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Aug 05, 2006
Spinal Cord Stenosis
by SirGan
 Spinal stenosis is one specific condition characterized by a narrowing of spaces in the spine. This narrowing result in pressure on the spinal cord and nerve roots which can lead to a number of problems, depending of course on - which nerves are affected.In great majority of patients - spinal stenosis is accompanied with cramping, pain or numbness in legs, back, neck, shoulders or arms; a loss of sensation in extremities; and sometimes problems with bladder or bowel function.
Good thing about this condition is that in most cases- mild symptoms of spinal stenosis are often helped by pain relievers, physical therapy or a supportive brace. However, if we talk about some more serious cases of spinal stenosis, doctors may recommend surgery.
It is important to understand that this disorder usually involves the narrowing of one or more of three areas of the spine:
3. The openings between vertebrae through which nerves leave the spine and go to other parts of the body can also be affected. The narrowing may involve a small or large area of the spine.
It is important to recognize the symptoms because it is proven that pressure on the lower part of the spinal cord or on nerve roots branching out from that area may give rise to pain or numbness in the legs. Pressure on the upper part of the spinal cord may produce similar symptoms in the shoulders, or even the legs.
Different types of stenosisThere are three different types of stenosis and they include:
It is important to understand that when the nerve root is about to leave the canal through a side hole, a bone spur can press on the nerve root and in this case- we have foraminal stenosis. It is also called lateral spinal stenosis.
Most people have also heard about this type of stenosis. The mechanism is well studied! It is about a narrowing of the central canal can compress the sack of the horse’s tail called cauda equina. Central spinal stenosis is more common at the second lowest lumbar spinal level and above.
This is not so common type of stenosis. It is about compressing the nerve on the outside of the spine after it has left the spinal canal. The cause of compression could be from either a bony protrusion or disc bulge.
Signs and symptoms of Spinal cord stenosisSeveral researches done in the past have shown that spinal narrowing doesn't always cause problems. Problems or symptoms appear only it the narrowed areas compress the spinal cord or spinal nerves, you're likely to develop signs and symptoms. These often start gradually and grow worse over time.
The most common include:
Compressed nerves in your lower spine can lead to a condition called pseudoclaudication which is characterized by pain or cramping in legs when patient is standing for long periods of time or when walking for a long time. There is also one another type of intermittent claudication which occurs when there's a narrowing or blockage in the arteries in the legs. Although both types of claudication cause similar symptoms, there is one important difference- this type of claudication becomes worse when a patient walks up-hill and improves when standing still. Pseudoclaudication is usually worse when going downhill and gets better when you lean forward or sit down.
It is proven that a herniated disk can compress nerves in lumbar spine, leading to pain that starts in hip or buttocks and extends down the back of leg. The pain is worse when you're sitting and generally affects only one side. Some patients also may experience numbness, weakness or tingling in leg or foot.
This is not so rare symptoms and it is likely to occur when the nerves in neck are compressed. For this type it is characteristic that the pain may occur only occasionally or it may be chronic, and it sometimes can extend into arm or hand. Some patients also reported headaches, a loss of sensation or muscle weakness.
Logically, pressure on the cervical spinal cord can affect the nerves that control patient’s balance. That’s why- many patients complain on clumsiness or a tendency to fall.
In severe cases, nerves to the bladder or bowel may be affected, leading to partial or complete urinary or fecal incontinence. This happen when the damage is in low back affecting cauda equina!
Possible causes of spinal cord stenosis
Everyone probably knows that the main cause of spinal degeneration is osteoarthritis, an arthritic condition that affects the cartilage that cushions the ends of bones in joints. Problem is that, when body tries to help and repair the damage, it may produce even more damage because it is producing bony growths called bone spurs which then narrow the spinal canal.
There is no doubt- It is proven that by the age of 30, disks may start to show signs of deterioration. These bony formations begin to lose their water content, becoming flatter and more brittle. So, what happens? Well, logically- with time, disk's center to seep out which is causing pressure on the surrounding nerves, causing pain in back, leg or both.
Every patient should know that ligaments in back can also undergo degenerative changes, same as bones! So, they are becoming stiff and thick over time. This loss of elasticity may shorten the spine, narrowing the spinal canal and compressing the nerve roots.
Reasonably, tumors can also form inside the spinal cord, within the membranes that cover the spinal cord, or in the space between the spinal cord and the vertebrae. Problem is that these, primary or metastastic, tumors can occur anywhere along the spine, including the sacrum and thoracic spine, where osteoarthritis is rare. Growing tumors may compress the spinal cord and nerve roots. This can lead to several problems in sensory and motoric system!
Everyone knows that trauma can significantly affect the spine and spinal cord. Sometimes the spine or spinal canal may be dislocated, putting pressure on the cord and lower motor neurons. Results are devastating.
Because bone is also a living tissue, normally old bone is constantly being removed and replaced by new bone. In Paget's disease, your body generates new bone at a faster-than-normal rate. This produces soft, weak bones that are prone to fractures. It can also create bones that are deformed or abnormally large.
Although this isn't so common condition- it is important to know some facts about this genetic disorder. It is about slowing the rate at which bone forms during fetal development and in early childhood. As a result, people with achondroplasia are of short stature.
Diagnosis of Spinal cord stenosis
The fact is that this diagnostic tool isn't so helpful in making the right diagnosis but it can help in ruling out problems that cause similar symptoms, including a fracture, bone tumor or inherited defect.
Fact is that this is probably the best possible imaging test for diagnosing spinal stenosis. Instead of X-rays, an MRI uses a powerful magnet and radio waves to produce cross-sectional images of your back.
Similarly to X-ray- this test uses a narrow beam of radiation to produce detailed, cross-sectional images of body.
This may be the most sensitive test for detecting spinal stenosis, but because it poses more risks than either MRI or CT.
Every patient should know that, in this test, a small amount of a radioactive material bone is injected into vein in patient’s arm. It is simple – now the material emits waves of radiation that are detected by a gamma camera.
TreatmentTreatments for spinal stenosis could be divided into two big groups. One is surgical and the other is non-surgical methods!
Non-surgical methods
Surgical solutions
This procedure is in most cases the best option! In this procedure, surgeon removes the back part of the bone over the spinal canal to create more space for the nerves and to allow access to bone spurs or ruptured disks that may also be removed. There are also some risks such as infection, a tear in the membrane that covers the spinal cord, bleeding, and a blood clot in a leg vein.
In this procedure, just a portion of the lamina is removed to relieve pressure or to allow access to a disk or bone spur that's pressing on a nerve.
This method is used to permanently connect two or more vertebral bones in spine.
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