Spinal Stenosis

What is Spinal Stenosis?

Spinal stenosis is a narrowing of the spaces within your spine canal, which compresses the nerves that travel through the spine. Spinal stenosis occurs most often in the lower back and the neck but can occur at multiple levels simultaneously. Spinal stenosis usually develops slowly over time. Spinal stenosis is also known as Pseudoclaudication, Central Spinal stenosis, Foraminal spinal stenosis

Types of Spinal Stenosis-

Depending on the location of the Symptoms of Spinal Stenosis, it is classified as 

• Cervical stenosis- Here, the narrowing occurs in your Neck Region.
• Lumbar stenosis- Here, the narrowing occurs in your lower back. This is more common among the People.

Note – It’s possible to have more than one type at the same time

Symptoms-

Some people with spinal stenosis may not have symptoms and may not even cause pain. But it may be confirmed by Imaging Tests such as MRI or CT Scan. When it occurs, The Symptoms often start gradually and worsen over time. 

Symptoms vary depending on Person to Person. You Might Feel the Following in your neck, back, arms, legs, hands or feet.

• Pain 
• Numbing
• Tingling
• Weakness 

In Addition to that, you May Also Feel –

• Problems with walking and balance
• Neck Pain
• In severe cases, bowel or bladder dysfunction
• Hard time Standing or Walking for a Long Time because of pain in one or both legs, which usually eases when you sit on a Chair.

Causes

Spinal stenosis has many causes. The Common Cause of Spinal stenosis is the Structural Change of the Spine Causing the Compression of the Nerves.

The Most Common Causes of these Structural Changes are –

Age – The most common cause of spinal stenosis is ageing. As you age, the space between your spine gets narrowed, causing compression of the nerves.

Bone Spurs – Bone spurs/ Bone Overgrowth commonly occurs due to osteoarthritis or due to Paget’s disease, which causes the formation of bone spurs, which can grow into the spinal canal and pinching the nerves from the spine.

Herniated disks – The soft cushions that act as shock absorbers between your vertebrae tend to dry out with age or breaks due to external factors like Trauma. These discs then cause the Gel Like Substances to go out, which compress the nerves around the spine.

Thickened ligaments – Ligaments are the fibre bands that hold the spine together. Thes Ligaments can become stiff and thickened over time due to Arthritis and can bulge into the spinal canal space. Resulting in the compression of the Nerves.    

Tumours – There may be an abnormal tissue growth within the spinal cord which can put pressure on the nerves coming out of the spine. These are very rare and can be detected by Imaging Test Such as an MRI or CT.  

Spinal injuries – Car accidents and other Trauma can cause dislocations or fractures of one or more vertebrae, narrowing down the canal space and Resulting in undue Pressure on spinal nerves.

Osteoarthritis – Osteoarthritis is the “wear and tear” condition that breaks down the cartilage in your joints, including your spine. Bones begin to rub against each other and may lead to the formation of abnormal bone growth. This can put pressure on your spinal cord and spinal nerves.

Congenital spinal stenosis is a Type of Condition where a person is born with a narrowed spinal canal. The issue Generally starts between the ages of 30 and 50.

Paget’s disease – With this condition, your bones grow abnormally large and brittle. The result is a narrowing of the spinal canal and nerve problems.

How is Spinal Stenosis diagnosed?

Medical History-

Your doctor will ask questions about your medical history and your Current Pain conditions. 

Physical Examination – 

Your doctor will do a Clinical examination by asking you to do some activities which will help him to Pinpoint the Cause of the Pain.

Imaging Tests – 

Depending on your Pain Condition, Your Doctor May Require Some Imaging Tests to Understand Your Condition Much better. These tests may include:

• X-rays – An X-ray of your Spine will reveal any Structural changes in the Bone, such as Bone Spurs. This Will Help to Identify if there are any Structural Causes which compresses your Nerves
• Magnetic resonance imaging (MRI) – An MRI uses a powerful magnet and radio waves to produce cross-sectional images of your spine. It can show tumours, growths, and even damage to discs and ligaments, which an X-Ray cannot Reveal.
• Computerized tomography (CT scan) – A CT scan takes several X-Ray Images from different angles. Computed softwares combines these Images to give an overall view of your Internal Body Structure. With the Use of Contrast (Dye) injected into your body, it can show damage to soft tissue and issues with your bones.

Treatment –

The Treatment you need for your spinal stenosis depends on where you have the Symptoms and how severe it is. Your doctor will recommend the Best Suitable Treatment for your Situation. These Treatments may Include –

Home Remedies

To Reduce the Pain, You can Try these Home Remedies like

• Exercise – Stretching and Strengthening exercises are recommended. But should be done under Doctor Guidance.
• Heat & Cold Packs – Heat Packs loosen up your muscles, and Cold Packs help reduce the swelling. Hot showers are also good.
• Practice Good Posture – A Good Ergonomic Sitting Position is recommended while you sit. Keep your spine straight while you stand. Sleeping on a firm mattress will help. A Pillow of height 3 inches is Recommended with it. And try to avoid lifting Heavyweights. And If you have to do it, get Someone’s Help. If not, Lift the Object by bending your knees and not your back.
• Lose Weight – Extra Body Mass will Put Undue Pressure on your back.

Medications

Initially, You are more likely to be Prescribed Medications. And these includes

• Pain relievers – Pain medications such as ibuprofen, naproxen and acetaminophen may be used temporarily to ease the discomfort of spinal stenosis. They are typically recommended for a short time only, as there are Side Effects if taken for a Long Period.
• Antidepressants – Antidepressants, such as amitriptyline, can help ease chronic pain.
• Muscle relaxants – These sets of Medicines will help to control muscle spasms.
• Nerve Related Drugs – Some anti-seizure drugs, such as gabapentin and pregabalin, are used to reduce pain caused by damaged nerves. You can take these to ease pain from damaged nerves.
• Opioids – Your Doctor may Recommend Opioids Drugs containing codeine-related drugs such as oxycodone and hydrocodone, which may be useful for short-term pain relief. Opioids may also be considered cautiously for long-term treatment. But they carry the risk of serious side effects, including becoming habit-forming.

Physical therapy –

Many Spinal Stenosis Patients become less active to avoid pain. Your doctor may recommend you to a Physical Therapist who will teach you some exercises to help strengthen and stretch your muscles.

Injections –

Corticosteroid Injections – These injections are injected into your spine, which can help reduce the inflammation and relieve some of the pain. It should be noted that these injections will not fix the stenosis but rather reduce the pain significantly. These Injections are maximum given 3 Times a Year.

Surgery – 

Suppose the above Treatment does not give a satisfactory response. Surgery may be recommended to treat spinal stenosis.

Surgery may also be recommended if it is 

• Affecting your ability to walk
• Control your bowel or bladder, 
• Affecting your Daily Routine activities.

Several types of surgery are used to treat spinal stenosis. The most common ones are-

• Laminectomy – Laminectomy is the most common type of surgery. A surgeon removes part of the vertebrae to provide more room for the nerves.
• Foraminotomy – Foraminotomy is used to widen the part of the spine where the nerves exit.

Spinal fusion – Spinal fusion is typically performed in more severe cases, especially when multiple spine levels are involved.