Spinal Stenosis

This is a condition in which bony growth puts pressure on and narrows the space for the spinal cord as well as the nerves that exit from the spinal column. Understanding your spine and how it works can help you better understand spinal stenosis.

The vertebrae are the bones that connect to form the spinal canal. This is where the spinal cord resides. The stacking of the vertebra allow for passage ways for the nerves. These nerves exit from each level of the vertebra and therefore are named based on the location from which they exit. The spine is composed of 7 Cervical Vertebrae, 12 Thoracic and 5 Lumbar followed by the Sacrum and Coccyx, which is vertebra that are fused together.

Think of the nerves as electrical cables that provide muscle and sensory function to different areas of the body. These cables carry the messages that makes your hand write or your legs move in the act of walking. The cables also carry the messages in sensation that allows you to know that something is hot or cold.

Spinal nerves relay sensation in specific parts of your body. Pressure on the nerves can cause pain in the areas that the nerves supply. Pain in the buttocks that radiates down the leg — called sciatica — is caused by this pressure.

Printed with permission from Griffen LY (ed): Essentials of Musculoskeletal Care, Edition 3. Rosemont, IL American Academy of Orthopaedic Surgeons, 2005. p. 770.
In spinal stenosis, the patient may complain of pain in the neck or back as well as pain, burning, numbness and/or weakness in the extremities or buttocks. Patients sometimes report that leaning forward improves the symptoms and they can only walk for short distances because walking worsens the condition. These symptoms can be evaluated by several means, including x-ray, CT scans and nerve conduction studies which can lead to the diagnosis of stenosis or narrowing around the spinal cord or the nerves.

Degenerative changes of the spine are common developments as we mature, with up to 90% of the general population being affected. Spinal stenosis most often occurs in adults over 60 years old, although a small percentage are born with congenital stenosis that may progress symptomatically in early adulthood.

The most common underlying cause of spinal stenosis is degenerative arthritis with both bone and intervertebral disc changes. As the body matures, the discs that provide cushion for daily activities weaken resulting in degeneration and settling of the spine. This places extra stress on the facet joints that also begin to degenerate and lose the friction reducing cartilage. Together these changes result in bony changes that narrow the area around the spinal cord and the exiting nerves.

Non-surgical treatments option should be considered in treatment for spinal stenosis. These include, but are not limited to, physical therapy, traction modalities, use of anti-inflammatory (taken as directed only) medications, pain management evaluation with possibility of steroid injections and chiropractic care. These treatments should be used to restore function and mobility and reduce and improve upon pain.

Surgical treatment should be considered after non-operative treatment has been exhausted and is generally reserved for patients with a poor quality of life due to the symptoms. The mainstay of surgical treatments offered include decompression procedures and spinal fusion.

– Decompression involves removing bony elements of the spine to make more room for the neural elements
– Fusion surgery involves removing bony elements as in a decompression in combination with a fusion of the bones to promote stability. This typically involves the use of rods and screws to hold the spine in place, but also can involve an interspinous process device and other fusion techniques that are determined on a case by case basis.
– Interspinous Process Device is a spacer that fits between the spinous process in the back of the spine and is used to keep the space open while maintaining stability. These devices were approved for use in 2005

References: www.spine-health.com – Spinal Stenosis Symptoms, Diagnosis and Treatment by Dr. Charles Ray 8/7/09
www.spineuniversity.com – Lumbar Spinal Stenosis 9/28/07