for spinal stenosis safe? What are the risks of surgery for spinal stenosis?

All surgeries have the risks of infection bleeding blood clots and anesthetic reactions Other risks from surgery for spinal stenosis include:

• Nerve injury.

• A tear in the membrane surrounding a nerve or spinal cord

• Failure of the bone after surgery

• Need for additional surgery.

• There is no relief of symptoms or return of symptoms

How do I prepare for a spinal stenosis surgery?

Before having spine surgery quit smoking if you smoke Exercise on a regular basis (after checking with your healthcare provider first) and ask your provider if you need to stop taking any non-essential medications supplements or herbal remedies that you may be taking You should never hesitate to ask your healthcare team any questions you may have or discuss any concerns

What happens after spinal surgery?

If you have had a laminectomy you may be in the hospital for a day or two If you have had spinal fusion your hospital stay can last 3-5 days If older your rehabilitation facility may take up to two weeks before going home

You will be given pain medications and/or NSAIDs to reduce pain and swelling You may be given a brace or corset to wear for comfort You will likely be encouraged to get up and walk as soon as possible Your healthcare provider or physical therapist will recommend a light form of exercise right away such as walking swimming or doing some gentle yoga.The first two days after the surgery you may feel nauseous and dizzy due to medication you were given while you were

Taking hot showers and using hot compresses may help lessen pain Additionally using an ice pack may ease discomfort before and after exercise

How long does it take for the recovery period following a lumbar spinal stenosis surgery?

Most of the full recovery after spinal stenosis surgery and return to normal activities typically takes three months and more depending on the complexity of your surgery and the speed you are making in rehabilitation

When can I return to work after spinal surgery? The doctor will recommend that you take it easy for a couple of weeks The doctor will recommend that you take it slow for a couple of weeks after the operation

If you have had a laminectomy you will likely be able to return to work at a desk within a few days after returning home If you have had spinal fusion it is possible that you will be able to resume work within several weeks of your surgery

Potential future treatments

Clinical trials are underway to test the use of stem cells to treat degenerative spinal disease; an approach sometimes called regenerative medicine Genomic medicine trials are also being done which could result in new gene therapies for spinal stenosis

Alternative medicine

Integrative medicine and alternative therapies may be incorporated into conventional treatments to help you cope with spinal stenosis pain Examples include:

• Massage therapy

• Chiropractic treatment

• Acupuncture

If you are interested in these options speak with your doctor

Lifestyle and home remedies

You will have regular follow-up appointments with your doctor to make sure you are responding to treatment Your doctor may suggest that you incorporate home treatments into your life including:

• Trying pain relievers.Over-the-counter pain relievers such as Advil Motrin IB others and Aleve and Tylenol can help reduce swelling inflammation and pain

• Applying hot or cold packs.Some symptoms of cervical spinal stenosis may be relieved by applying heat/ice to your neck

• Maintaining a healthy weight.If you are overweight or obese your doctor may recommend that you lose weight Losing excess weight can reduce pain by taking some stress off the back and the lumbar region of the spine

• Exercising.Stretching can help open up the spine Speak with your doctor or a physical therapist about what type of stretching exercises are safe to do at home

• Using a cane or walker.These devices can help relieve pain by allowing you to bend forward while walking

Preparing for your appointment

If your doctor suspects you have spinal stenosis he or she may refer you to a doctor who specializes in disorders of the nervous system (neurologist) Your symptoms may also require an examination by a surgeon who specializes in disorders of the nervous system (neurosurgeon) Some people with spinal stenosis also need physical therapy

What you can do

Before the visit you might want to prepare a list of answers to the following questions:

• When did you first notice this problem?

• Has it worsened with time?

• Have your parents or siblings ever had the same symptoms you are experiencing?

• Do you have other medical problems?

• What do you take daily?

• What have you done to your spine?

What to expect from your doctor

Your doctor may ask the following questions:

• Do you have pain? Where is it?

• Do any positions relieve the pain or make it worse?

• Do not use the same knife that you used to cut the flowers for decorating Clean and dry the knife then put it back in its plastic case when your work is completed

• Do you feel more clumsy lately?

• Have you had any problems controlling your bowel or bladder?

• What treatments have you used already for these problems?

General summary

1. Spinal stenosis is a narrowing of the spinal canal leading to pressure on the nerves The disorder develops when the space between two vertebrae narrows or when bony growths (spurs) form inside the tunnel As a result the nerve roots are compressed and may become inflamed resulting in pain and numbness in areas innervated by that nerve The most common area to be affected is in the lower back and legs.

2. caused by scoliosis Scoliosis is a disease in which the spine has been curved due to an abnormality in the growth of bones When this happens it can put pressure on spinal nerves or cause muscle spasms resulting in pain and discomfort Nerves can become irritated as they are compressed against bone or other structures inside your body causing numbness and tingling sensations down both arms into each hand These symptoms can radiate down the back and legs which is called sciatica In severe cases where surgery may be necessary to alleviate pressure other symptoms include weakness and loss of sensation.

3. symptoms Symptoms of spinal stenosis vary widely so it is important to educate yourself about the symptoms that are specific to your condition The most common symptoms of spinal stenosis include pain numbness and tingling in the lower back area leg weakness or paralysis and a loss of bladder control Take note if you experience any new or different signs as well since this can be an indication that your condition is worsening Consult with your doctor if you are experiencing a change in symptoms or pain that continues for more than six weeks.