Spinal stenosis

What is Spinal stenosis?

Spinal stenosis is a narrowing of the spinal canal in the low back (lumbar) area. It is classified as primary or secondary stenosis.

Primary stenosis is a congenital or developmental abnormality that causes the constriction. Secondary stenosis is caused by degenerative changes in the spine that occur as part of the natural aging process. The combined form occurs in individuals with small canals that undergo further constriction by acquired degenerative changes. Once the narrowing gets to a critical point, the blood supply to the nerve roots that supply sensation and motor power to the legs becomes compromised.

The three primary structures that contribute to spinal stenosis are the ligaments, joints and disc space. The diameter of the spinal canal varies with race, age and gender; but the diagnosis may depend less on the size of the canal than on the configuration of the canal. The stenosis may be central, lateral recess, and/or foraminal, depending on which region(s) of the spinal canal are involved.

How is it diagnosed?

History: The chief complaint of individuals is an intense pain brought on by walking (neurogenic claudication) or standing and is usually felt in one or both legs. The pain is often sufficiently intense to force individuals to stop walking and to sit in order to seek relief. Others may report that they are more comfortable walking uphill than downhill, or that they can walk farther if they bend forward while they walk.

Physical exam: Having the individual extend the spine may reproduce or exacerbate the symptoms. Flexing the spine reduces the symptoms.

Tests: Either MRI or a myelogram and CT scan in combination can accurately show the degree and extent of stenosis. A plain x-ray will not show spinal stenosis though it may be suggestive.

How is Spinal stenosis treated?

Pain medication, physical therapy and bracing all aid in the treatment. However, only surgery can actually enlarge the spinal canal. The "decompression" surgery is performed through an incision in the back. During the procedure the bony arches of the spinal canal and the ligaments are removed. Occasionally, portions of the facet joints need to be resected as well. If a sufficient portion of the joints are removed, then it may also become necessary to perform a fusion operation to stabilized the spine.

Medications

Soma (Carisoprodol), Motrin (Ibuprofen), Decadron (Dexamethasone), Medrol (Methylprednisolone)

What might complicate it?

Since secondary spinal stenosis is a result of degeneration of the spine, other degenerative changes of the spine may cause complications.

Predicted outcome

Spinal stenosis often runs a gradual course or symptoms may not worsen for several years. Surgery is successful in eliminating leg pain and allowing individuals to walk in about 80% to 85% of cases.

Alternatives

A spinal cord tumor and diabetes mellitus can produce some of the same signs and symptoms of spinal stenosis. Vascular insufficiency (atherosclerosis of the aorta and/or leg arteries) may produce similar symptoms.

Rehabilitation

Lumbar region: Physical therapy, three times a week, for a period of two to four weeks.

Appropriate specialists

Neurosurgeon, orthopedic surgeon, and physiatrist.

Last updated 23 June 2011


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