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Spinal
Stenosis
Overview/Definition
Symptoms
Potential Causes
Diagnosis
Treatment Options
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Overview/Definition
Spinal stenosis is a disorder in which the spinal canal narrows, leading
to back pain and leg pain that comes and goes with activities such as walking.
Although stenosis can occur in all areas of the spine, it most commonly affects
the lumbar (lower) spine. However when spinal stenosis occurs in the back,
it produces pressure on the spinal cord and may affect gait, bowel and bladder
function. Thus spinal stenosis almost always requires spinal treatment. Since
it most commonly results from a combination of aging and degeneration of
the spine, stenosis usually affects people over 60 years of age. However,
the disorder also occurs in younger people who have abnormally small spinal
canals from birth.
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Symptoms
Since spinal stenosis gives the spinal cord and nerves less room to move,
they can become irritated and inflamed. Stenosis in the lower back can cause
pain in both the back and legs, with the pain becoming worse when walking
or standing for a prolonged period of time. Rest, which takes pressure off
the nerve roots, may ease or even eliminate these symptoms.
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Potential
Causes
Anything that narrows the spinal canal makes the spinal cord and spinal nerves
vulnerable to pressure that may cause irritation and inflammation. Conditions
that can narrow the spinal canal include wear and tear of the joints (degeneration),
bulging or herniated discs, arthritis, swollen ligaments, facet joint enlargement
(hypertrophy), bone spurs and spondylolisthesis. Rarely, spinal
infection or tumors may mimic the symptoms of spinal stenosis.
Any activities that increase the demand for blood flow cause the blood vessels
to swell and enlarge. If the spinal canal has narrowed, it may leave little
or no room for the blood vessels to enlarge. This makes it difficult for
blood flow to increase, which causes pain. Weakness also results because
the nerves cannot get enough oxygen (which is carried through the bloodstream)
to meet the demand.
People who have a narrow spinal canal from birth are at risk for developing
stenosis earlier in life because even minor crowding inside the spinal canal
can cause pain.
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Diagnosis
The most common diagnostic tests used to determine the presence of spinal
stenosis are X-rays of the lower back and an MRI. In some cases, a CT
scan may be ordered, either in addition to an MRI or instead of one.
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Treatment
Options
Conservative Treatment
Spinal stenosis is a slowly progressive back problem that in its early stages
may respond to conservative care, such as pain
medications and rest. Your
doctor may also recommend physical
therapy and/or an epidural
steroid injection (ESI). In some cases, simply bending over can relieve the back and leg pain
caused by spinal stenosis, because bending over enlarges the spinal canal
so that the blood flow to the spinal nerves increases.
Surgical Treatment
Spinal stenosis may worsen over time, necessitating surgery. The main goal
of any surgical procedure is to remove the pressure on the nerve roots in
the lumbar spinal canal. The surgeon will therefore enlarge the tube of the
spinal canal and remove any bone spurs that are pushing into the nerve roots.
This procedure is called a decompression, or a decompressive laminectomy,
of the lumbar spine.
The surgeon may also have to remove a portion of the facet joints. The lamina
and facet joints normally provide stability in the spine. Removal of either
or both can cause the spine to become loose and unstable. If this occurs,
doctors will restabilize the spine by including spinal
fusion as part of
the procedure. In most cases, surgery to correct spinal stenosis is appropriate
only when the patient regards the pain as unbearable.
In the cervical spine, stenosis may sometimes require decompression from
the front, back or both front and back of the spine depending on the severity
of the stenosis.
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