What is Spinal Stenosis and What are the Treatment Options Available?
Anatomy of the Spine
The spine is made of 24 movable bones known as vertebrae. The vertebrae are separated by discs, which act as shock absorbers and prevent the vertebrae from rubbing together.
In the middle of each vertebra is a hollow space known as the spinal canal. The spinal canal contains the spinal cord and nerves, ligaments, and blood vessels. The spinal nerve root canals are surrounded by ligaments and bones.
Spinal Stenosis in a Nutshell
Spinal stenosis is a degenerative condition characterised by the narrowing of the bony canals where the nerves and the spinal cord pass. The condition can develop gradually over time and can also refer to:
- Narrowing of the spinal and nerve root canals
- Stiffening and thickening of the ligaments
- Overgrowth of the bone and bone spurs
- Enlargement of the facet joints
While common in the lumbar area, stenosis can also develop along any areas of the spine (lumbar, thoracic, and cervical). Typically, every spinal canal narrows down to some degree with age. However, most people don’t experience any symptoms from a small amount of narrowing.
Common Symptoms of Spinal Stenosis
Symptoms of the condition typically develop over time. However, it can also occur as a sudden onset of pain. Patients may feel a sharp and severe pain or dull ache in different areas, depending on which part of the spinal card has narrowed. The pain can come and go or can occur when performing certain activities such as walking.
Possible Causes of Spinal Stenosis
As one gets older, the bones will undergo degenerative changes that are considered part of the ageing process. Such osteoarthritis is considered one of the common causes of spinal stenosis. However, the rate at which these degenerative changes takes place will vary among different people.
Also, as one ages, the cushioning disc between the vertebrae can start to dry out and shrink. There is also a tendency to lose bone mass. At the same time, bone spurs can also develop. With age and due to stress and strain, the facet joints can also get enlarged. The larger the facet joint becomes, the less space there will be available for the spinal nerve. All of these above issues can collectively contribute to onset of spinal stenosis symptoms.
Stenosis may also be the result of other degenerative conditions like spondylosis or spondylolisthesis, dislocation, traumatic injury, and vertebral fracture. The condition can also occur due to systemic conditions affecting the spine like ankylosing spondylitis or rheumatoid arthritis.
Treatment Options for Spinal Stenosis
No medications or treatments can totally cure spinal stenosis. However, non-surgical conservative treatment is the first step to controlling symptoms of the condition for most people. However, in some cases when there is severe and disabling pain or difficulty walking, surgery may be recommended.
Nonsurgical Treatment Options
Some of the best conservative treatment options for spinal stenosis include:
Non-surgical spinal decompression (NSSD), or spinal decompression therapy, is a very effective treatment option for patients with spinal stenosis. Modern, computerised machines may help to target areas of the spine which are being compressed by slipped discs and other swollen tissues and slowly decompress them to relieve pressure on nearby nerves. This treatment is especially effective when combined with other conservative treatment approaches.
Specific spinal manipulation is a treatment option where manual or instrument-assisted techniques are applied to the spine in order to return the joints to their normal range of motion. Good motion can help remove muscle tightness or spasms, reduce pain, improve the function of the nervous system as well as overall health. Motion also minimises the formation of scar tissue which leads to stiffness.
Physical therapists can recommend proper lifting, walking, and posture techniques. They’ll also encourage patients to stretch and increase the flexibility of the spine and legs.
Surgery for spinal stenosis can involve removal of the bony overgrowth to relieve pressure as well as the pinching of the spinal nerves.
Surgical spinal decompression (Laminectomy)
In a laminectomy, the back portion of the vertebra (lamina) is removed to expose the nerves and spinal cord. Bone spurs and thickened ligaments are also removed. Overgrown facet joints situated directly over the nerve roots may be trimmed to provide more room for the spinal nerves.
For patients with slippage or spinal instability, two or more vertebrae may be joined permanently together with screws to give the spine more stability. This procedure may often done at the same time as a laminectomy. This may protect the segment which has been damaged; however, may contribute to increased stiffness and affect other segments later on.