Spinal Stenosis: Causes, Symptoms, Diagnosis, Treatment, and Prevention
In spinal stenosis, the space around the spinal cord or the nerves that branch off it becomes too narrow. This can cause back, neck, arms, legs, hands, or feet pain, numbness, tingling, or weakness. Although spinal stenosis can affect anyone, it is more common in people over 50.
Causes of Spinal Stenosis
Spinal stenosis can be caused by various factors, such as:
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A person's discs (the spine's bones) may dry out and shrink as they grow older, causing the spaces between them to narrow. A person's spine may also become stiffer and thicker as the ligaments that hold the vertebrae together become thicker and stiffer. Furthermore, bone spurs (bony growths) may form on the spine or facet joints (the joints connecting the vertebrae), narrowing the spinal canal or nerve exit points.
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The most common form of arthritis is osteoarthritis, which causes the cartilage that covers the ends of bones in the joints to wear away, causing pain, stiffness, and bone spurs. Arthritis: Arthritis is a group of diseases that cause inflammation and damage to the joints. An autoimmune disease called rheumatoid arthritis causes the immune system to attack the joints, causing swelling, inflammation, and damage. Both types of arthritis can cause spinal stenosis.
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Trauma to the spine, such as those caused by a car accident, a fall, or sports injuries, can result in fractures, dislocations, or nerve damage. Scar tissue or bone fragments may compress the spinal cord or nerves as a result, resulting in spinal stenosis immediately or over time.
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There are two kinds of tumors: benign (noncancerous) tumors and malignant (cancerous) tumors. Tumors can occur anywhere in the body, including the spine. By pressing on the spine's spinal cord or nerves, or by invading the bone and causing instability or fractures, tumors in the spine can cause spinal stenosis.
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Some people are born with narrow spinal canals or other structural defects that can lead to spinal stenosis. These conditions may not cause symptoms until later in life, when the spinal canal narrows further.
Symptoms of Spinal Stenosis
People with spinal stenosis can experience different symptoms depending on the location and severity of the narrowing. Some people may not experience any symptoms, while others may suffer from mild to severe pain and disability.
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Pain in the back or neck, which may radiate to the arms, legs, hands, or feet. The pain may be worse with standing, walking, bending, or twisting, and may be relieved by sitting, lying down, or leaning forward.
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Numbness, tingling, or weakness in the arms, legs, hands, or feet. These symptoms may affect one or both sides of the body, and may vary in intensity and frequency. They may also cause difficulty with balance, coordination, or fine motor skills, such as buttoning a shirt or holding a pen.
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These include urinary incontinence (loss of bladder control), urinary retention (difficulty emptying the bladder), or fecal incontinence (loss of bowel control). Cauda equina syndrome is a medical emergency caused by compression of the nerves controlling the bladder and bowel. This is a serious condition that requires immediate care.
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Erectile dysfunction (difficulty erections) or decreased sensation in the genital area may result from nerve compression in the pelvic area.
Diagnosis of Spinal Stenosis
In order to diagnose spinal stenosis, your doctor will ask you about your symptoms, medical history, and physical activities. Your health care provider will also conduct a physical exam, where they will examine your spine, reflexes, strength, sensation, and mobility. An imaging test may also be necessary to confirm the diagnosis and determine the cause, location, and extent of the narrowing. These tests may include:
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Spinal X-rays: X-rays are images that show the bones of the spine, and they can reveal disc degeneration, bone spurs, or fractures that cause spinal stenosis.
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The MRI produces detailed images of the soft tissues in the spine, including discs, ligaments, nerves, and spinal cord. Tumors or inflammation can be detected using MRI, which can detect damage to these structures.
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A CT scan is a cross-sectional image of the spine created by X-rays and a computer. CT can reveal the size and shape of the spinal canal, as well as the openings where nerves exit the spine. To outline the spinal cord and nerves, a CT myelogram may be performed by injecting contrast dye into the spinal fluid.
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Nerve conduction studies (NCS) and electromyography (EMG) can determine whether the symptoms are caused by nerve damage or compression by measuring the electrical activity of the muscles and nerves.
Treatment of Spinal Stenosis
The treatment of spinal stenosis depends on the severity of the symptoms, the cause and location of the narrowing, as well as the patient's overall health and preferences. Treatment is aimed at reducing pain, improving function, and preventing further damage to the spinal cord or nerves. Options include:
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The pain and inflammation caused by spinal stenosis can be reduced with medications. Ibuprofen and naproxen, for example, are nonsteroidal anti-inflammatory drugs (NSAIDs), amitriptyline and duloxetine are antidepressants, gabapentin and pregabalin are antiseizure drugs, and oxycodone and hydrocodone are opioids. Health care providers should supervise the use of these medications as they may have side effects, such as stomach irritation, drowsiness, addiction, or liver damage.
