The Complete Guide To Spinal Stenosis
When it comes to wear and tear because of age, one may see it in different things. These include a person’s car, his home, his clothes, and more. But when a person starts noticing this happening to his body, it can be a particularly painful and disturbing development. There is a number of chronic conditions which affect the back and neck which can lead to pain and immobility, some of the worst in a person’s lifetime.
One such condition is spinal stenosis. This condition occurs when the spinal canal becomes narrower as a person grows older. When this happens, it puts pressure on the nerves within the spine. As the pressure increases, this can lead to numbness, pain, and even muscle weakness in the neck (known as cervical spinal stenosis) or the lower back (known as lumbar spinal stenosis). In more severe cases, this can also lead to an impaired bowel and bladder control.
The good news is, even if one is diagnosed with this condition, there are different treatments available out there. These treatments range from surgical to non-surgical options depending on the severity of the person’s condition, the cause of the condition, and the person’s medical history. To reiterate, spinal stenosis occurs when there is a narrowing of the spaces within a person’s spine. This, in turn, places pressure on the nerves which travel through one’s spine and usually, the condition occurs in the neck and the lower back. Some people who suffer from spinal stenosis may not manifest any symptoms. The unlucky ones, however, may experience tingling, pain, muscle weakness, and numbness. As time goes by, the symptoms may even worsen. The most common cause of this condition is the wear-and-tear changes which occur in the spine as a person grows older. In the most severe cases, doctors may even recommend surgery in order to create more space for the nerves or the spinal cord.
Types of Spinal Stenosis
The different types of spinal stenosis vary depending on the compression’s placement in the spine. These variations of the areas which are affected typically dictate which body parts will suffer from the compression and the symptoms. The spinal stenosis types depending on the vertical placement are:
Cervical Spinal Stenosis
This type is typically caused by a pinching of a person’s spinal cord in his neck. One of the most common symptoms of this type of spinal stenosis is a person experiencing a difficulty in performing fine motor skills such as buttoning up his shirt, writing, and more. Also, a person may experience numbness in the shoulders and neck when the compression occurs in this part of the spine.
Thoracic Spinal Stenosis
Among all the types of spinal stenosis, this is the rarest one. Along with the more common symptoms of the condition, a person suffering from this type of spinal stenosis may also experience an impaired ability to rotate his torso. Because the thoracic portion of the spine has a thinner structure, if any spinal compression in this part occurs, it may put a person at a high risk for paralysis.
Lumbar Spinal Stenosis
This type of spinal stenosis occurs when the compression of the spinal cord happens in a person’s lower back. The common symptoms for this type of spinal stenosis are usually observed in one’s lower part of the body. Usually, a person may experience difficulty bending over, walking or even standing.
There are also various types of spinal stenosis based on the compression of the nerve exit. When it comes to this, the condition may also be classified into three different groups, this time depending on the compression in the spine’s cross section. These types are:
This type occurs when one of the bone spurs in a person’s foramen hinders the spinal nerve’s passage on both sides of the spine.
This type occurs when the spinal compression happens in the central opening of the spine which then pinches the cauda equina or the thecal sac.
Far Lateral Stenosis
Finally, this type occurs when the compression happens in the individual nerves, known as the neuro-foramen, at the back part of the spine. It’s usually caused by bulging or herniated discs or bone spurs.
When a person suffers from severe spinal stenosis, he may experience extreme levels of pain in his legs. With this symptom, the person may also experience a complete inability to move around without aggravating the leg pain.
Most commonly, people suffer from the acquired type of spinal stenosis. However, there’s also a possibility that a baby would be born with the painful condition and this is known as congenital spinal stenosis. This is usually caused when a baby is born with a narrow spinal canal which, in turn, would limit the opening for his spinal cord to pass through. Let’s take a look at these types:
Acquired Spinal Stenosis
This type of stenosis usually develops gradually. It starts to develop when a person is middle-aged and it’s the result of different joint and bone disorders. Acquired spinal stenosis usually starts with the flattening and desiccation of a person’s vertebral discs, which, in turn, would lead to a number of structural complications. This condition is commonly caused by other conditions such as spinal injuries, osteoporosis, and rheumatoid arthritis.
Congenital Spinal Stenosis
As we’ve stated, this type occurs when a baby is born with a narrow spinal canal. This type may also worsen as the person grows older. Also, it occurs more in men than in women.
