Spinal stenosis is a term used to refer to a narrowing of the spinal canal.
When the narrowing occurs in the center of the spinal canal, it can press on the spinal cord. If the narrowing occurs on the side of the spinal canal, it can press on the nerves; this can result in what is called a lateral recess stenosis or foraminal stenosis depending on whether the stenosis is in the lateral aspect of the spinal canal or in the neuroforamen where the nerve outlets are located. Both subtypes of spinal stenosis can affect the nerve in the region.
Spinal stenosis is one of the most common causes of back pain in Americans. In fact, about 70% of people with spinal stenosis have back pain. This can range from intermittent discomfort to severe and disabling spinal arthritis pain.
Many of those who suffer from spinal stenosis experience what is called neurogenic claudication. This results in leg pain or weakness when a person tries to walk a long distance. Eventually, the distance a person can walk is severely limited. As a result, these people may be disabled.
One of the common signs of neurogenic claudication is called the “shopping cart sign,” meaning that when a person with significant neurogenic claudication walks a distance, they begin to feel symptoms in their legs. When this occurs, they can simply sit for a few minutes and the symptoms may go away. However, many people will simply lean forward and lean on the cart for relief. The effect of leaning forward in the carriage opens up the spinal canal and provides more space for the spinal cord or nerves. Even a small amount of extra space can have a significant impact on how far/duration these people can walk.
There are many causes of spinal stenosis, but the most common cause is simple aging. As we age, our spine degenerates and a condition known as spondylosis develops. Spondylosis is the medical term for spinal degeneration or arthritis.
Spondylosis can occur in the lower back and is called lumbar spondylosis. It can also occur in the neck and is called cervical spondylosis.
When cervical spondylosis puts pressure on the spinal cord, it is called cervical spondylotic myelopathy (CSM); when cervical spondylosis affects a nerve in the upper extremity, it is called cervical spondylotic radiculopathy (CSR); and, when both the spinal cord and a nerve are associated with cervical spondylosis, it is called cervical spondylotic myeloradiculopathy (CSMR).
Unfortunately, there is no cure for spinal stenosis and it is a progressive disorders However, there are many treatments available that provide relief, including physical therapy, chiropractic, pain injections, and surgery.
Regardless of the treatment selected, it is important for people with spinal stenosis to stay active and exercise to keep the core muscles that support the spine strong.
For those who do not respond to conservative treatment, surgery may be necessary. The goal of surgery is to resolve neurogenic claudication and back pain. Simple decompression of spinal stenosis will usually relieve back pain and neurogenic claudication. Spinal fusion is rarely necessary.
One of the most advanced and well-tolerated treatments for spinal stenosis uses minimally invasive spinal surgery techniques. Using tiny cameras called endoscopes, specially trained spine surgeons can remove spinal stenosis using only very small incisions. Many innovative surgeons also use laser spine surgery techniques because the laser has the unique ability to vaporize areas of stenosis that would otherwise require more tissue removal to resolve.
Minimally invasive spine surgery is usually performed on an outpatient basis without the need for a hospital stay. It is done using small endoscopes or very small tubular retractors. Each of these techniques has its own indications but the result is the resolution of spinal stenosis through very small incisions designed to protect the overlying muscles of the spine. This minimizes any scarring and there is virtually no blood loss.
These types of surgical procedures do not require general anesthesia, so patients with heart conditions who might not otherwise tolerate a spinal procedure are not excluded.
Laser spine surgery offers the additional benefits of ablating the nerves of small joints that may be an additional source of back pain. The laser can also safely decompress painful discs.
All of these techniques are performed in a single setting so that all sources of pain are addressed in a single procedure.
Some innovative, minimally invasive spine surgeons now also use adult stem cells derived from the patient’s own bone to further minimize scar formation. These adult stem cells not embryonic stem cellsthey play an important role in the negative regulation of inflammation and pain reduction.
If left untreated, spinal stenosis can seriously affect your ability to walk.
However, today’s advanced minimally invasive spine procedures can resolve spinal stenosis and prevent progression during a simple outpatient procedure without the need for general anesthesia or spinal fusion.
Additional articles by author:
Sciatica treatment: