Stenosis of the spine is characterized by abnormal narrowing of the spinal canal or the canal through which the spinal cord and various nerves passes. Due to this narrowing, the spinal cord and the nerves may get compressed and cause various neurological symptoms.
Types of stenosis of the spine
Stenosis of the spine is of two main types: Stenosis of the lumbar spine and Stenosis of the cervical spine. Thoracic spinal stenosis is a less common form of stenosis.
Lumbar stenosis: Compression of spinal nerve roots of the lower back area occurs in lumbar stenosis, producing symptoms of sciatica or compression of sciatic nerve.
Cervical stenosis: Compression of the spinal cord occurs in cervical stenosis making it far more dangerous than lumbar stenosis.
Causes of stenosis of the spine
The various causes are:
Age: Stenosis of the spine may develop due to normal age related changes occurring in the body such as thickening of the ligaments, development of spurs on the vertebral bones and wear and tear of facet joints and intervertebral discs.
Arthritis: Arthritis is associated with degenerative changes of the bones that may cause narrowing of the spine. There are two types of arthritis that affect human body: Osteoarthritis and Rheumatoid arthritis.
Hereditary abnormalities: An individual may be born with either a very small spinal canal or with structural deformities of the vertebral bones. Both of these defects can cause stenosis of the spine.
Spondylolisthesis: It is a condition characterized by unstable spine and slipping forward of one vertebral bone on another.
Spinal tumors: Tissue growth may occupy space in the spinal canal causing canal narrowing.
Trauma to the spine: Spine may get dislocated due to injuries leading to narrowing of a portion of the spinal canal.
Symptoms of stenosis of the spine
The various symptoms of spinal stenosis are:
- Numbness and weakness of the areas supplied by the compressed nerve root.
- Discomfort during standing with pain in the lower extremities in cases of stenosis affecting the lower back region. Symptoms are also increased on bending forward.
- Intermittent neurogenic claudication that is manifested as symptoms of numbness, weakness, heaviness and pain in the lower extremities on walking or prolonged standing. The symptoms disappear only after the patient sits and rests for a few minutes.
- Symptoms of radiculopathy i.e., weakness, numbness, loss of sensation and reflexes in either arms or legs.
- Cauda equine syndrome is manifested as lower extremity symptoms in association with loss of bladder and bowel control.
- Symptoms of sciatica: numbness, weakness and pain that radiate from the lower back region to the lower extremity and is worse with activity.
- In cases of cervical stenosis, more serious symptoms are produced including whole body weakness and paralysis. This happens due to compression of the spinal cord.
- Some of the other symptoms are: disturbances of gait, structural deformity, pain during rest and at night and lower back pain.
Diagnosing stenosis of the spine
A complete and thorough evaluation of the spine is required to diagnose stenosis of the spine. A detailed medical history is taken and a complete physical examination is performed. This is followed by conducting various imaging studies such as MRI, x-ray, CT etc. to determine the exact location and severity of the stenosis.
Medical History: A complete and detailed medical history of the patient is very important in making an accurate diagnosis of stenosis of the spine. Details are taken regarding exact type and location of symptoms, history of any injury or trauma to the spine and presence of any other illnesses such as osteoarthritis, cancer etc.
Physical examination: The physician conducts a complete neurological examination to find out the extent of neurological deficit caused due to the stenosis. He checks for signs of numbness, irregular reflexes and weakness of muscles.
Imaging studies: The most important imaging study that is used to confirm the diagnosis of spinal stenosis is MRI. It is superior to both x-ray and CT scan as it presents a view of more structures including muscles, nerves and ligaments in comparison to both x-ray and CT. MRI’s can exactly determine the cause of stenosis of the spine.
Treatment of stenosis of the spine
Treatment depends on the severity of the symptoms present.
Non-surgical treatment options: Symptoms of stenosis of the spine can be controlled by various non-surgical treatment options including, exercises, and activity modification and epidural injections. A suitable exercise program by a trained physical therapist is very important to relieve the symptoms and keep patients active. Patients are also advised to modify their activities, so as to avoid those activities that worsen their symptoms. Temporary relief in symptoms can be obtained by a steroid injection in the outer space between the membranes covering the spinal cord. Symptoms may also be relieved by taking anti-inflammatory medicines such as ibuprofen.
Surgical treatment: A decompression surgery may become necessary in those cases of stenosis of the spine that have severe disability due to the disease. The benefits of the surgery should be weighed against the risks before undergoing the procedure.
Filed under: Spinal Stenosis