Spinal Stenosis
Spinal stenosis is the narrowing of the open spaces or openings in the spinal column that creates passageways for the spinal cord and the spinal nerve. The narrowing, or in some cases an intrusion into these gaps, can be a source of nerve compression. The cervical and lumbar areas are the most frequently affected regions of the spinal cord.
The spinal canal located at the rear of every vertebra has a large opening where the spinal cord travels, particularly in the thoracic and cervical regions of the spine. On the other hand, a group of nerve roots is located on the opening in the lumbar region. These openings that branch away from the spinal canal is called foramina. The foramina provide different paths used by the nerve roots traversing the spinal column to the other parts of the body.
Stenosis impedes nerve functions, as one or more (foramina) openings narrow, creating a compression or harmful pressure on the vertebral bone causing pain in the spinal column and or in other body parts.
Symptoms
Spinal stenosis typically affects the lower back or neck. The most common symptoms include pain, numbness and stiffness. The pain usually starts as an ache in the lower back which then shoot down to the buttocks and legs. Patients with sciatica may also experience “foot drop,” which is a painful leg weakness. Because of the pain and discomfort, the patient may experience a hard time walking or standing. In severe cases, sciatica weakness the nerves in the bowel or bladder.
Treatment
Recent estimates suggest that between 250,000 and 500,000 Americans suffer from spinal stenosis. Approximately five of every 1,000 people over the age of 50 and one of every 1,000 people over the age of 65 experience this condition. The prevalence of spinal stenosis is expected to rise significantly in the coming years. This increase is largely because more than 80 million people will soon be age 50 or older.
Fast Facts
- Lumbar spinal stenosis is the most common reason why individuals that are age 65 or older have spinal surgery.
- Younger people may experience these problems to a lesser extent.
- Many associated conditions are also common among those over the age of 60.
- Often, the symptoms of spinal stenosis are quite mild and people will not experience any noticeable effects.
Types of Spinal Stenosis: Lumbar vs Cervical
Spinal stenosis is categorized as either being lumbar or cervical based on the part of the spine that the condition exists. The lumbar region refers to the lower back, while cervical refers to conditions that extend into the neck region. It is possible for someone to have both conditions.
Lumbar Spinal Stenosis
The lumbar vertebrae consist of five sections at the base of the spine designated as L1 to L5 that extend from the ribs to the pelvis. These are the largest sections of the spine that assist with supporting the body and facilitate movement. Those suffering from lumbar spinal stenosis are likely to experience numbing, pain, and loss of function in the legs.
Two commonly associated conditions are degenerative spondylolisthesis and degenerative scoliosis. Degenerative spondylolisthesis occurs when one (vertebra) “slips” over on to another. It most commonly involves the lowest two bones, which are the L4 and L5. The term scoliosis refers to a condition where the spine is abnormally curved.
Cervical Spinal Stenosis
The cervical spine consists of seven upper vertebrae sections designated as C1 to C7. These discs commonly bulge and degenerate as we age. Two associated conditions include cervical myelopathy and cervical radiculopathy. Cervical myelopathy is when spinal compression in the middle part of the neck creates an impaired function in the extremities. Cervical radiculopathy involves compression or inflammation in the nerves of the neck and results in impaired function in the upper extremities.
Understanding Sciatica
The sciatic nerve is the body’s largest nerve. It extends from the lower back down through the legs. Sciatica is the term used to describe the pain associated with this nerve. The onset of sciatica may be sudden and create pain or weakness that lasts for weeks. Sciatica is often the result of a ruptured disc located within the lumbar spine.
Who Treats Spinal Stenosis?
Many seeking treatment for spinal stenosis will initially visit their primary care provider. These physicians are generally certified in internal medicine, family practice, or pediatrics. Patients may undergo imaging tests and may be referred to a rheumatologist. This is a physician with additional training in treating various musculoskeletal conditions. The rheumatologist may conduct a physical examination of the spinal column and order other tests.
A physiatrist is a doctor that practices in the realm of physical medicine and rehabilitation. They treat many conditions that impair movement and are often seen by those who have work-related injuries. They may treat back-related conditions involving the spinal cord and nerves when surgery is not needed.
A neurosurgeon is a surgical specialist focused on conditions that affect the central nervous system. An orthopedic surgeon is another professional that performs surgeries involving the musculoskeletal system.
Other allied health professionals such as physical therapists may be involved in rehabilitation. They may aid recovery by improving strength, range of motion, and stability so that regular tasks and activities can be performed.
Surgery Considerations
Those who have not experienced significant improvement from more conservative options may consider surgery. Some patients find spinal stenosis prevents them from participating in activities they enjoy or limits their ability to complete daily tasks. A lumbar laminectomy is the most common procedure. The success rate is an estimated 80% for this surgical option.
As with any surgical procedure, there are risks to consider. For example, complications are more common among the elderly, those who are significantly overweight, and those with a medical history of serious conditions. It is possible to react badly to anesthesia, experience excessive bleeding or develop an infection.
Lumbar Laminectomy
An open lumbar laminectomy, or decompression, is a procedure that requires a hospital stay of between one and four days. This may depend on the severity of the condition, how extensive the procedure is, the patient’s age, and other considerations. The process involves making an incision to access the troubled region of the spine.
The surgeon may relieve pressure by extracting bone, ligaments, and bone spurs. This allows increased space within the segments of the spine. The term laminoplasty refers to when the laminae are severed but not removed. When lacking stability, the surgeon may make a spinal fusion.
Minimally Invasive Decompression
Less invasive surgical options are an option that may allow patients to recover more rapidly. These involve smaller incisions and using scopes or imaging devices to assist with navigating the interior. This option is most appropriate for patients where the problem is concentrated in a smaller region of their spine.
Interspinous Process Devices
There are devices that can be implanted to create space and relieve spinal compression. Approval of this process occurred in 2005 and it is considered to be a minimally invasive option. Not all patients are good candidates for this method. Your medical provider will assist you when making this determination.
Rehabilitation
The majority of those who undergo a surgical procedure for spinal stenosis will be referred to physical therapy. Some of the goals of rehabilitation are to increase strength and flexibility. Often the strengthening of the abdominal muscles is successful in developing support for the back.
Treatment Provider for Spinal Stenosis in the Mesa Region
The Arizona Pain and Spine Institute offers effective treatment for those suffering from many painful health conditions. Our team of professionals utilizes the latest advancements in technology and medical techniques to deliver results. Contact our office today to schedule an appointment at (480) 986-7246.
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If you want safe and efficient solution to your pain problem, you must seek attention from the specialist. Rest assured that we in AZ Pain and Spine are not only specialists in the field of pain, we are also well-equipped and widely experienced. We treat various pain conditions including spinal stenosis.
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