Spinal Stenosis – Causes, Symptoms, Diagnosis, Treatment

Spinal stenosis
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Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with bending forwards. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.

Types of Spinal Stenosis

  • Central stenosis – Narrowing of the central canal (called central stenosis) in the lumbar (low back) area can compress the thecal sac. This narrowing can cause pressure on the nerve bundle at the end of the spinal cord (cauda equina) or the individual nerves within the thecal sac.
  • Foraminal stenosis – Foraminal stenosis is the most common type of lumbar spinal stenosis, and may also be referred to as lateral spinal stenosis. As the nerve root is about to leave the canal through a side hole in the back of the spine, called the neuro-foramen, a bone spur (osteophyte) that has already developed from a degenerating disc, or an arthritic facet joint, can press on that nerve root.
  • Cervical stenosis – In this condition, the narrowing occurs in the part of the spine in your neck.
  • Lumbar stenosis – In this condition, the narrowing occurs in the part of the spine in your lower back. It’s the most common form of spinal stenosis.
  • Far lateral stenosis – The individual nerves exit from the center of the spinal canal out hole in the back of the spine called the neuro-foramen. Beyond the neuro-foramen, there can also be narrowing secondary to the development of bone spurs from the facet joints, bulging discs, herniated discs, and ligament hypertrophy.

Causes of Spinal Stenosis

Age

Any of the factors below may cause the spaces in the spine to narrow.

  • Spinal ligaments can thicken (ligament Flava)
  • Bone spurs develop on the bone and into the spinal canal or foraminal openings
  • Intervertebral discs may bulge or herniate into the canal or foraminal openings
  • Degenerative disc disease causes narrowing of the spaces
  • Facet joints break down
  • Compression fractures of the spine, which are common in osteoporosis
  • Cysts form on the facet joints causing compression of the spinal sac of nerves

Causes of Spinal Stenosis

  • Overgrowth of bone – Wear and tear damage from osteoarthritis on your spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal. Paget’s disease, a bone disease that usually affects adults, also can cause bone overgrowth in the spine.
  • Osteoarthritis – Can lead to disc changes, a thickening of the ligaments of the spine, and bone spurs. This can put pressure on your spinal cord and spinal nerves.
  • Herniated discs – If the cushions are cracked, the material can seep out and press on your spinal cord or nerves.
  • Injuries – An accident may fracture or inflame part of your spine.
  • Tumors – If cancerous growths touch the spinal cord, you may get stenosis.
  • Paget’s disease – With this condition, your bones grow abnormally large and brittle. The result is a narrowing of the spinal canal and nerve problems.
  • Herniated disks – The soft cushions that act as shock absorbers between your vertebrae tend to dry out with age. Cracks in a disk’s exterior may allow some of the soft inner material to escape and press on the spinal cord or nerves.
  • Thickened ligaments – The tough cords that help hold the bones of your spine together can become stiff and thickened over time. These thickened ligaments can bulge into the spinal canal.
  • Tumors – Abnormal growths can form inside the spinal cord, within the membranes that cover the spinal cord or in the space between the spinal cord and vertebrae. These are uncommon and identifiable on spine imaging with an MRI or CT.
  • Spinal injuries – Car accidents and other trauma can cause dislocations or fractures of one or more vertebrae. Displaced bone from a spinal fracture may damage the contents of the spinal canal. Swelling of nearby tissue immediately after back surgery also can put pressure on the spinal cord or nerves.
  • Arthritis – Osteoarthritis, Rheumatoid arthritis—much less common cause of spinal problems
  • Congenital – The spinal canal is too small at birth. Structural deformities of the vertebrae may cause narrowing of the spinal canal.
  • Instability of the spine – A vertebra slips forward on another (spondylolisthesis)
  • Trauma – Accidents and injuries may dislocate the spine and the spinal canal or cause burst fractures that yield fragments of bone that go through the canal patients with cervical myelopathy caused by narrowing of the spinal canal are at higher risks of acute spinal cord injury if involved in accidents.

