Spinal Stenosis

The spine consists of a series of bone blocks (vertebral bodies) which are separated from one another by the intervertebral discs and a set of small joints (facet joints). Within the structure of the spine sits a tunnel called thespinal canal. This tunnel contains the neurologic structures including the spinal cord and nerve roots. Although there is some free space between the neurologic structures and the edges of the spinal canal, this space can be reduced by many different conditions. The canal is surrounded by bone and ligaments and can not expand if the spinal cord or nerves require more room. Therefore, if any condition or injury leads to a narrowing of the spinal canal, there is risk for irritation or injury of the spinal cord or nerves. This can lead to a variety of symptoms ranging from tingling, numbness, and weakness to severe pain and paralysis. Common conditions which can narrow the spinal canal include a herniated disc (often called a slipped disc), fracture of the spine, tumor, infection and degeneration

Degenerative Spinal stenosis refers to the condition of neurologic problems associated with narrowing of the spinal canal due to degenerative changes in the spine. Arthritis of the small joints in the spine (facets) as well as thickening of ligaments and formation of bony spurs can all lead to gradual squeezing and irritation of neurologic structures. This process is usually gradual and can lead to symptoms such as pain with walking, a decreased endurance for physical activities, heaviness in the legs, tingling sensations, tightness and numbness in the legs with activity, and often associated low back pains.

Treatment Approach

The treatment for spinal stenosis is dependant on the severity of symptoms and the cause of the stenosis. In older individuals with degenerative type spinal stenosis, aerobic activities like walking combined with a guided exercise program and weight loss (in overweight patients) is often recommended first. Other treatments for spinal stenosis range from physical therapy to epidural injections and finally surgery in certain cases. Since patients affected by spinal stenosis are usually elderly, treatment must carefully consider not only the disease in the spine but also the risks and benefits of treatment in each individual. Although therapy and steroid injections into the affected area of the spine can offer good relief in some patients, there are people who will only get temporary relief at best. In patients who have failed non-operative treatment, surgery can sometimes be considered. Prior to designing a treatment plan for any individual, careful diagnosis must be made. This will often involve tests such as an MRI, CT scan, or myelogram and plain X-rays.

In those patients who are candidates for surgery, the goal is to open up the constricted regions of the spinal canal to ensure freeing the affected neurologic structures. Common surgical techniques applied to achieve this include: decompression, laminectomy, laminotomy. Occasionally, in order to stabilize a degenerated part of the spine, a fusion will be performed in addition to the 'freeing up' part of the surgery. This involves laying down of bone over an area of the spine so that solid bone bridging is created where there was previously arthritis with pain and an unstable spine.

Surgery for spinal stenosis has a high success rate in patients carefully selected for this procedure. It remains a useful approach in treatment when other options have been exhausted and after careful review of the risks and benefits with the patient.

Frequently Asked Questions