Spinal stenosis is a condition where the bony vertebral canal that the spinal cord runs through narrows leading to compression of this structure. The result is pain and neurological issues such as numbness reduced reflexes and decreased muscle power at the level of spinal cord compression. Paralysis may occur if the stenosis is severe enough which makes this a very serious condition that needs to be managed adequately and appropriately. Spinal stenosis causes include the following pathologies and scenarios:
- The spinal canal develops a narrow structure.
- There may be deformities of the vertebrae leading to canal stenosis.
- The spinal ligaments can become thicker.
- Intervertebral discs may bulge or herniate into the canal.
- Bone spurs may form taking up space in the spinal canal.
- Breakdown of facet joints leading to spinal column collapse.
- Degenerative disc disease resulting in narrowing of the spaces in the spinal column.
- Cyst formations on the facet joints resulting in compression of the thecal sac which is the spinal sac of nerves.
- Osteoporosis (brittle bones) complicating into compression fractures of the vertebral bones.
- Patients with spinal stenosis caused by cervical spine myelopathy are at a higher risk of acute cord injury if they are involved in any accidents.
- Injuries and accidents may result in dislocation of the spine or spinal canal or lead to burst fractures where fragments of bone may end up in the canal.
- Osteoarthritis and less commonly rheumatoid arthritis results in narrowing of the canal due to persistent inflammation in or around the bony structure resulting in the formation of space-occupying canal lesions.
Spinal stenosis treatment protocols involve conservative (non-surgical) and surgical therapies.
Conservative treatments may include:
- Oral medications such as acetaminophen, non-steroidal anti-inflammatories, and narcotics.
- Aerobic exercising to help to achieve or maintain overall satisfactory health.
- Physical therapy to help perform and learn stretching and to strengthen exercises to build-up muscle mass to help support the back.
- Weight loss in order to reduce pressure on the back and slow down the progression of the spinal stenosis.
- Epidural steroid and/or anesthetic injections to help with pain relief.
Surgical interventions may include:
- Lumbar decompressive laminectomy where the roof of bone overlying the narrowed spinal canal and surrounding thickened ligaments are removed to allow more space for the nerves and spinal cord to displace in. Around 70 to 90 percent of patients have good results after this procedure reporting decreased pain and neurological deficits.1
- An interlaminar implant is placed in the area where the decompression was done to offer stability to the spine and to allow the nerves to freely run through the device without any compression of the tissue.
- Patients with cervical myelopathy may have a discectomy and fusion performed where the intervertebral disc where spinal cord compression is located is removed from the cervical spine. The procedure can be done via access to the front or back of the neck.