Symptoms of Spinal Stenosis

  • Standing discomfort
  • Discomfort/pain, in the shoulder, arm, hand
  • Bilateral symptoms
  • Numbness at or below the level of involvement
  • Weakness at or below the level of involvement
  • Pain or weakness in Buttock / Thigh only
  • Pain or weakness below the knee 
Overall
  • Sciatica – These shooting pains down your leg start as an ache in the lower back or buttocks.
  • Foot drop – Painful leg weakness may cause you to “slap” your foot on the ground.
  • A hard time standing or walking – When you’re upright, it tends to compress the vertebrae, causing pain.
  • Loss of bladder or bowel control – In extreme cases, it weakens the nerves to the bladder or bowel.
  • Developing slowly over time, or slow onset
  • Coming and going, as opposed to continuous pain
  • Occurring during certain activities (such as walking for lumbar stenosis, or biking while holding the head upright) and/or positions (such as standing upright for lumbar stenosis)
  • Feeling relieved by rest (sitting or lying down) and/or any flexed forward position.

In the neck (cervical spine)

In the lower back (lumbar spine)

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Neurological disorders

  • Cervical (spondylotic) myelopathy, a syndrome caused by compression of the cervical spinal cord which is associated with “numb and clumsy hands”, imbalance, loss of bladder and bowel control, and weakness that can progress to paralysis.
  • Pinched nerve, causing numbness.
  • Intermittent neurogenic claudication characterized by lower limb numbness, weakness, diffuse or radicular leg pain associated with paresthesis (bilaterally), weakness, and/or heaviness in buttocks radiating into lower extremities with walking or prolonged standing. Symptoms occur with extension of the spine and are relieved with spine flexion. Minimal to zero symptoms when seated or supine.
A human vertebral column
  • Radiculopathy (with or without radicular pain) neurologic condition—nerve root dysfunction causes objective signs such as weakness, loss of sensation, and of reflex.
  • Cauda equina syndrome Lower extremity pain, weakness, numbness that may involve perineum and buttocks, associated with bladder and bowel dysfunction.
  • Lower back pain due to degenerative disc or joint changes

Diagnosis of Spinal Stenosis

A rheumatologist will ask about your symptoms and medical history. If he suspects spinal stenosis, he will do a physical exam. Some symptoms he will look for include:

  • Numbness, weakness, cramping or pain in the legs, thighs or feet that makes it hard to walk
  • Pain that goes down the leg
  • Abnormal bowel/and or bladder function
  • Loss of sexual function
  • In severe cases, partial or complete leg paralysis. This is considered a medical emergency and you should get to an emergency room as quickly as possible.

A rheumatologist will also consider other conditions that can cause similar symptoms, such as arthritis of the hips or knees; disorders of the nervous system; or disorders of the heart and blood vessels. A rheumatologist may also order other tests to confirm the diagnosis and determine the seriousness of your condition. These include:

  • An X-ray of the spine to check for osteoarthritis, bone spurs and narrowing of the spinal canall
  • A magnetic resonance imaging (MRI) scan of the spine to take pictures of the spinal cord and nerves
  • An EMG (electromyogram) – to check the nerves going to your legs
  • X-rays of the hips or knees, blood tests, as well as tests to check the circulation in your legs and to rule out other diseases with similar symptoms
  • Magnetic resonance imaging (MRI) – By using radio waves, an MRI creates a 3-D image of your spine. It can show tumors, growths, and even damage to discs and ligaments.
  • Computerized tomography (CT scan) – A CT scan uses X-rays to create a 3-D image. With the help of a dye injected into your body, it can show damage to soft tissue as well as issues with your bones.

Treatment of Spinal Stenosis

Rest

It is important that patient take proper rest and sleep and avoid any activities which will further aggravate the disc bulge and its symptoms. Many minor disc bulges can heal on their own with rest and other conservative treatment.

Ice & Moist Heat Application

Ice application where the ice is wrapped in a towel or an ice pack for about 20 minutes to the affected region, thrice a day, helps in relieving the symptoms of a disc bulge. Heat application in the later stages of treatment also provide the same benefit.