Causes and Risk Factors for Spinal Stenosis
The spine or the backbone runs from a person’s lower back to his neck. The bones of the spine form the spinal canal and this protects the nerves of the spinal cord. There are some people who are actually born with a smaller spinal canal. But usually, most cases of spinal stenosis occur when something starts to happen to the open space within a person’s spine which is already narrow. Here are the common causes of spinal stenosis:
When a person suffers from osteoarthritis, this causes wear and tear damage to the spinal bones. Because of this, it prompts the formation of what’s known as bone spurs which, in turn, can grow into a person’s spinal canal. Another bone disease known as Paget’s disease can also cause this bone overgrowth and it typically affects adults.
As a person grows older, the soft cushions which serve as the shock absorbers between a person’s vertebrae may dry out. Because of this, the exterior of the discs might start getting cracks. This may permit some of the inner material which is soft to escape than press on the nerves or the spinal cord.
The tough cords which help keep the spinal boned together may thicken and become stiff as time goes by. When this happens, the thickened ligaments will start bulging right into the person’s spinal canal.
Abnormal growths may start forming inside a person’s spinal canal. These growths occur within the membranes which cover the spinal cord. They may also occur in the space between the vertebrae and the spinal cord. Such tumors are uncommon but doctors can identify them by using spine imaging with a CT or an MRI.
Car accidents and other traumatic occurrences may cause fractures or dislocations on one or more of a person’s vertebrae. If a bone gets displaced because of a spinal fracture, this may cause damage to the spinal canal’s contents. Also, swelling which happens in the nearby tissues right after undergoing back surgery might also place pressure on the nerves or the spinal cord.
Most of those who suffer from spinal stenosis are aged 50 and over. Although the degenerative changes may also cause the condition in younger individuals, other causes must also be considered. These include a congenital deformity of the spine (like scoliosis), trauma, and even a genetic condition which affects the development of muscles and bones throughout a person’s body. In order to differentiate these causes, one can undergo spinal imaging.
Common Symptoms of Spinal Stenosis
The common symptoms of spinal stenosis vary depending on which part of the spinal canal it occurs and how severe the condition is. The symptoms which are caused by the spinal cord’s compression are referred to as myelopathy. Such symptoms may include:
- falling or a worsening of balance
- difficulty of picking up small objects, the difficulty of buttoning buttons, or dropping items and objects frequently
- losing control of the bladder or bowel
When the symptoms that manifest are caused by the nerves’ compression, these are referred to as radiculopathy. Such symptoms may include
- numbness, tingling or pain along the nerve’s path
- weakness along the nerve’s path
If stenosis occurs in a person’s neck, a compression of his spinal cord may occur along with the nerves which travel into his hands and arms. When this happens, it may cause symptoms such as:
- tingling, weakness, cramping or numbness of the hands and arms
If stenosis occurs in a person’s lower back, a compression of his spinal cord may occur along with the nerves which travel into his feet and legs. When this happens, it may cause symptoms such as:
- tingling, weakness, cramping or numbness of the feet and legs
- these symptoms are also known as false blockage or pseudoclaudication since they’re similar to the symptoms one would experience because of insufficient circulation to his legs
After undergoing a CT scan or an MRI, a lot of people would show evidence of the condition without manifesting any of the symptoms. But once they start, the symptoms would appear gradually then get worse as time goes by.
Diagnosing Spinal Stenosis
In order to diagnose the condition, the doctor may as the person if he has noticed any of the common signs and symptoms. Also, the doctor may ask about the person’s medical history and perform a physical exam. It’s common to ask for a number of imaging tests which will help determine the cause of the signs and symptoms the person experiences. Such imaging tests are:
X-ray. When a person has an x-ray of his back, it may reveal any changes in the bone structure such as the growth of bone spurs which may cause the narrowing of the space within his spinal canal. Keep in mind though, that x-ray involves minimal radiation exposure.
MRI (magnetic resonance imaging) This test makes use of radio waves and a powerful magnet in order to product cross-sectional spinal images. An MRI can detect any damages to a person’s ligaments and discs along with the presence of any tumors. More importantly, it can also show the doctor which nerves are being compressed or pressured.
CT or CT myelogram. Finally, if a person isn’t able to have an MRI, his doctor may recommend a CT which is a combination of x-ray images which have been taken from various angles. This combination produces cross-sectional images of the body in full detail. In a CT myelogram, the doctor will first inject a contrast dye then conduct a CT scan. The purpose of the dye is to outline the nerves and the spinal cord. Through this test, the doctor can see any bone spurs, tumors, and herniated discs.
