Spinal stenosis is a situation where the vertebrae in the spine come close together and lie on one or more of the spinal nerves which come from the spinal cord. When this occurs, the individual may experience various symptoms such as:
Numbness and a tingling sensation
The spinal nerves emerge from the spinal cord through the intervertebral discs and then spread to other parts of the body depending on their point of origin. Spinal nerves from the cervical spine provide sensation to the neck, shoulders and arms while those from the lumbar provide sensation to the pelvic areas of the body down the legs. When these nerves are compressed by the cervical vertebrae but are not completely cut off, it creates a deficiency in the reception of nerve signals. The individual will experience this reduction of nerve signals in the form of numbness in some regions or a tingly sensation similar to the one experienced when seated in an awkward position for long.
Though numbness is caused when the spinal nerves are compressed to a small degree, back pain results from a total collapse of the intervertebral discs pressuring the spinal nerves. This often develops if feelings of numbness are ignored and the damage to the spinal vertebrae continues to worsen.
In the case of a cervical spine, pain is experienced around the neck muscles up to the jaw and then it radiates down to the shoulders and arms. When the lumbar region of the spine is affected, pain is experienced around the pelvic region resulting in hip pain which radiates down to the legs.
The level of pain will depend on the extent of damage to the vertebrae and the bone spurs formed in them. Nevertheless, it begins as a mild pain, usually aggravated by physical activity such as walking and carrying heavy objects and then develops into a constant pain with debilitating results.
Apart from providing sensation, spinal nerves are also responsible in encouraging motor activity. Therefore, spinal stenosis that blocks or inhibits a spinal nerve can also cause weakness in the area where the nerve supplies motor activity. This can cause weakness in the arms and legs when the cervical or lumbar spine is affected. Damage to vertebrae in the thoracic spine can have severe consequences. If left without monitoring for a long time, it can render a person totally incapable of using their arms or legs.
The lumbar spine contains nerves which provide sensation and motor activity to the chest and stomach regions including the lungs and heart. If these nerves are damaged, then there could be deficiencies in the functioning of the heart muscles and lungs. Obviously, this could have potentially fatal consequences. But the good news is, the condition develops slowly thus providing the individual some time to take measures in order to tackle the damage.
Problems with sex and control of the bladder and bowels
Spinal nerves from the lumbar spine spread over the pelvic region and down the legs providing sensation to the bladder, rectum and reproductive organs. Spinal stenosis to the lumbar region of the spine will affect the functioning of these body organs and lead to problems such as:
- loss of control of the bladder
- lack of control of bowel movements
- lack of stimulation in the reproductive organs
Again, these problems develop gradually, hence the individual will begin to notice mild symptoms before they lose control of these areas completely.
How does spinal stenosis develop?
This condition occurs when the ligament separating the individual spinal vertebrae wears off leaving the vertebrae lying on one another and compressing the spinal nerves. Though various causes such as genetic factors like rheumatoid arthritis or direct trauma to the spine can lead to this condition, the most common factor is osteoarthritis which develops with age.
The development of spinal stenosis is a gradual process. As the intervertebral discs start to wear off gradually, the signs and symptoms will often start as mild to moderate, worsening with time if they are not treated properly.
Early interventions to spinal stenosis
Once the doctor realizes that the individual may be suffering from spinal stenosis, surgery will not be the first option. Various interventions are attempted first, leaving surgery to be the final resort. Some of these interventions include:
- Physical therapy – targeted physical activity which is directed by a professional physical therapist can help strengthen your spinal vertebrae and prevent the advance of spinal stenosis.
- Medication – when the intervertebral disc begins to disintegrate, infection and inflammation may occur between the vertebrae creating pressure even more on the spinal nerves. NSAIDs can be prescribed to reduce the inflammation while pain relievers may also be given to reduce the pain experienced. The purpose of pain relievers is not to mask the problem but to give the physical therapist the opportunity to perform their job without having to deal with a client screaming out in pain.
- Rest – sometimes, nothing can be done to stop the intervertebral disk from disintegrating, perhaps because of a degenerative condition like rheumatoid arthritis. During these cases, the individual may be advised to limit the level of physical activity in order to avoid speeding up of the damage.
When is surgery needed?
Most patients with spinal stenosis respond very well to conservative treatment and often do not require surgery. However, despite all these measures, sometimes it’s just not enough and the damage will persist making the symptoms worse by the day. If all non-surgical measures have failed, then surgery remains as the last resort. There are various forms or surgery. Some are less invasive than others and can be done to slow the progress of spinal stenosis. However, these minimally invasive procedures are not the most effective as they may cause the condition to develop again. Hence it’s best to perform the most effective spinal stenosis surgery techniques.
Spinal stenosis surgery is recommended in cases when:
- All the other non–surgical treatments have failed
- You’ve been in severe pain for a long period of time
- You’ve lost sensation in your upper and lower extremities
- You’ve lost bladder or bowel control
- You have a decreased motor strength on your upper and lower extremities, etc.
In some cases, symptoms may develop too fast to be slowed by any non-surgical measures described above. For example, an accident or sports injury that damages the spinal vertebrae does not allow the individual to attempt any non-surgical measures. In these situations, there is no option but to have spinal stenosis surgery performed on the patient.
Typically, there are two techniques used for spinal stenosis surgery:
- Stabilization – a surgical procedure during which the surgeon limits the motion between vertebrae.
- Decompression – a surgical procedure during which the surgeon removes some tissue pressing against the nerve structure making more room for the spinal cord or nerve roots.