Cervical Pillow

It is important to use the right pillow to give your neck the right type of support for healing from a cervical disc bulge and also to improve the quality of sleep.

Hot Bath

Taking a hot bath or shower also helps in dulling the pain from a disc bulge. Epsom salts or essential oils can be added to a hot bath. They will help in soothing the inflamed region.

Over the Door Traction

This is a very effective treatment for a disc bulge. It helps in relieving muscle spasms and pain. Typically a 5 to 10 pound weight is used and it is important that patient do this under medical guidance.

  • Patient education on proper body mechanics (to help decrease the chance of worsening pain or damage to the disk)
  • Physical therapy, which may include ultrasound, massage, conditioning, and exercise
  • Weight control
  • Use of a lumbosacral back support

The effectiveness of non surgical treatments is unclear as they have not been well studied.

  • Education about the course of the condition and how to relieve symptoms
  • Exercise, to maintain or achieve overall good health, aerobic exercise, such as riding a stationary bicycle, which allows for a forward lean, walking, or swimming can relieve symptoms
  • Weight loss, to relieve symptoms and slow progression of the stenosis

Medication

Surgery of Spinal Stenosis

Lumbar decompressive laminectomy: This involves removing the roof of bone overlying the spinal canal and thickened ligaments in order to decompress the nerves and sac of nerves. 70-90% of people have good results.

  • Interlaminar implant – This is a non-fusion U-shaped device that is placed between two bones in the lower back that maintains motion in the spine and keeps the spine stable after lumbar decompressive surgery. The U-shaped device maintains height between the bones in the spine so nerves can exit freely and extend to the lower extremities. Surgery for cervical myelopathy is either conducted from the front or from the back, depending on several factors such as where the compression occurs and how the cervical spine is aligned.
  • Anterior cervical discectomy and fusion – A surgical treatment of nerve root or spinal cord compression by decompressing the spinal cord and nerve roots of the cervical spine with a discectomy in order to stabilize the corresponding vertebrae.
  • Posterior approaches – seek to generate space around the spinal cord by removing parts of the posterior elements of the spine. Techniques include laminectomy, laminectomy and fusion, and laminoplasty.
  • Less invasive back surgery – For moderate to severe pain, decompression can be achieved through less invasive surgical procedures like interspinous spacers.
  • Traditional back surgery – For moderate to severe pain, decompression or spinal fusion may be considered when more conservative treatments aren’t successful at relieving pain.
  • Targeted drug delivery – For severe chronic pain from spinal stenosis, targeted drug delivery may be a treatment option when more conservative treatments are not helping to relieve pain.
  • Laminectomy – is the most common type of surgery. A surgeon removes part of your vertebrae to provide more room for the nerves.
  • Foraminotomy – is a surgery that’s done to widen the part of the spine where the nerves exit.
  • Spinal fusion – is typically performed in more severe cases, especially when multiple levels of the spine are involved, to prevent instability. Bone grafts or metal implants are used to attach the affected bones of the spine together.
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Alternative  Rx of Spinal Stenosis

Physiotherapy

Before examining different exercises that may help with spinal stenosis, here are 5 important reasons to stay active:

  • Exercise will increase the blood flow to the back, bringing needed oxygen and nutrients and washing away toxic metabolites.
  • Exercise will strengthen the muscles around the spine, helping to take the pressure off of the bones and other static structures in the back.
  • Exercise will help maintain flexibility, which will help prevent tight muscles that pull and torque the spine, which can worsen symptoms of spinal stenosis.
  • Exercise will help maintain a healthy weight. Excess weight can lead to worsening back pain and leg pain.
  • Staying active helps with emotional and mental health as well. Getting up and moving gets the blood and endorphins flowing and improves one’s overall outlook, which in turn helps reduce pain and improve physical symptoms.
  • Physical therapy to support self-care. Also may give instructs on stretching and strength exercises that may lead to a decrease in pain and other symptoms.
  • Practice good posture – Stand up straight, sit on a supportive chair, and sleep on a firm mattress. And when you lift heavy objects, bend from your knees, not your back.
  • Lose weight – When you are heavier, there will be more pressure on your back.
  • Acupuncture – Acupuncture can be helpful in treating some of the pain for less severe cases of lumbar stenosis. Although it can be very safe, long-term success with this treatment has not been proven scientifically.
  • Chiropractic manipulation
  • Chiropractic manipulation – is generally safe and can help with some of the pain from lumbar stenosis. Care should be taken if a patient has osteoporosis or disk herniation. Manipulation of the spine in these cases can worsen symptoms or cause other injuries.

