Spinal stenosis is a common cause of neck and back pain. This pain results from pressure on the spinal cord. This pressure is caused by the narrowing of the spinal canal. There are a few different causes of this narrowing. Correspondingly, there is a multitude of different treatment options too.
Spinal Stenosis Definition
What is stenosis? Stenosis is defined as the narrowing or restriction of a blood vessel, valve, or nerve. The spinal cord is a complex bundle of nerves that connects your brain to the rest of your body.
The spinal cord is housed within a channel formed by the bones (vertebra) of your spine. Spinal stenosis occurs when this channel narrows, placing pressure on the spinal cord. The narrowing is usually because of wear and tear as people grow older.
Different Types of Spinal Stenosis
Spinal stenosis usually occurs in people over the age of 50. However, younger individuals who have suffered a spinal injury can also develop spinal stenosis. There are two main types of stenosis of the spine.
1. Lumbar spinal stenosis
This is the most common form of stenosis. It is a narrowing in the lumbar region (lower back) of the spine. Lumbar spinal stenosis symptoms include:
- Back pain
- Weakness, numbness, or tingling in a foot or leg
- Pain or cramping in one or both legs when walking or standing for long periods
2. Cervical stenosis
Cervical stenosis arises when the narrowing occurs in the neck region of the spine. Cervical stenosis symptoms include:
- Neck pain
- Issues with balance and walking
- Weakness, numbness, or tingling in a hand, arm, foot, or leg
- In severe cases, urinary urgency and urinary incontinence can develop
What Causes Spinal Stenosis?
In most cases, spinal stenosis happens when something happens to narrow the space in which the spinal cord is housed. Spinal stenosis causes may include:
- Damage from wear and tear on your vertebrae can cause the formation of bone spurs that protrude into the spinal canal.
- A bone disease, called Paget’s disease, usually occurs in adults. This can also cause an overgrowth of the spinal bones.
- Spinal injuries. Trauma that causes fractures or movement of one or more of the vertebrae can lead to damage of the spinal canal.
- Back surgery. The swelling of tissue nearby a surgery site immediately after back surgery can put pressure on the nerves and/or spinal cord.
- Thickened ligaments. The cords of connective tissue that attach your vertebrae can thicken and stiffen with time. This thickening can protrude into the spinal canal, allowing less space for the spinal cord.
- Herniated discs. The soft discs of cartilage that act as shock absorbers between the vertebrae can dry out with age. If the disc’s exterior cracks, soft tissue from within the disc can escape and press on spinal nerves.
Is Spinal Stenosis Hereditary?
Lumbar spinal stenosis is considered to mostly be a degenerative condition. However, studies show that there is a correlation between genetic changes and the development of lumbar stenosis. Indirectly, a genetic disease that affects bone and muscle development in the body can lead to spinal stenosis. The congenital spinal deformity, scoliosis, may also lead to impingement of the spinal cord.
Diagnosing Spinal Stenosis
To diagnose spinal stenosis, your doctor will ask for an in-depth medical history and perform a physical examination. To pinpoint the cause of your stenosis of the spine, your doctor may order one or more imaging tests. For example, X-rays, MRI (magnetic resonance imaging), or a CT (computerized tomography) scan.
Spinal Stenosis Treatment
What is the best treatment for spinal stenosis? Well, that depends on the cause and the extent of the stenosis. The best treatment is a multi-faceted one. With pain medications to manage the pain, anti-inflammatory drugs to reduce swelling, and perhaps surgery to reduce the narrowing of the spinal canal.
By teaching you the right kind of exercises to do, a physical therapist can help you to build up your strength and improve your balance. Keeping to a good exercise schedule can help you to maintain and improve the flexibility and stability of your spine.
Depending on the extent of your pain, your physician might prescribe one or more of the following pain medications.
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as acetaminophen, naproxen, or ibuprofen may be used to ease the pain of spinal stenosis temporarily.
- Opioids are not advised for long term use. However, codeine-related drugs such as oxycodone (Oxycontin) and Hydrocodone (Vicadin) can be used short term for pain relief.
- To ease chronic pain, tricyclic antidepressants (e.g. amitriptyline) can be taken before going to bed.
- Gabapentin (Neurontin) and pregabalin (Lyrica) are anti-seizure drugs. However, they have also shown efficacy in reducing pain caused by damaged nerve endings.
Epidural Steroid Injections
This minimally invasive procedure usually takes less than 15 minutes. It can help to alleviate inflammation and reduce pain for a few weeks to a few months. The epidural steroid injection comprises a local anesthetic (such as lidocaine) and a long-lasting corticosteroid (cortisone). This medication is injected into the epidural space near the impinged nerve/s. The anesthetic goes to work immediately to numb and reduce pain. The steroid might take a few days to come into effect, it works to reduce inflammation.
Adhesiolysis is the removal of adhesions (scar tissue) from the epidural space. Also called the Racz procedure, adhesiolysis involves the injection of a needle into the caudal epidural space. Under fluoroscopy guidance, a catheter is then directed into the epidural space. A mixture containing hypertonic saline, corticosteroid, anesthetic, and wydase is then injected to facilitate the breaking down (lysing) of the scar tissue.
Surgery is seldom the first port of call when treating spinal stenosis. However, if other options have been exhausted and the patient is still suffering severe pain and reduced movement, several surgical options can be considered. Surgery aims to relieve the pressure on the spinal cord by creating more space within the spinal column.
- Laminectomy is a procedure that involves the removal of the back part (lamina) of the affected vertebra. This creates more space and eases the pressure around the spinal cord.
- Laminotomy removes only a part of the lamina to relieve pressure.
- Laminoplasty is only performed on the neck vertebra. In other words, for cervical spinal stenosis. Laminoplasty involves opening up space within the spinal canal by creating a hinge on the lamina. Metal hardware is used to bridge the gap between the two separated bones.
- Discectomy is the removal of all or part of a disc that has slipped out of place and is placing pressure on the spinal cord.
What is the Right Treatment for My Spinal Stenosis?
At MidSouth Pain Treatment Center we have a team of specialists that can consult together about the best way to manage and treat your spinal stenosis pain. Combining careful investigation and advanced technology we can create a treatment program that will help to effectively treat your pain.