What exactly is spinal stenosis?
Spinal stenosis is a condition characterized by a narrowing of the spinal canal. The narrowing is caused by degeneration of both the facet joints and the intervertebral discs. Bone spurs (also known as osteophytes) grow into the spinal canal in this condition. As the facet joints become arthritic, they enlarge, reducing the amount of space available for the nerve roots. Facet arthropathy is the medical term for this condition.
The ligaments of the spinal column, particularly the ligamentum flavum, stiffen, become less flexible, and thicken with age, contributing to spinal stenosis. These processes narrow the spinal canal, putting pressure on the nerve roots and spinal cord, resulting in the symptoms of spinal stenosis.
Stenosis can occur in the central spinal canal (central stenosis), which houses the spinal cord or cauda equina, the tract where the nerve root exits the central canal (lateral recess stenosis), or the lateral foramen (foraminal stenosis), which houses the individual nerve roots.
Almost everyone will experience some spinal canal distortion as they age, but the severity of the symptoms will depend on the size of the spinal canal and the encroachment on the nerves. The rate of deterioration varies greatly between individuals, and not everyone will experience weakness or pain.
What Factors Contribute to Spinal Stenosis?
True sciatica is a condition that occurs when a herniated disc or osteoarthritic bone spur compresses and pinches one of the sciatic nerve’s contributing roots. This is referred to as a pinched nerve. This type of lower back pain is less common than other back pain causes and conditions. Sporting activities, recreational activities, and heavy labor, for example, can cause back and leg pain, which is frequently misdiagnosed as sciatica. A physician’s challenge is distinguishing between radicular pain (also known as radiculopathy), which is caused by an inflamed nerve root, and referred pain, which is caused by a musculoskeletal sprain or strain.
What Are the Signs and Symptoms?
The cause of stenosis-induced weakness and pain is the subject of much debate and medical research. The compression of the microvascular structures carrying blood flow to the nerve roots may be associated with pain in the buttocks or leg, which is a common symptom of lumbar spinal stenosis. Simultaneously, the symptoms of spinal stenosis may be caused by physical compression of the nerve roots. Each of these processes has the potential to disrupt normal nerve root function and reduce the effectiveness and endurance of the spinal nerves.
Some people with degenerative spine disease have no symptoms at all, while others complain of mild lower back pain and others are unable to walk. People with significant spinal stenosis will experience pain in the buttocks, thigh, or leg that worsens with standing or walking and improves with rest. A person may complain of leg pain and weakness without experiencing back pain in some cases.
Numbness, tingling, and weakness in the lower extremities are more severe symptoms of the disorder. Certain positions, by increasing the amount of space available for the nerves, can alleviate the symptoms of spinal stenosis. These positions typically involve flexion (bending) of the lower spine and forward bending. Most people with spinal stenosis, for example, can ride a bike and walk up an incline or flight of stairs without pain. They can frequently walk for long distances if they have something to lean on, such as a shopping cart. However, if they are walking down an incline or a flight of stairs, or if they must abandon the shopping cart, their symptoms will frequently reappear. The presentation and severity of spinal stenosis symptoms are determined by several factors, including the original width of the spinal canal, the susceptibility of the nerves involved, the person’s unique functional demands, and their individual pain tolerance.
How is it identified?
A complete medical history and physical examination are used to diagnose spinal stenosis. Your doctor will assess which symptoms are present, what causes them to worsen or improve, and how long they have been present. A physical examination is required to determine the severity of the condition and whether it is causing weakness or numbness in specific areas of the body. A neurological examination reveals abnormalities in the strength and sensation of specific parts of the body, providing the most objective evidence of chronic nerve root compression caused by spinal stenosis. The examination is also used to rule out other conditions such as hip and knee arthritis and diabetes.
There are no laboratory tests that can detect the presence or absence of a stenosis, but they may be useful in determining unusual causes of nerve root and spinal cord dysfunction. MR or CT scanning can visualize the canal where the nerves reside, quantify the degree of narrowing, and rule out other possible causes.
What is the treatment for spinal stenosis?
Treatment options vary depending on the severity of your symptoms and how much they interfere with your daily activities. Depending on your level of pain, you may want to discuss the following treatments with your doctor:
- Non-surgical treatments – For mild to moderate pain, non-surgical treatments such as medications, physical therapy, and steroid injections can be used.
- Less invasive back surgery – Decompression can be achieved through less invasive surgical procedures such as interspinous spacers for moderate to severe pain.
- Traditional back surgery – When more conservative treatments fail to relieve moderate to severe pain, decompression or spinal fusion may be considered.
- Targeted drug delivery – When more conservative treatments aren’t working to relieve pain from spinal stenosis, targeted drug delivery may be an option.