Spinal stenosis is the narrowing of the spinal canal. This leads to pressure on the spinal cord that causes tingling, numbness, pain, and muscle weakness. There are several causes for spinal stenosis, and it can be treated. People at risk for spinal stenosis are usually over the age of 50 or have been born with a narrow spinal canal. Anyone with degenerative bone or nervous system disease could also be at risk for spinal stenosis.
The usual causes of spinal stenosis are numerous. Some people are born with a narrow spinal canal. The damage done by osteoporosis is the most common cause of it. Overgrowth of bone in the form of bone spurs from the wear and tear of osteoporosis can grow into the spinal canal, putting pressure on the spinal cord. Paget’s disease, which also causes an overgrowth of bone, can also cause the bone spurs.
Stenosis often occurs in the neck and lower back. Cervical stenosis occurs in the neck and often results in neck pain, tingling or numbness in arms, hands and legs, and difficulty walking or balancing. Severe cases can result in the loss of bowel or bladder control. Lumbar stenosis in the lower back can result in tingling, numbness, and weakness in the legs or feet and can cause cramping in one or both legs.
Vertebral disks that have broken down and herniated from between the vertebrae it cushions can cause pressure and pinch the spinal cord. Ligaments that hold the vertebrae together can swell and encroach upon the space inside the spinal column.
Things that ultimately cannot be avoided can cause stenosis as well. Tumors growing near the spine can press into the spinal canal. Unfortunately, most of these cannot be detected with an MRI or CT scan. Spinal injuries as a result of an accident can cause pieces of the vertebrae to break off and irritate the spinal cord. Swelling in the immediate area can also push the spinal cord against the walls of the canal.
Symptoms of spinal stenosis include pain, tingling, numbness, or muscle weakness in the extremities. Some severe cases can also be accompanied by paralysis. Testing for spinal stenosis involves using medical imaging equipment like an X-ray or MRI, both of which will allow doctors to identify areas where bone spurs might be present or if any disks are bulging. In lieu of an MRI, a doctor might order a CT myelogram. A CT myelogram starts with injecting a contrast dye into the spinal column. The dye highlights the spinal cord and nerves. Then X-rays from multiple angles are used to identify any abnormalities.
Treatment for spinal stenosis depends on the severity of the condition. Mild cases can be treated with over-the-counter pain relievers. Prescription remedies are also available. Some anti-depressants such as amitriptyline, can ease the nerve pain. Neurontin and Lyrica, common anti-seizure drugs, can be used to ease pain resulting from damaged nerves. For more severe pain, opioids can be used but they are not recommended for long term pain management due to their addictive nature.
Physical therapy can be used to retain and build muscle strength and flexibility, as stenosis sufferers often become sedentary to avoid pain. Nerves can swell and become irritated in the areas where the stenosis is worse, and injections of corticosteroid can lower the swelling and reduce the pain.
If medication is not enough, there are procedures that can repair the stenosis. Decompression can be used to remove swollen ligaments that are pressing against the spinal cord. This procedure is only used on patients with lumbar stenosis. Surgical options, both invasive and non-invasive, are also available. Each surgery is dependent upon the type of stenosis the patient is suffering from.
A laminectomy removes the back part of a vertebra, called the lamina, that is causing the stenosis. A laminotomy is a similar procedure that only removes enough of the lamina to relieve the pressure on the spinal cord. A laminoplasty is only performed on cervical stenosis patients. It adds a hinge to the lamina, and metal is used to bridge the space in between the gaps in the vertebrae.
There are methods to treat spinal stenosis that are currently in the trial stages of development. Using stem cells to treat nerve degeneration can relieve some of the symptoms of stenosis.
Spinal stenosis can be a painful problem to endure. Thankfully, it is relatively easy to diagnose and there are several ways to treat it depending on the severity of the problem. There is no reason to live with pain every day.