Spinal stenosis is the narrowing in one or more areas of the spinal canal as a result of injury or deterioration of the discs, joints or bones of the spine. Most cases of spinal stenosis develop as a result of the degenerative changes that occur during aging. Osteoarthritis is the main cause of spinal stenosis, since this condition causes deterioration of cartilage in the area that leads to the bones rubbing against each other. As bones make repeated abnormal contact, bone spurs form, narrowing the spinal canal.
Other causes of spinal stenosis are traumatic injury, herniated disc, ligament thickening and, in rare cases, spinal tumors, any of which can damage the alignment of the vertebrae. A subtype of spinal stenosis is foraminal stenosis. This condition is caused by a narrowing of the foramen, the opening within each of the spinal bones that allows nerve roots to pass through.
Symptoms of Spinal Stenosis
Patients with spinal stenosis may experience a number of troubling symptoms. These may include:
- Pain in the back, neck, shoulders or extremities
- Muscle cramping
- Loss of sensation in affected areas
- Loss of balance
- Bladder or bowel dysfunction
The loss of bladder or bowel control is a rare, but particularly distressing symptom, for which surgery is most often necessary.
Diagnosis of Spinal Stenosis
In order to diagnose spinal stenosis, a medical history and a physical examination are always necessary. The condition is often difficult to diagnose, not only because its symptoms may resemble the symptoms of other conditions, but because they may only occur intermittently. A diagnosis of spinal stenosis is usually achieved only after ruling out other disease conditions. Typically, imaging exams such as a spinal X-rays, MRI, CT or bone scans are administered to definitively diagnose the condition and to pinpoint the spinal region affected. An electromyography (EMG) may also be administered to measure electrical impulses in the affected skeletal muscles.
Treatment of Spinal Stenosis
Most cases of spinal stenosis can be effectively treated through conservative methods such as physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), rest and a supportive back brace or cervical collar. In some situations, corticosteroid injections may provide relief.
For more severe cases, surgical procedures such as a decompressive laminectomy, laminotomy or spinal fusion may be required to relieve pressure on the nerves. When the patient is diagnosed with foraminal stenosis, a surgical procedure known as a foraminotomy may be performed. This operation widens the area where the spinal nerve roots project from the spine.
Spondylolisthesis is a displacement of one of the bones of the spine. When the displaced vertebra slips out of its normal location onto the bone beneath it, it may compress a spinal nerve, causing pain. This condition most commonly occurs in the lumbar (lower) region of the back and may occur for a variety of reasons. Spondylolisthesis is graded by radiologists according to the amount of slippage that has occurred, Grade I being the mildest displacement and Grade IV the most serious.
Symptoms of Spondylolisthesis
The severity of spondylolisthesis symptoms is quite variable. Patients with spondylolisthesis may be completely asymptomatic or may experience symptoms ranging from mild to extremely serious. These symptoms may include:
- Lower back pain
- Upper leg pain
- Leg weakness
- Pain in the buttocks
- Tight hamstring muscles
- Extreme tenderness at the slippage site
- Stiffness, numbness or tingling in the region
Untreated, spondylolisthesis can lead to extreme postural difficulties, including lordosis (swayback) or kyphosis (hunchback). In extreme cases, these postural abnormalities, in turn, can result in diminished lung capacity or neurological problems.
Diagnosis of Spondylolisthesis
Spondylolisthesis is diagnosed through evaluation of a medical history, a thorough physical examination, and detailed X-rays of the spine. When the patient has pain when raising a straightened leg, this may be indicative of the disorder. Spinal X-rays will help the physician to detect fractures or misalignment of vertebrae.