Treatment Options for Spinal Stenosis
The treatment options for spinal stenosis would depend on the affected area of the spine as well as the severity of the condition. A person who has spinal stenosis should talk to his doctor about the best treatment option which would suit his situation. For instance, if one only has mild to no symptoms, the doctor may only monitor the condition through regular follow-up appointments. Also, the doctor may give recommendations and suggestions about remedies one can do at home. However, if these home remedies don’t do any good, the doctor may either recommend physical therapy or prescribe some medications. Here are some treatment options doctors may recommend:
First of all, a doctor may prescribe the patient with pain medications such as ibuprofen and acetaminophen. These may help alleviate the pain and discomfort caused by the condition temporarily. That’s why such medications are only recommended for short-term use.
The doctor may also prescribe nightly doses of certain antidepressants which may relieve chronic pain. Anti-seizure drugs are also effective in reducing the pain caused by nerve damage.
There are also opioids available which may be helpful for short-term relief from pain. Such medications may also be cautiously considered for long-term treatment. However, taking such medications may potentially cause serious side effects and are habit-forming.
Usually, people who suffer from spinal stenosis tend to become less active than they were before they acquired the condition. They lessen their physical activities in order to reduce the pain felt while moving. Unfortunately, this may lead to muscle weakness which, in turn, might result in feeling more pain. Another form of treatment for this condition is physical therapy wherein the person would learn some exercises which will prove helpful. Such exercises may help build a person’s endurance and strength. They can also maintain the stability and flexibility of the spine while improving balance.
When the nerve roots get pinched or pressured, they might get swollen and irritated. In such cases, the doctor may recommend steroid injections. Although this procedure won’t really cure the stenosis, it can help reduce any inflammation and ease the pain felt by the person. However, steroid injections aren’t really effective for everyone who suffers from the condition. Also, frequent steroid injections may weaken the nearby connective tissues and bones. Therefore, a person may only get these injections a couple of times each year.
This procedure involves the insertion of needle-like instruments which the doctors would use to take out a part of the thickened ligament located at the back of one’s spinal column. This will help increase the space in the spinal canal and eliminate any impingement of the nerve roots. But only those who suffer from lumbar spinal stenosis or a thickening of the ligament may get this type of treatment.
There are various types of surgery doctors may recommend for those with spinal stenosis. Usually, surgery would be recommended if other types of treatments won’t work or if the person is already disabled by his condition. The goal of this type of surgery is to relieve the pressure on the nerve roots or spinal cord by creating space within the person’s spinal canal. The surgery helps to decompress the area affected by the stenosis and it’s a definitive way to resolve the symptoms one may experience. According to research, such surgeries may result in fewer complications when done correctly by seasoned or highly-experienced surgeons. Surgical options for spinal stenosis include:
This surgical procedure can only be performed on the vertebrae in the neck or the cervical spine. The doctor would create a hinge on the person’s lamina which would open up space within his spinal canal. The doctor would then make use of hardware made of metal to bridge the gap in the spine’s opened section.
This surgical procedure involves removing the lamina of the vertebra affected by the condition. This can also be called decompression surgery since it helps ease the pressure on a person’s nerves by creating enough space around them. Sometimes, the doctor would make use of hardware made of metal to link the adjoining vertebrae. He may also use a bone graft or a spinal fusion to maintain the strength of the spine.
This procedure involves the removal of only a part of the person’s lamina. The doctor would typically carve out a hole large enough to relieve the built-up pressure.
Minimally Invasive Surgery
Finally, this procedure involves the removal of the lamina or bone in such a way that minimizes any damage to the nearby tissues which are still healthy. With such procedure, there’s a lesser need to perform fusions. Although fusions are useful in terms of reducing pain and stabilizing the spine, by avoiding them, one can reduce the potential risks they come with. These include inflammation, post-surgical pain, and even disease in the nearby parts of the spine. Aside from reducing the need for a spinal fusion, this type of surgery may also shorten a person’s recovery time.
Potential Treatment Options in the Future
There are clinical trials being performed these days which test the potential of using stem cells in the treatment of spinal stenosis. Such procedure is sometimes referred to as regenerative medicine. There are also genomic medicine trials being performed which may result in innovative gene therapies to treat spinal stenosis.
Should One See a Physical Therapist for the Treatment of Spinal Stenosis?
