Spinal Stenosis Pain Relief Strategies
Spinal Stenosis is the medical term for a narrowing of the spinal canal or foramina. The spinal canal is the space created within the spine through which the spinal cord passes. The foramina are the spaces between each vertebrae on either side where the individual nerves branch off and leave the spinal column. Accumulation of bone around the spinal canal or spinal foramina can put pressure on the spinal cord (central canal stenosis) or nerves as they leave the spine (foraminal stenosis). This condition is usually the result of degenerative changes in the spine. Nerves are sensitive to compression and need sufficient space to be able to function. Severe stenosis can cause back and leg pain along with nerve dysfunction.
Effects of Spinal Stenosis
The outer layer of tissue surrounding the spinal cord includes the various layers of meninges (dura mater, arachnoid mater, pia mater), and the spinal nerve roots. The thecal sac is the membrane that surrounds the nerve tissue. It is filled with cerebral spinal fluid that must flow freely in and around the nerves. A normal spinal canal has sufficient space to insure the free flow of fluid for proper neurological function. Inside a constricted spine, the diameter of the space is reduced which can lead to restriction of spinal fluid flow and compression of the spinal cord and nerve roots. This compression causes back pain with activities such as walking and climbing stairs.
Stenosis is typically found in seniors after age 60. Stenosis is most common in the low back and neck. These parts of the spine are susceptible to vertebral disc problems in midlife that can ultimately result in degenerative disc disease and stenosis. The physical signs of stenosis are a normal part of the aging process. However such symptoms may progress to the stage where pain and disability may require treatment.
Typical Causes of Spinal Stenosis
There are many potential underlying causes of spinal stenosis:
Disc herniations can push into the spinal canal. If the disc herniates directly backward it can cause what is know as a “mass effect” (mechanical pressure) on the spinal cord. This may be considered a stenotic condition. Herniations however do not generally disrupt neurological function of the spinal cord and most pain associated with a disc bulge will usually resolves in a matter of weeks.
Degenerative disc disease is when the intervertebral discs dehydrate and shrink causing loss of space between the individual vertebrae. This process may also cause disc bulges that may result in a reduction in the space needed by the spinal cord or nerve roots. This condition is also a natural part of the aging process.
Spondylolisthesis can cause stenotic symptoms. Sometimes the shifted vertebra can move far enough forward to actually push into the spinal canal. Under these circumstances, the stenosis is a result of the spondylolisthesis and not a condition in and of itself.
Osetoarthritis in the Spine may lead to spinal stenosis. As we age bone spurs (osteophytes) can grow in and around the spinal canal. Large symptomatic bone spurs can be difficult to treat without surgery.
Symptoms of Spinal Stenosis
Spinal Stenosis symptoms differ from person to person. Spinal stenosis is in fact quite commom as we grow older. However most people never develop any kind of symptoms. If symptoms do develop, they may be severe or mild. They may be persistent, or they may be intermittent or episodic (occasional). It is difficult to provide a clear clinical picture of a typical case of stenosis. Many of the usual stenosis symptoms are the same as many other types of lower back pain that involve nerve impingement (pinched nerves).
The actual symptoms experienced may include:
* Pain in the low back, hips or legs
* Weakness in the muscles of the arm or legs
* Numbness or tingling in arms, hands, legs or feet
Cervical Stenosis / Lumbar Stenosis
The location of the symptoms depends on where the spinal stenosis occurs in the spine. Cervical spinal stenosis can cause symptoms in the upper extremities, such as the arms and hands. Lumbar spinal stenosis may cause symptoms in the lower extremities, buttocks, hips, pelvis, legs or feet. Lumbar stenosis can cause what is known as sciatic pain, pain that runs down the leg. Lumbar stenosis symptoms tend to be worse when one is standing or walking. Certain stationary positions such as sitting or lying can relieve the pain.
Proper diagnosis of spinal stenosis begins with a physical exam and a patient history of the problem. If the symptoms are indicative of spinal stenosis x-rays will usually be taken to rule out any tumors or cancerous growths. It is alsocommon to perform imaging studies such as MRI, CT Scan or Myelogram. These will show greater detail than an x-ray, given that they can image nerves and soft tissues, as well as bone. After reviewing all the tests and interviewing the patient about the symptoms, the physician will make a recommendation for treatment. A good doctor should begin with the most conservative treatment options. Even if structural changes such as bones spurs are present beware of care providers who recommend back surgery early in the treatment regimen, as this option must be considered only as a last resort.
In cases of spinal stenosis it is always wise to get a second and possibly a third opinion. While structural changes such as bone spurs may be present, there is a good chance that stenosis is not the cause of the back pain.
Treatment For Spinal Stenosis
Spinal stenosis treatment can range from conservative to extremely invasive. This will depend on the seriousness of the condition and the symptoms involved. It is essential to fully understand the potential risks and benefits of all treatment choices prior to making a decision about the best treatment for your condition.
Conservative Treatment For Spinal Stenosis
Conservative treatment for spinal stenosis must always be exhausted before considering surgery. Conservative treatment will not usually resolve the structural changes associated with stenosis, but might often relieve the symptoms. Common forms of non-invasive or mildly invasive treatment include the following:
Pain Management Drugs
Physical therapy is the most common conservative treatment for Spinal Stenosis. Physical therapy for stenosis involves massage, stretching and therapeutic exercise. The success or failure of physical therapy depends on many factors including the cause of the pain, the degree of the stenosis and the compliance of the patient with the therapy exercises.
A primary objective of physical therapy is to stretch and strengthen the muscles of the back and hips. This helps restore proper spinal mechanics (posture and movement patterns) so that normal everyday activities such as walking and standing no longer aggravate the joints, nerves and soft tissues that are affected by the stenosis. Proper spinal mechanics are very important to reducing stenosis symptoms because a spine that has minimal space around the nerves has very little room for error before things start running into each other. Therefore the mechanics of the spinal movements must be very precise in order to avoid aggravating nerves and causing pain and inflammation of soft tissues.
Spinal Stenosis Surgery Options
Back surgery is the only treatment option that can do anything to alter the structural causes of spinal stenosis. Surgery should only be considered if the patient has rigorously tried physical therapy and other conservative treatment options.
There are several varieties of stenosis surgery. The most common surgery is the lumbar laminectomy. This surgery has been used for many years to address numerous spinal conditions. More recently this surgery has been used with limited success to treat many other spinal abnormalities. Laminectomy is one of the most invasive back surgeries there is. The surgery can be performed as a full laminectomy or a decompressive laminectomy. The laminectomy is often done in combination with a foraminotomy and/or a spinal fusion. A laminectomy and fusion is the most invasive and the hardest surgery to recover from.
Patients who do not improved with the appropriate conservative treatment do not always have a positive long-term outcome with back surgery for stenosis. This is because the amount of the amount of spinal muscle and bone that must be stretched, torn or removed from the spine causes so much para-spinal scaring. The scar tissue that is deposited in and around the spine as a part of the healing process can cause a whole new painful condition even if the structural cause of the stenosis is removed.
If surgery is necessary, be sure to consult with a number of different back surgeons and spinal specialists who are well versed in the least invasive procedures. Make sure that some of them are considered “conservative surgeons”. This means a surgeon who has a reputation for prescribing conservative treatment before surgery for spinal stenosis.