Spinal Stenosis – Symptoms ,Causes , Diagnosis and Treatment

What is Spinal Stenosis?

The vertebral column runs from the neck to the tail and has stacked 33 vertebrae, while adults have 26 vertebrae because bones fuse with age. It protects the spinal cord and nerves from injury. It is a flexible column, as the vertebrae have space among them. However, the lowest vertebrae i.e., sacrum and coccyx, are fused and as a result, their movement is restricted. If the space among the upper vertebrae reduces then the condition results in spinal stenosis. The reduction in the availability of space within the spine reduces the space for nerves to branch off from the spinal cord. Moreover, it results in compression and irritation in the spine and nerves, often leading to back pain and sciatica. Usually, spinal stenosis occurs with age and is caused by osteoarthritis.

As discussed above the vertebral column consists of vertebrae. In addition, it consists of the transverse bone and laminae; a ridge-like part of the laminae is called spinous. Each vertebra has three parts i.e., body (round front portion), the spinal canal (ring-shaped opening), and facet joints (flat bony areas). The facet joints connect one vertebra to another. The intervertebral disk is a flat and round structure between the vertebrae that act as a shock absorber. The vertebrae are held together by ligaments that provide stability to spin and protect disks. Nerve fibers originate from the spinal cord and exit from the spaces between the vertebrae; these are known as the neural foramen. The initial segment of the nerve fibers is known as the nerve roots. The vertebrae are divided into three parts, based on their location. The vertebrae present in the neck region are known as cervical vertebrae, the vertebrae in the middle region are known as thoracic vertebrae and the vertebrae in the lower back is called lumbar vertebrae.

The following sections of the blog will discuss the spinal stenosis symptoms and causes, treatment for spinal stenosis, preventive measures, and prognosis.

Types of Spinal Stenosis

Usually, spinal stenosis can occur anywhere throughout the vertebral column, but the most common areas are lumbar vertebrae and cervical vertebrae and are known as lumbar spinal stenosis and cervical spinal stenosis, respectively.

Lumbar Spinal Stenosis

Lumbar spinal stenosis is also known as lumbar canal stenosis. It is associated with the narrowing of the space between the vertebrae in the lower part of the spine i.e. between the rib and the pelvic region. The lower back consists of five vertebrae. Being a degenerative condition it is likely to affect the elder section of the population; 60 or above. However, the changes in the lifestyle and developmental changes have made the progression of the disorder prominent among the younger section of the population. The two main conditions associated with lumbar spinal stenosis are degenerative spondylolisthesis and degenerative scoliosis. Degenerative spondylolisthesis is a condition in which one vertebra comes over the other, commonly caused by osteoarthritis of facet joints. Whereas, in the case of degenerative scoliosis curvature is formed in the spine and is associated with back pain.

Cervical Spinal Stenosis

It is a condition similar to lumbar spinal stenosis, however, the only difference lies in the part of the backbone. In this case, the narrowing of the space between the vertebrae occurs in the neck region. The diameter of the spinal canal becomes too small for the spinal cord and nerve fibres to pass through. This often results in a condition called myelopathy, in which the spinal cord is damaged. Similarly, damage to the nerve roots that exit the spinal canal is called radiculopathy.

Spinal Canal Stenosis Causes

Spinal stenosis can be caused by several factors, that all contribute to change in the structure of the spine, narrowing of the space between the vertebrae and around the spinal cord, and affecting the nerve roots that pass through the spinal cord. As a result, the spinal cord nerve roots become compressed leading to symptoms such as pain in the lower back and sciatica.

Following are the Causes of Spinal Stenosis:

Bone Spurs: The overgrowth of the bones can be due to Paget’s disease and Osteoarthritis. The bones in the spine overgrow in the case of Paget’s disease and compress spine. Whereas, osteoarthritis condition in which the wear and tear of the cartilage, including the spinal cord that results in the bones rubbing against each other and new bones, growing. This results in the overgrowth of the bones. The bone overgrowth is also known as bone spurs. The bone spurs in the case of the vertebrae extend into the spinal canal, and the space between the vertebrae reduces.

Vertebral Disk Bulging: As discussed above, vertebral disks act as shock absorbers in the spine. With the progression of age, the vertebral disk dries out and becomes flattened. In addition, the cracking of the outer edge of the vertebral disk breaks the gel-based centre of the disk. Therefore, such conditions result in the bulging of the disk. 

Thickening of Ligaments: The function of the ligament is to bind the spine together. Arthritis results in the thickening of the ligaments. The thickened ligaments then enter the space between the vertebrae. Thus resulting in the narrowing of the spinal canal.

Fracture / Injury in Spine: Any injury or fracture in the spine can narrow the space in the spinal canal and can increase pressure on the spinal cord and nerves.

Tumor / Cysts in Spinal Cord: Growth of the extra tissue or cell, known as a tumor within the spinal cord or vertebrae can reduce the space and can cause the problem of spinal stenosis. The presence of a tumor or cyst can itself be an indication of cancer in the spinal cord.

Congenital Spinal Disorders: a condition in which a child is born with a small spinal cord by birth. Similarly, scoliosis is a congenital condition in which the spine is of abnormal shape. Thus, both these congenital conditions have a higher tendency to cause spinal stenosis as age progresses.

Spinal Stenosis Symptoms

The occurrence of spinal stenosis symptoms may or may not be definite. The disorder can affect any part of the spinal cord. As discussed above the major areas affected are the lower back and the neck. The symptoms vary with the area of the spinal cord affected.

Symptoms of lumbar spinal stenosis (lower back) are as follows:

• The person experiences pain in the lower back. The pain can be tender or severe. It is not consistent; it comes and goes.
• Sciatica pain; a kind of pain starting from the butt and going to the entire leg or foot.
• Legs generally feel heavy and are accompanied by pain and cramps.
• The legs, foot, and butt feel numb.
• A longer period of standing and walking (especially downward walk) results in severe pain in the legs.
•  Reduction in the pain when body leans, bend slightly forward, upward walk, and sit.
•  Severe cases often result in loss of control over the bowel and bladder.

Symptoms of Cervical Spinal Stenosis (neck) Are as Follows:

• Severe to moderate pain in the neck.
• The arm, leg, hand, and foot feel numb, weak, and clumsy.
• Body balance gets disoriented.
• Common hand functions, such as writing, cooking, picking up articles get disturbed.
• Severe cases often result in loss of control over the bowel and bladder.

Diagnosis

The diagnosis of spinal stenosis is done with help of imaging tests. These tests help in the examination of the spine and determine the exact location, type, and severity of the problem.

 X-rays: X-rays emit a limited quantity of radiation and can reveal changes in the bone structure such as disc height reduction and the formation of bone spurs that narrow the spine’s space.

Magnetic resonance imaging (MRI): It creates cross-sectional pictures of the spine using radio waves and a strong magnet. MRI pictures show the nerves, discs, spinal cord, and the existence of any malignancies in great detail.

Computed Tomography (CT) scan: It is a series of X-rays used to produce cross-sectional pictures of the spine. A contrast dye is added to a CT myelogram so that the spinal cord and nerves may be seen more clearly.

Treatment

The treatment for spinal stenosis depends on the type, severity, and location of the pain in the spinal cord. Mild symptoms can be treated by self-care methods, while moderate symptoms may require physical therapy and medication. The severe symptoms can be treated by surgery.

Treatments For Mild Symptoms Are as Follows:

Heat treatment can provide great relief in pain due to osteoarthritis. The heat can be applied via heat pads. The heat pads help in regulating the blood flow, muscle relaxation, and reducing pain in joints.

Ice treatment can be an alternative to heating treatment, as some people who are sensitive to heat can get burns. Ice packs are applied for some time and then are released. The ice packs help in reducing pain, swelling, and inflammation.

Exercise can be the best method to get relief from pain in a long run. It strengthens muscles improves body flexibility and balance.  

Treatment Methods For Moderate Symptoms Are As Follows:

Medications: Several medicines are available to get relief from the pain. Non-steroidal anti-inflammatory medications (NSAIDs) that are commonly prescribed are ibuprofen, naproxen, and aspirin. However, the long-term intake of such medicines can lead to ulcers in the stomach, damage to kidneys, and changes in the stomach acid composition. Other categories of drugs that provide relief in the pain are the anti-seizure drug gabapentin and tricyclic antidepressants. Sometimes, opioids are recommended to provide relief from pain for the short term. To treat muscle cramps and spasms muscle relaxants such as cyclobenzaprine are given.

Physical Therapies: these therapies are conducted by well-qualified physio-therapists. They help patients to perform exercises that improve the condition of the back and reduce pain.  Physical therapies help in regaining back strength and improving body balance. Moreover, they help in improving the flexibility and stability of the spinal cord.

Injections: Injecting corticosteroids at the gap in the spine where nerve roots are compressed or worn portions of bone rub together can help relieve inflammation, discomfort, and irritation. However, because corticosteroids can damage bones and adjacent tissue over time, only a limited number of injections are normally administered (often three or four injections each year).

Treatment Methods For Severe Symptoms are as follows:

Laminectomy (decompression surgery): it is the most frequent form of surgery that includes removing the lamina, which is a part of the vertebra. Bone spurs and ligaments may also be removed. The operation relieves the symptoms by making room for the spinal cord and nerves.

Laminotomy: It is a partial laminectomy. Only a little portion of the lamina; the region generating the most pressure on the nerve, is removed in this surgery.

Laminoplasty: Part of the lamina is removed to provide extra canal space, and metal plates and screws construct a hinged bridge over the area where the bone was removed in this treatment, which is exclusively performed in the neck (cervical) area.

Foraminotomy: The nerve roots escape through the foramen in the vertebrae. The surgery is the removal of bone or tissue in this location to make room for the nerve roots.

 Interspinous process spaces: For certain persons with lumbar spinal stenosis, this is the least invasive operation. Spacers are placed between the spinous processes, which stretch from the rear of each vertebra. The spacers aid in maintaining the vertebrae apart, allowing for extra nerve space. The treatment includes removing a portion of the lamina while under local anesthetic.

Spinal Fusion:  Spinal Fusion is the presence of persisting nerve pain from spinal stenosis, which indicates that the spine is not stable, and other techniques have failed. Then this technique is followed. In this technique, the two vertebrae are permanently joined together. A laminectomy is typically performed initially, with bone taken during this treatment being utilized to construct a bridge between two vertebrae, stimulating new bone formation. Until the vertebrae heal and grow together, they are kept together with screws, rods, hooks, or wires. The healing process might take anything from six months to a year.

Prognosis

Prognosis is the prediction of a medical professional on the development of the disease and the outcome of the likely treatment. The spinal stenosis has slow progression and sometimes the symptoms are not very prominent. Usually, the most visible or noticeable symptoms are pain, numb feeling in the back, fore, and hind limbs; depending primarily on the type of spinal stenosis. Such symptoms can be treated via conservative treatments, such as pain killers and anti-inflammatory medicines. However, in case of severe conditions, surgical methods are adopted. The outcome of surgery largely depends on the medical history of the patient, severity of the disease, type of spinal stenosis, and healthcare habits adopted by the patient. It is important to highlight that arthritis of the spine can sometimes progress even after surgery and can develop new symptoms after surgery. These symptoms can be severe or may be of the same kind as the previous.