Spinal Stenosis Explained
Spinal stenosis is described as the narrowing of the spaces involving the spinal structures. These spaces can be in between the individual vertebrae or between the vertebrae and the spinal cord known as the spinal canal which runs the full length of the spine.
Narrowing of these spaces can cause pressure on the nerves and can be minimal or very severe. Normally occurring in the lower back, the most frequently affected nerve is the sciatic nerve.
Causes Of Spinal Stenosis.Spinal stenosis may be an inherited condition called achondroplasia in which the person is born with abnormal bone growth and development.
Scoliosis or other curvatures may result in narrowing of the spinal canal due to the physiology of the affected vertebrae.In general, spinal stenosis is the result of the natural ageing process. Structural changes and inflammation of the spinal column can cause abnormal and extra growth of bony appendages called bone spurs. These can grow in to the spinal column and cause a great deal of pressure of the spinal cord. They can also grow outwards causing pressure on nerves and discs that are not directly adjacent to the spinal cord.
Osteoarthritis and rheumatoid arthritis can both add to the risk of narrowing of the spinal spaces, as they cause the tissues to become thicker and tougher, and these can eventually harden (calcify) and ‘block-up’ the spinal canal.Misalignment of the spine, known as spondylolisthesis, (when the vertebrae move), can cause the spinal canal to become displaced and restricted. This can cause a lot of nerve compression.
Signs And SymptomsThe narrowing process is normally quite slow so symptoms get progressively worse over time. Common symptoms are pain, tingling, numbness of the extremities and feeling stiff with aches.
In sever cases there may be such significant damage to the nerves that bowel or bladder function may be disturbed. This is a very serious problem and will definitely need medical intervention.
TreatmentsThe first treatment given would be a pain relieving medication, usually with an anti-inflammatory drug. Long-term use of analgesics and anti-inflammatory drugs will need to be carefully monitored by your doctor as the side-effects can be quite serious, including gastric bleeding. Sometimes the doctor will suggest the use of steroid injections to help reduce inflammation, but these cannot be used long-term due to their side-effects.
Occasionally the use of anaesthetic injections will be beneficial as they target the nerves and block pain messages.Changes in position or sleeping position may temporarily relieve symptoms as certain postures and stances help to open up the vertebral spaces; a chiropractor or physiotherapist will help you find these positions.
The use of a back brace may help stabilise the spine and help find a position that opens up the spaces.Exercise and stretching are vital in the treatment of spinal stenosis; by building-up muscle and strength, particularly of the abdomen, the spine will become much more stable. Exercise is vital prior to considering surgery as a good level of fitness will speed up the recovery process and will help metabolise and process the anaesthetic drugs used.
Surgery may be necessary, in order to remove the protrusion that has caused the narrowing and resulting nerve pressures. Commonly removed structures are bone spurs, disc protrusions and the lamina of the vertebra. In doing this the space is made larger and nerves become decompressed. Prior to surgery, extensive physical examinations and images must be performed in order to find out the exact cause and location of the stenosis. Choosing surgery should be considered when all other treatment options have been thoroughly tried.