What is Spinal Stenosis?
Any individual who suffers from back, leg, or arm pain may find that they have some form of spinal stenosis. A stenosis is an unintended narrowing of a channel in the body. In the case of spinal stenosis, it refers to the space in the spinal column where the spinal nerves or cord reside. The narrowing of this channel, of course, results in the pinching or compression of the nerves. This condition causes pain in a variety of places on the body, depending primarily on where in the spine the narrowing occurs.
Sciatica, a common symptom of lumbar stenosis, presents as pain, weakness,
tingling or a numb sensation in the leg or buttocks and low back.
Cervical stenosis, on the other hand, is more often identified with pain in an arm. This can be paired with problems coordinating movement.
Narrowing of the spinal canal is usually part of a progressive degeneration of the spine. Some people do not sense the stenosis, but at some point, most will experience at least some of the symptoms:
- Weakness
- Numbness
- Pain that radiates
A small percentage of individuals have a congenital form of this condition from birth, but the majority find it comes with the aging of the body.
How is Spinal Stenosis Diagnosed?
While various tests are required to determine the location and/or type of stenosis, there are common symptoms. Spinal stenosis does not typically have a sudden onset, but is more likely to develop over time. It is not a constant pain, arriving and disappearing in unpredictable intervals. Temporary relief is normally found by either sitting or reclining or being in a position that is bent forward. The flexed forward positioning opens the spinal canal and stretches the ligament, thus relieving pain in the leg. Returning to standing will bring the onset of pain.
Most often, diagnosis of spinal stenosis is made through imaging with an MRI scan or a CT scan with an X-ray dye in the sac of spinal fluid. The use of the dye provides a better view to identifying possible causes for the stenosis that emanate from soft tissues. These can include bulging or herniated discs as well as thickened ligaments, all of which can impinge on the nerves. Because the symptoms of the stenosis are variable, it is not always possible to diagnose it through physical examination.
In the case of cervical stenosis, an additional procedure for diagnosis is known as a selective nerve root block. This involves identifying a nerve thought to be involved in the symptoms and injecting it with a local anesthetic. If a remission of the symptoms follows the injection, the source of those symptoms can be determined, thus possibly aiding in the reduction of any necessary surgery’s size and its complex nature.
Treatment Options
Surgery is not the only treatment for spinal stenosis. A prescribed regimen of exercise is included in almost every course of treatment. While not seen as a cure, it is intended to maintain flexibility and mobility through building strength. A partner to exercise is modification of one’s activities, avoiding those that aggravate the stenosis symptoms and substituting some positions for others. Maintaining the forward bend in a variety of activities and using a reclining chair as opposed to sitting up straight are some examples of those modifications.
Injections of cortisone in the epidural space have long been used to provide temporary relief for the symptoms of spinal stenosis. There are concerns about the risk of fractures in patients who have osteoporosis, and long-term effectiveness of corticosteroids, has been questioned. As with almost any medical treatment, risks must be weighed against benefits.
Oral medications of various types can be useful in relieving the symptoms of stenosis. Aspirin, ibuprofen and other anti-inflammatories have a role in treatment, as do narcotics when patients suffer severe episodes of pain. Other physicians rely on muscle relaxers and sometimes also prescribe anti-depressants for pain relief.
It is always important to be aware of possible side effects. Doctors should also be properly informed of any allergies the patient has and any other prescription medicines the patient may be taking.
When surgery is indicated, a variety of approaches and techniques is in use. First and foremost, a correct diagnosis is essential. Adequate MRI or CT scan information is needed to identify the sections of the spine in which stenosis is occurring, so that none are left unaddressed in the surgery. The quality of today’s diagnostic imaging typically prevents any surprises in the operating room. Spinal stenosis decompression is a highly successful procedure. Patient outcomes are excellent and most people find themselves able to be more active post recovery.