Often, people would choose to consult with a physical therapist when they suffer from spinal stenosis. The purpose of a physical therapist is to help the person perform all of his daily activities without too many hindrances because of the condition. When a person consults with a therapist, he may get a customized treatment program that’s based on the evaluation of the therapist and the patient’s personal goals. Such treatment programs would involve a combination of various exercises. For instance, if the person’s goal is to increase mobility and relieve pain, the therapist will come up with a program which includes:
- Exercises which will take the pressure off the person’s nerves in order to ease the pain
- Flexibility exercises and stretching which will help enhance the person’s mobility in the muscles and joints of the spine as well as in the extremities.
- Strengthening exercises which will provide the needed support for the spinal joints and also make the leg and arm muscles stronger in order to take some of the pressure and workload away from the person’s spinal joints.
- Aerobic exercises which may increase a person’s tolerance for certain activities which may have been affected by the condition.
Just looking at the list would make one think, “that’s a lot of exercises!” But actually, research shows that the more exercises a person is able to handle, the faster he will be able to reduce the pain he feels along with the other symptoms he’s experiencing. Aside from such a treatment program, a physical therapist may also recommend other treatments including:
- Manual therapy which may enhance the mobility of a person’s stiff joint which might be contributing to the symptoms he’s experiencing.
- A special device similar to a harness which is connected to a treadmill. This device may help reduce the pressure on a person’s spinal nerves while he’s walking.
- Posture education which involves learning how to relieve the pressure on the nerves by making some modifications on how a person sits, stands or walks.
- Special treatments for pain such as electrical stimulation or using ice to relieve severe pain or pain that’s not relieved by other forms of treatment.
Lifestyle Changes and Home Remedies for Spinal Stenosis
In order to monitor a person’s condition, he may have to visit his doctor regularly for follow-up appointments. The doctor may recommend that the person incorporates a couple of home treatments into his lifestyle such as:
- Taking pain relievers or over-the-counter medications which can help reduce the inflammation and pain.
- Applying cold or hot packs on the affected areas in order to provide relief.
- Maintaining a healthy weight in case the person is overweight or obese. In such cases, the doctor may recommend that the person lose some weight in order to reduce the pain by taking some of the stress off his back.
- Using a walker or a cane which will provide stability. Such devices may help relieve pain as well by allowing the person to bend forward while he walks.
How Can One Prevent the Development of Spinal Stenosis?
Spinal stenosis can be caused by different conditions such as osteoarthritis or degenerative changes which occur in a person’s spine. The main characteristic of this condition is when spaces through with the spinal nerve or the spinal cord pass start narrowing. A person’s spinal cord and nerves are actually made of a material that’s very sensitive. So when they come into contact with obstructions such as the nearby bones, the person would start experiencing the symptoms of the condition.
Over time, spinal stenosis develops as the ligamenum flavum or the spinal ligament thickens or becomes bigger. This is a phenomenon which is known as hypertrophy or an overgrowth of the ligamentum flavum. Aside from this phenomenon, the facet joints nearby may also develop what’s known as bone spurs which will start encroaching on the space in the spinal canal.
Either bone spurs or a hypertrophic ligamentum flavum around a person’s facet joints may cause compression on the nerves. This creates weakness, pain, and other symptoms which are common with spinal stenosis. Another classic symptom of this condition is a difficulty with walking otherwise called neurogenic claudication.
The bad news is, nearly everyone will develop one form of degeneration or another that comes with age. This is especially common after people reach the age of 50 and over. Of course, nobody wants to develop a condition such as spinal stenosis which comes with painful symptoms. So what are people to do? Is there a foolproof way to prevent it from happening? Technically, the answer to that questions is no. However, there are some ways people can reduce the risk of developing the condition.
When it comes to preventing spinal stenosis, it’s a matter of employing healthy habits so as not to compromise the parts affected by the condition. Although making small adjustments to a person’s lifestyle may not seem like much, the long-term effects are definitely worth it. Making these simple, gradual changes will surely help one reduce the risk of getting the condition. And since one doesn’t have to make any huge changes, what’s the harm in trying? Consider these healthy habits:
Exercising regularly is one habit which comes with a lot of benefits. Having a good exercise plan which one can do and it tailored to one’s needs is important. This means that the plan would take into consideration the person’s age, any health concerns (such as spinal stenosis, arthritis, and more), and the person’s fitness level. Exercising regularly may help a person build his endurance safely while maintaining or increasing the flexibility of his spine. It may also help develop the abdominal muscles which are important when it comes to supporting the back.