Home Remady of  Spinal Stenosis

Positioning Yoga( only home practice)

Spinal stenosis

Physiotherapy is a very cheap and good way of getting rid of a herniated disc itself. Therapists will teach you proper exercises and stretches which will improve the disc shape to a great extent.

You will notice good differences while performing daily chores after just 4-5 sessions of therapy.

  • Turmeric – Turmeric contains curcumin which is a very good anti-oxidant and anti-inflammatory agent. This is why it stops the gel-like fluid inside the discs from coming out and bulge. It also shows antihistamine properties which help to reduce pain because of slowed blood circulation to the area of pain.
  • Dimethyl Sulfoxide (DMSO) – Dimethyl sulfoxide is a derivative from sulfur which has antioxidant properties as well as the organic sulfur present in it helps in the growth of new cells and detoxification of the body. The growth of new cells helps to replace the old cells of the discs and prevent the fluid from leaking outside.
  • Massage With Essential Oils – Massage with essential oils on the full-body, especially on the spine and lower back regions, will help in good blood circulation and promote the growth of new cells. It will help relieve pain and promote better absorption of oxygen and nutrients. Essential oils will also regenerate the cells of the disc and hence stop the disc from getting slipped.
  • Acupressure And Acupuncture – In both techniques, pressure is used for relieving the pain from the swelled area. In acupressure fingers, hips and elbows are used and acupuncture needles are used. But this should be done with the help of an experienced practitioner and not alone. This is not recommended for patients having high blood pressure and for women who are pregnant.
  • TENS – TENS stands for Transcutaneous Electrical Nerve Stimulation and this is one of the best remedies for herniated disc at home. This treatment uses low voltage electric current which is applied to the affected area and helps the body to release endorphin which decreases the pain.
  • Cayenne Pepper –  It is a very effective ingredient for the treatment of herniated discs. You can drink its tea or make a paste of the pepper using water and apply it to the affected area.
  • Diet – Diet is necessary to keep away all types of bad conditions that might affect you. Drink a lot of water and eat a balanced diet. Take excess of fibers and proteins. During this condition, you should avoid dairy products and red meat. Also, avoid fat-free foods.
  • Epsom Salt – Epsom salt is one of the widely used natural painkiller and anti-inflammatory agents. You can use this by adding 3-4 cups of salt in a hot water bath. Stay inside the bath for 15 minutes. It will help you achieve maximum relaxation. Do not use this remedy if you are diabetic or pregnant. If you are on any type of medication consult your doctor before bathing in Epsom salt.
  • Horsetail – Horsetail is a herb that has high quantities of minerals in it. It nourishes our tissues and has the ability to heal broken bones and torn ligaments. All you need to do is add some horsetail leaves to half a liter of water. Boil on low heat till the water quantity reduces to half its quantity. Cool the solution and filter it off. You can drink 5 ml of the solution thrice a day. It will heal herniated disc very fast.
  • California Poppy – California poppy is anti-inflammatory and analgesic in nature. This is what makes it a good treatment for a herniated discs. You can tear the leaves of California poppy into small pieces and make a paste out of it using water. Use little hot water so that when you apply the paste to the affected area it is still warm.
  • White Willow Bark – White willow bark is used for reducing the discomfort of herniated discs. The chemical structure of these drugs shows a marked similarity to aspirin hence acts as an analgesic but doesn’t irritate your gut. It is also astringent and anti-inflammatory in nature. This herb might react with drugs hence do consult your doctor if you are on any kind of medication.
  • Comfrey Leaves – Comfrey leaves have the power to heal bones and connective tissues of the body. All you need to do is take some fresh leaves and add them to cold water. Let it remain undisturbed for around 12 hours. After 12 hours heat the above solution and filter it. Add the filtrate to bathwater and take a bath in it 2 times a day. Do not consume it orally because it contains hepatic-toxin alkaloids.
  • BoswelliaBoswellia is a naturally occurring painkiller that is a very effective remedy for a herniated discs. All you can do is make a decoction of Boswellia and consume it 2 times a day to reduce pain and discomfort associated with herniated discs. Boswellia is an organic painkiller that effectively treats the problem of the herniated disc. It is also an herbal cure for osteoarthritis.
  • Omega-3 Fatty AcidsOmega-3 Fatty acids are helpful in decreasing the inflammation and pain experienced due to herniated disc disorder. This acid forms the collagen which is used by the broken discs for repairing itself. Eat foods that are high in this kind of fat like fish, almonds, sprouts, and walnuts. \
  • Colchicine – Colchicine is an active amino-alkaloid found in the plant of Kurchi or autumn crocus. This powder is obtained by crushing the seeds of the plant. It has anti-inflammatory properties which are effective against the slipped disc. Make a paste with kurchi powder and honey and consume it once a day. You can also make tea out of the powder or mix the powder in milk and have it once or twice a day.
  • BurdockBurdock contains a lot of anti-oxidants which is helpful to detoxify the body and remove all kinds of harmful substances and decrease the pain and inflammation in your body. It also treats arthritis. Burdock can be consumed as a decoction once or twice a day.
  • Passionflower – Passionflower is helpful for slipped discs because the essential oils present is antispasmodic in nature. It reduces pain and inflammation. You can massage with passionflower essential oil or take capsules made from it, however, do consult your doctor before taking capsules.
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Additional Tips

  • If you are overweight, try to lose some pounds.
  • Exercise every day.
  • Lift things in a proper way, as guided by a therapist. Do not lift heavyweights.
  • Stop smoking and drinking.
  • Always make sure you are in the right posture whatever activity you may be doing.
  • Wear flat and soft shoes. Avoid heels.
  • Walk and move around cautiously.

Slipped discs can be really painful but with the right treatment and precautions, you can become as fit as you were before. So start taking home remedies and consult a doctor whenever you feel any kind of severe pain.

Homeopathic treatment for Spinal Stenosis

Calcarea fluorica

  • The patient had a long history of pain in the back (lumbago).
  • Pain in the back is aggravated when the patient begins to move.
  • Pain is relieved in continuous motion.
  • Tumors of vertebrae(osseous tumors) i.e. exostosis.
  • Pain in the lumbar( lower) region of the back with a burning sensation.

Petroleum

  • The nape of the neck is stiff and painful.
  • The patient feels weakness in the lumbosacral region of the back.
  • There is cracking in joints.
  • Coccyx region is painful.

Silicea terra

  • The spine of the patient is weak and needs support.
  • Patient is very susceptible to slight effects on the back. Recurrent history of back troubles.
  • Patient has pain in the coccyx.
  • There is irritation of the spine in patients with a history of spine injury.
  • Well indicated medicine for pott’s disease of vertebrae.
  • Also indicated for diseases of vertebrae.

Zincum metallicum

  • The patient complains of pain in the lumbosacral region.
  • The patient cannot bear to be touched on back.
  • Well indicated medicine for spinal irritation due to myelitis.
  • There is a burning sensation along the spine.
  • Dull pain is present in the lumbar region.
  • Tearing pain is present in shoulder blades.

Cocculus indicus

  • On moving ahead there is cracking of cervical vertebrae.
  • Lumbosacral pain is of paralytic type.
  • There is a bruising type of pain in the shoulders and arms.
  • Pressure is felt on the scapulae and nape of the neck.
  • A patient feels stiffness on moving the shoulders.

References

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