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You can improve your spine's strength, flexibility, and stability with physical therapy. As well as improving balance, posture, and mobility, physical therapy can help you learn how to perform daily activities safely and pain-free. A physical therapist can design an individualized exercise program for you, and may also use other techniques, such as heat, cold, massage, or electrical stimulation, to relieve pain and inflammation.
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An epidural steroid injection is a procedure in which a health care provider injects cortisone into a space around a nerve that is compressed by spinal stenosis, reducing swelling and inflammation. An epidural steroid injection involves injecting steroid medication, such as cortisone, into the space around the affected nerve. There may be side effects, such as infection, bleeding, nerve damage, or bone loss, and this may not work for everyone. Only use steroid injections when all other treatments have failed.
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If spinal stenosis symptoms are severe, disabling, or progressive and other treatments have not provided adequate relief, surgery may be considered. By removing structures that are compressing the spinal cord or nerves, such as bone spurs, disc fragments, or tumors, surgery can create more space for them. Based on the cause and location of spinal stenosis, surgery may be performed as follows:
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A laminectomy is the most common procedure for spinal stenosis. It involves removing the back part of the vertebra to create more space for the spinal cord and nerves. The surgery may also involve removing part of the facet joint or the ligament that connects the vertebrae, to relieve pressure on the nerve roots. Spinal fusion, in which two or more vertebrae are joined together with screws, rods, or bone grafts, may also be performed with a laminectomy to stabilize the spine.
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In laminotomy surgery, a small hole is made in the lamina to access and remove structures that are compressing the spinal cord or nerves, such as bone spurs or disc fragments. The spinal structure is preserved more and the recovery time may be shorter than in laminectomy surgery.
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A foraminotomy involves enlarging the foramen, an opening in the spine where the nerve root exits, to relieve pressure. In this procedure, bone spurs, disc fragments, or ligaments can be removed that narrow the foramen. It can be performed as part of a laminectomy or laminotomy, or as a separate procedure.
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An interspinous spacer is inserted between the spine's spinous processes, which are bony projections at the back of the vertebrae in order to create more space for the spinal canal and nerves. By limiting the extension (backward bending) of the spine, this device can reduce the symptoms of spinal stenosis. It is less invasive than a laminectomy and does not require spinal fusion, but it may not be effective for everyone and may have complications, such as device migration, fractures, or infections.
Prevention of Spinal Stenosis
In some cases, spinal stenosis cannot be prevented, especially if it is caused by congenital conditions, tumors, or injuries. However, certain steps can be taken to reduce the risk of developing or worsening spinal stenosis, including:
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Maintaining a healthy weight and avoiding obesity, which can put extra pressure on the spine and the discs.
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Exercising regularly and keeping the spine and the muscles that support it strong and flexible. Low-impact activities, such as walking, swimming, or cycling, are recommended, while high-impact or twisting activities, such as running, jumping, or golfing, should be avoided or done with caution.
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Practicing good posture and ergonomics, and avoiding prolonged or repetitive bending, twisting, or lifting of heavy objects. Using proper techniques and equipment when performing these activities can also help prevent injury and strain to the spine.
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Quitting smoking and limiting alcohol consumption, which can impair the blood flow and the healing of the spine and the discs.
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Getting regular check-ups and screening tests, and treating any medical conditions that may affect the spine, such as arthritis, diabetes, or osteoporosis.
As a result of various factors, including aging, arthritis, injury, tumors, or congenital conditions, spinal stenosis can cause pain and disability in the back, neck, arms, legs, hands, or feet. A spinal stenosis narrowing can cause a variety of symptoms, including pain, numbness, tingling, weakness, bladder or bowel problems, and sexual dysfunction, depending on its location and severity. Medical history, physical examination, and imaging tests, including X-rays, MRIs, CTs, or EMGs, are used to diagnose spinal stenosis. The treatment of spinal stenosis depends on the severity of the symptoms, the cause and location of the narrowing, and the patient's overall health and preferences. In addition to medications, physical therapy, steroid injections, surgery, and interspinous spacers, there are several treatment options available. There are some steps you can take to reduce the risk of developing or worsening spinal stenosis, including maintaining a healthy weight, exercising regularly, practicing good posture, quitting smoking, and getting regular check-ups. Even though spinal stenosis can adversely affect patients' quality of life, it can be managed and relieved with proper diagnosis and treatment.