However, not everyone enjoys exercising. Either that or a person is already experiencing pain and other symptoms which makes exercise unappealing. In such cases, it’s best for the person to consult with a doctor or a physical therapist to help get things started. One may get an evaluation first then a treatment plan which involves exercises. Once the person already has an exercise plan, it’s important to start small and progress gradually.
While exercising, the person must observe how his body responds to the different exercises in terms of weakness, nerve symptoms, and pain. If he experiences any of these, it’s important to stop the exercises and try to perform an easier workout routine the next time around. But even if one experiences pain, weakness, and such, that shouldn’t make him stop exercising altogether. It’s still important to exercise regularly, it’s just a matter of finding out which routines work and which don’t.
If a person suffers from spinal stenosis and the condition makes walking painful, the person may have to look for another type of aerobic exercise to perform. Some possible alternatives are swimming, deep water exercises, stationary cycling, and more. The right amount of physical activity and exercise can help people maintain a healthy body and a healthy lifestyle. Although most people see exercising as nothing but a part of muscle building or weight loss, the purpose of a good exercise routine isn’t just limited to those goals.
Being physically active will help maintain a person’s bone strength and body alignment. It can also help prevent age-related wastage of bones known as osteopenia. When it comes to spinal stenosis, exercising is one of the most effective ways to reduce the risk of developing it. Of course, one must perform the proper exercises if he really wants to prevent this condition from occurring.
Aside from stiffness and pain, a noticeable reduction in a person’s range of motion is one of the symptoms of spinal stenosis. With this in mind, another strategy for preventing the condition is to perform flexibility training regularly. Such training typically involves stretching but one may also perform water exercises, relaxation exercises, and even holistic therapies to enhance the training.
The important thing to keep in mind is that the flexibility training must improve one’s mobility. This, in turn, may help relieve pain and keep the symptoms of spinal stenosis at bay. Again, one may consult with a physical therapist to get a tailored exercise program which includes flexibility training. The therapist may even teach specific movements which may alleviate the early symptoms of the condition and prevent it from getting worse.
Get the Proper Posture
To reduce the risk of developing spinal stenosis, one must learn how to sit with the proper posture and perform tasks and chores with the proper posture too. This is important as it may help the person avoid any wear and tear or injury which would result in spinal stenosis.
Although this condition is usually caused by herniated discs or bone spurs, the pressure or compression on the spinal cord can become aggravated when a person slouches while sitting. The proper alignment of the body may help prevent any bone breakage and other bone-related issues. Here are some tips to help one improve his posture:
- Learn to evenly distribute one’s body weight to the various sides of the foot. While standing, people often use the balls of their feet in order to stay balanced. However, this may cause feet pain as well as pain in the lower back because of the body weight’s unequal distribution. But if a person learns how to distribute his weight evenly, this will also relieve the pressure on his lower back.
- When a person tries to lift something, make sure to place the pressure on the hips rather than the lower back. A common mistake when lifting is bending over at the waist and applying full pressure on one’s lower back. But when the person bends his knees and hips, this relieves the compression on the lumbar region and it also balances the weight more evenly. This, in turn, helps minimize the risk of getting back injuries.
- It will also help one’s posture to sleep on a mattress that’s firm. One which can fully support the person’s lumbar region. This will ensure that the person maintains a proper body alignment even while he’s sleeping.
- Finally, one can also use a standing desk at work. Sitting down for a long period of time each day can have negative effects on a person’s metabolism as well as his structural health. Constantly sitting with a bad posture may cause increased pressure on the back muscles and the spine which will make back pain worse and hasten the degeneration of bones.
Manage One’s Weight
Achieving a healthy weight and maintaining it will go a long way in keeping a person healthy. This can also help keep spinal stenosis at bay. Even if the person already has the condition, a healthy weight may prevent the condition from being too bothersome. When a person is obese or overweight, he needs to carry that extra weight wherever he goes. This places unnecessary pressure on the different parts of his spine including his facet joints.
It’s common knowledge that smoking may cause back pain. Aside from this, it can also be the cause of degenerative changes when it constricts the blood vessels which feed a person’s spine. Also, it can amplify a person’s perception of pain. So it’s better to kick the habit if one wants to prevent the condition. As a matter of fact, quitting this unhealthy habit may be beneficial to people in a lot more ways.
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