Spinal stenosis

Spinal stenosis is a medical condition marked by a narrowing of the spaces within the spine. This narrowing often puts pressure on the nerves that travels through the spine and may lead to compression of the spinal cord. Spinal stenosis mostly commonly occurs in the lower back or the neck. While some patients diagnosed with spinal stenosis may have no symptoms at all, many experience pain, tingling, numbness, and/or muscle weakness. The severity of symptoms may increase over time as the spaces within the spine grow narrower. In most cases, spinal stenosis is caused simply by aging or by wear-and-tear spinal changes tied to osteoarthritis. For many patients, spinal stenosis can be treated pharmaceutically with cortisone, nonsteroidal anti-inflammatory drugs (NSAIDs) or other medications. More severe cases may also require surgical intervention. The most common surgical procedures used to treat spinal stenosis include laminectomy, foraminotomy, and spinal fusion.

Background

The spine is a critical component of the human body that provides necessary structure and support and protects the spinal cord. The spinal cord is a column of nerves that serves as a link between the brain and the rest of the body’s nervous system. Many of the body’s functions, include those related to movement and the activities of the vital organs, are carried out through the spinal cord. As a result, the protection provided by spine is essential to keeping the spinal cord safe and functioning properly.

The spine is a series of twenty-four small bones, or vertebrae, that are stacked on top of one another. Together, these vertebrae make up a larger structure known as the spinal column. Each pair of vertebrae is separated by a soft, gel-like cushion called a disc that keep one vertebra from rubbing against the next. The vertebrae are held together by groups of ligaments that connect bone to bone and tendons that connect bone to muscle. In addition, the spinal column has joints called facet joints that connect the vertebrae and provide them with a certain amount of flexibility. Each vertebra has a hole in the center that forms part of a hollow tube that houses the spinal cord. The spinal cord branches off into thirty-one pairs of nerve roots that exit through either side of the spine via small spaces between each vertebra called neural foramina.

The spine as a whole is divided into three separate sections, including the cervical spine, thoracic spine, and lumbar spine. The cervical spine, which is made up of seven vertebrae that run through the neck, is the uppermost portion of the spine. The middle portion of the spine, the thoracic spine is composed of twelve vertebrae. The lumbar spine is the lower portion of the spine. While most people have five vertebrae in the lumbar spine, some have six. A group of specialized fused vertebrae called the sacrum is found below the lumbar spine. The sacrum forms the base of the spine and serves as the exit point for nerves that control bladder and bowel function and allow for sensation in the groin region.

Overview

Spinal stenosis is a common medical condition that occurs when the spaces in the spinal column narrow over time. This narrowing ultimately leads the spinal cord to become compressed. Spinal stenosis can occur in any part of the spine. Each type of spinal stenosis is categorized based on where in the spine it occurs. The two most common forms of spinal stenosis are cervical stenosis and lumbar stenosis. While cervical stenosis affects the vertebrae in the neck, lumbar stenosis affects the vertebrae in the lower part of the spine. Some patients may have more than one type of spinal stenosis at the same time.

The symptoms associated with spinal stenosis vary depending on where it occurs. Patients with cervical stenosis may experience numbness or a tingling sensation in the hand, arm, foot, or leg; weakness in the hand, arm, foot, or leg; difficulty walking or maintaining balance; neck pain; or bladder or bowel dysfunction. Patients with lumbar stenosis may experience numbness or a tingling sensation in the foot or leg, weakness in the foot or leg, pain or cramping in one or both legs when standing for long periods of time or walking, sciatica, or back pain. Pain caused by spinal stenosis may worsen over time as the spine continues to narrow. In extreme cases, spinal stenosis can lead to permanent numbness or paralysis if the spinal cord is compressed for an extended period of time.

Spinal stenosis has many potential causes, all of which alter the structure of the spine in some way. The two most common causes of spinal stenosis are bone overgrowth and bulging disks. Osteoarthritis is a common age-related condition that breaks down the cartilage in a person’s joints. As cartilage breaks down over time, bones start to rub against each other and the body responds by growing new bones, or bone spurs. Vertebral bone spurs push into and narrow the spinal canal, which can pinch spinal nerves. Similarly, vertebral disks dry out and flatten over time. This can lead to cracking in the outer edge of a disk that allows the gel-like center to break through and press on the nearby nerves. Spinal stenosis can also be caused by thickened ligaments, spinal injuries, or spinal cord cysts or tumors. Spinal stenosis can sometimes also be a congenital disorder.

Treatment for spinal stenosis can vary depending on where it occurs and the severity of symptoms. Most cases of spinal stenosis can be treated with medication designed to provide pain relief. This often includes cortisone injections or nonsteroidal anti-inflammatory drugs (NSAIDs). Doctors also sometimes prescribe physical therapy to help strengthen and stretch a patient’s muscles. In more severe case, surgical intervention may be required. Laminectomy is a common type of spinal stenosis surgery that involves removal of part of the vertebrae to make more room for the nerves. A foraminotomy helps to relieve the symptoms of spinal stenosis by widening the area of the spine where nerves branch out into the body. Spinal fusion, in which bone grafts or metal implants are used to fuse parts of the spine together, may be performed in particularly severe cases where more than one part of the spine is involved.

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