Spinal Stenosis
Spinal stenosis refers to the narrowing of the spinal canal. This narrowing causes pinching or compression of the spinal cord or nerves within the spinal canal, which can in turn lead to pain in the back, buttocks, thighs, and legs, as well as an overall decrease in physical activity. There are two basic types of spinal stenosis: Lumbar spinal stenosis is the result of narrowing of the spinal canal on the lower part of the spinal column, whereas cervical spinal stenosis affects the upper part of the spine. In most cases, spinal stenosis is the result of a degeneration of the spine, which occurs with aging.
Symptoms
Lumbar spinal stenosis usually causes pain, numbness, tingling, and/or burning in one or both legs (buttocks, thighs, calves) and in many cases a feeling of fatigue in the legs. The symptoms are typically worse when standing or walking and relieved by sitting down or leaning forward (for example, leaning forward on a grocery cart while shopping). Higher up the spinal column, cervical spinal stenosis can create painful sensations in the shoulders, arms, and hands. A feeling of clumsiness and a lack of balance may also accompany this condition if the spinal cord is being compressed.
Nonoperative Treatment
There are a variety of nonoperative treatment options available for stenosis. Your doctor may suggest:
*Medication. Initially, your doctor may prescribe analgesics to relieve the pain, along with anti- inflammatory drugs to reduce the swelling.
*An epidural steroid injection may be prescribed to provide temporary relief of acute pain and swelling for pain that radiates to the hips or down the leg. It is typically recommended that a patient does not received more than three epidural injections per year.
*Activity modification, that is, avoiding those things that cause increased pain.
*Exercise and physical therapy. These are special exercises designed to help build endurance, increase your flexibility, and stabilize your spine. Your doctor, along with a trained physical therapist, can determine the right program for your needs.
Surgical Treatment
If nonoperative treatments fail to effectively suppress the symptoms of spinal stenosis, your doctor may recommend surgery.
The goal of surgery is to simply widen the spinal canal and thus relieve the pain-inducing pressure on the spinal cord or the spinal nerves.
One commonly recommended form of surgery is called a decompressive laminectomy. This procedure creates more space for the nerves by effectively removing the roof (or lamina) of the vertebra with or without removing part of the disc or fusing vertebrae. Unstable areas of the spine may need to be fused with the use of rods and screws.
Stenosis can also be treated by a number of other surgeries:
*Laminotomy. This surgery specifically removes only a small portion of the lamina, thus relieving pressure on the nerve roots.
*Anterior cervical discectomy and fusion. This procedure involves relieving the condition called nerve root compression by removing the intervertebral disc through a small incision made near the front of the neck. The removed disc is replaced by a bone graft between the adjacent vertebrae.
*Cervical corpectomy. The removal of the vertebral body and adjacent intervertebral discs to allow decompression of the cervical spinal canal as well as spinal nerves. A metal plate and screws along with a bone graft is used to obtain a fusion. |
