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 may press upon the spinal cord. If thenarrowingoccurs on the side of the spinal canal it may press upon the nerves - this may result in either what are termed 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 exits. Both of these sub-types of spinal stenosis may affect the nerve in the region.
Spinal stenosis is one of the most common causes of back pain for Americans. In fact, approximately 70% of people with spinal stenosis have back pain. This may range from intermittent discomfort to severe and disabling spinal arthritis pain.
Many of those suffering with spinal stenosis experience what is termed, neurogenic claudication. This results in pain or weakness in the legs as a person attempts to walk a long distance. Eventually, the distance a personis able towalk is severely limited. As a result, these people may be disabled.
One of the common signs of neurogenic claudication is called the "grocery cart sign", i.e., when a person with significant neurogenic claudication walks a distance, they begin to feel the symptoms into their legs. When this occurs they may simply sit down for a few minutes and the symptoms may resolve. However, many people will simply bend forward and lean on the cart to obtain relief. The effect of leaning forward on the cart opens the spinal canal and provides more room for the spinal cord or nerves. Even a small amount of additional room can have a significant impact on the distance/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 may occur in the lower back and is termed, lumbar spondylosis. It may also occur in the neck and is termed, cervical Spondylosis.
When cervical spondylosispresses upon the spinal cord, it is termed cervical spondylotic myelopathy (CSM); when the cervical spondylosis affects a nerve to the upper extremity, it is referred to as cervical spondylotic radiculopathy (CSR); and, when both the spinal cord and a nerve are associated with cervical spondylosis, it is referred to as cervical spondylotic myeloradiculopathy (CSMR).
Unfortunately, there is no cure for spinal stenosis and it is a progressive disorder. 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 those with spinal stenosis to stay active and exercise to maintain strong core muscles which support the spine.
For those who do not respond to conservative treatment, surgery may be required. The goal of surgery is to resolve the neurogenic claudication and the back pain. Typically, a simple decompression of the spinal stenosis will relieve the back pain and the neurogenic claudication. A spinal fusion is rarely necessary.
One of the most advanced and well-tolerated treatments of spinal stenosis uses minimally invasive spine surgery techniques. Using small camerascalled endoscopes, specially trained spine surgeons can remove the spinal stenosis using only very small incisions. Many innovative surgeons also use laser spine surgery techniques as well 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 typically performed on an out-patient basis with no hospitalization required. It is performed using the small endoscopes or very small tubular retractors. Each of these techniques has their own indications but the result is resolution of the 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 may not otherwise be able to tolerate a spinal procedure are not excluded.
Laser spine surgery offers the additional benefits of ablating the nerves to the small joints that may be an additional source of back pain. The lasercan also safely decompress painful discs.
All of these techniques are performed in a single setting so that all the sources of pain are addressed in one procedure.
Today, some innovative minimally invasive spine surgeons are also using adult stem cells derived from the patient's own bone to further minimize any scar formation. These adult stem cells, not embryonic stem cells, play an important role in down-regulating inflammation and reducing pain.
Left untreated, spinal stenosis can severely affect the ability to walk.
However, today's advanced minimally invasive spine procedures can typically resolve the spinal stenosis and prevent progression during a simple out-patient procedure without the need for general anesthesia or spinal fusion.
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