Spinal Stenosis
A Brief Anatomy of the Spine
The human spine comprises of 24 movable bones called vertebrae each held together by ligaments and discs. The discs are consist of a gel-like substance, that absorbs shock and keeps the bones from rubbing against each other. There are also joints called facet joints that join the vertebrae together and keep them flexible.
At the centre of each vertebra exists a hollow tunnel, which contains the spinal canal through which the spinal nerves and spinal cord runs, connecting the brain to the rest of the body. The nerve roots exit the spinal canal through an opening called the neural foramen (nerve root canal) to reach the other parts of the body.
Since both the spinal canal and neural foramen are surrounded by bones and ligaments, any changes in these bones can compress the spinal cord and nerves, causing spinal stenosis.
Spinal stenosis usually occurs after the age of 50, but it can also develop sooner, especially for people born with a smaller spinal canal. This condition is called congenital spinal stenosis. It can also occur anywhere in the spine (cervical, thoracic and lumbar). However, it occurs mainly in the neck (cervical spinal stenosis) and the lower back (lumbar stenosis).
Cervical Stenosis
When the central spinal canal or one or more neural foramina narrows down, it causes cervical spinal stenosis. It causes pain in the neck that can slowly radiate to your shoulders, upper back and arms. Muscle weakness and a decrease in motor function of hands are also other symptoms. Headache is also an early symptom of cervical stenosis.
The patient also may find he or she struggles to push or pull without the arm muscles becoming fatigued. The patient may even noticed numbness and pins and needles in the arms, hands and feet. There may also be a loss of coordination and dizziness.
Lumbar Stenosis
When the central spinal canal or one or more intervertebral foramina in the lumbar region narrow, it causes lumbar stenosis. This causes pain in the lower back and leg. It is also one of the reasons for sciatica. Lumbar Spinal Stenosis is more common than cervical stenosis
In extreme cases, it causes acute cauda equina syndrome, which is the compression of a group of nerves, the Cauda Equina, present at the lower end of the spinal cord. This is often a medical emergency
Symptoms of Spinal Stenosis
The symptoms of spinal stenosis slowly develop over time. It starts showing symptoms like pain in the spine itself or the neck, back, hands, legs or buttocks, depending upon the specific location in the spine where the stenosis has occurred. The following symptoms are commonly encountered in where there is stenosis in the spine.
- Sharp pain or dull ache especially in the calves when walking
- Numbness or tingling
- Muscle weakness
- Loss of balance or function
- Difficulty in walking (lumbar stenosis)
- Bladder or bowel difficulties in extreme cases
A common scenario we often see is in lumbar spinal stenosis is where a patient gets pain in the calves when walking on a level for 200-300 metres and then must bend or sit down to alleviate the pain. After 3-5 minutes the patient can get up and walk again but the cycle repeats. This would often be due to lumbar spinal stenosis.
Cervical stenosis would present with neck pain, numbness or tingling in the arms, hand, legs or feet. In some cases this may also present with loss of balance and coordination, weakness in the arm, hand, leg or foot or even loss of bladder or bowel control (severe cases)
Causes of Spinal Stenosis
- Bulging/Herniated disc: Vertebral discs tend to dehydrate and get smaller with age, and the gel-like material may break through the outer disc material called the annulus fibrosus, pressing the spinal cord and nerves.
- Thickened ligaments: Ligaments in the spine become stiff and thicken with age— and bulge into the spinal canal, pressing the spinal cord and nerves.The posterior longitudinal ligamentand the ligamentum flavum are two of the ligaments that can cause this to occur. This ‘thickening’ narrows the spinal canal and causes pressure on the spinal nerves.
- Osteoarthritis: The wear and tear from this condition prompt new bone growth in the spine— bone spurs, narrowing the space in the spine. These spurs may ‘pinch’ the nerves exiting the spine replicating symptoms of sciatica or cervical radiculopathy (in cervical spinal stenosis)
Other causes of spinal stenosis are:
- Spinal fracture or injuries
- Spinal tumours
- Scoliosis
- Congenital spinal stenosis
- Paget’s disease
- Fluorosis due to calcification in the ligaments in the spine
- Past spinal surgery
Diagnosis of Spinal Stenosis
Spinal stenosis diagnosis starts with a complete medical history and examination. A physical examination of the spine will follow, where your doctor will test different spinal segments to see if that brings pain, muscle weakness or other symptoms.
Often you will be asked you to bend your neck and lower back in different direction and to walk to observe your movements. There is also an examination to see see if a particular position causes you pain or discomfort or a reproduction of symptoms
After physical examination, your doctor may ask for imaging tests if required. These range from an X-ray to an MRI scan although on rare occasion a CT scan or even Myelogram may be requested. This is to determine the exact location of the source and the health of your spine.
Treatment for Spinal Stenosis
There are several conservative treatments to treat cervical and lumbar spinal stenosis. These treatments are tailored carefully to the patient as the wrong treatment may make things work.
Lumbar or Cervical traction in addition to specific muscle strengthening work (cervical and abdominal flexor muscles) is often the cornerstone of physical therapy rehab. Often patients find this helps greatly and in many cases surgery may be avoided If there is no relief, your doctor will move on with other treatments based on your symptoms.
- Oral Medication: Many non-steroidal anti-inflammatory drugs (NSAIDs) and other pain-relieving drugs like opioids and muscle relaxants help relieve the pain and inflammation.
- Injections: Injecting corticosteroid injections directly into the epidural space also help reduce the pain and inflammation from spinal stenosis. This injection is termed a Caudal Epidural.
- Osteopathy: Osteopathy helps reduce inflammation and improve the myofascial pain by physical manipulation techniques, stretching and massaging.
- Cervical Traction: Cervical traction is an effective treatment for relieving pain from Cervical spinal stenosis. It stretches and relaxes the spine and eases intradiscal pressure as well as opening the intervertebral Forman.
- Surgery: If the symptoms become intense and do not improve with other non-invasive treatments, surgery helps. Laminectomy, foraminotomy, laminoplasty, cervical corpectomy and spinal fusion are some of the procedures to treat spinal stenosis and these would be discussed with a surgeon. There is no known cure for spinal stenosis (unless it is caused from an acute mass effect in some cases) but there are many treatment strategies to alleviating the pain and strengthening the back. However, ignoring or delaying your treatment can cause severe pain, numbness in your legs and in some cases also cause paralysis.
Final Thoughts
Spinal stenosis is common in people above 50. It is a degenerative process and can come with back problems that occur with wear and tear and ageing. There are many things that can be done to help treat it or slow it down once it develops. If you suspect you have Spinal Stenosis or would like an assessment please book in at MyMSK Clinic via our booking page or Please call us at 0333 772 9655.
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