Grades and Treatment Options For Spinal Stenosis Severity

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Being diagnosed with any spinal condition, including spinal stenosis, can be stressful and confusing. However, knowledge is power. Understanding the grading system used in the diagnosis of spinal stenosis, as well as the available treatment options, can help you get on the path to relief. 

What Are The Grades of Spinal Stenosis?

There are two popular, universal grading systems to evaluate the severity of spinal stenosis cases. These systems include the Lee grading system and the Schizas grading system. Both systems are implemented by visually assessing MRI results and have been deemed reliable. 

The Lee grading system includes four grades. It’s based on the obliteration of the CSF (cerebrospinal fluid) space in front of the cauda equina, which are the roots of the spinal nerves in the lumbar and sacral spine in the dural sac. The dural sac is the sac that encloses the spinal cord.  

  • Grade 0, or no stenosis

A case given a grade 0 has an anterior CSF space that’s not obliterated. 

  • Grade 1, or mild stenosis

A case given a grade 1 has an anterior CSF space that’s mildly obliterated, but all of the cauda equina can be distinctly visually separated. 

  • Grade 2, or moderate stenosis

A case given a grade 2 has an anterior CSF space that’s moderately obliterated and some of the cauda equina can’t be visually separated. 

  • Grade 3, or severe stenosis

A case given a grade 3 has an anterior CSF space that’s severely obliterated with apparent dural sac compression. None of the cauda equina can be visually separated. 

The Schizas grading system includes seven grades. It’s based on the form of the dural sac and the ratio of nerve roots to CFS. 

  • Grade A: no/minor stenosis

Grade A indicates that CSF is apparent in the dural sac with a heterogenous distribution.

  • Grade B: moderate stenosis

With grade B spinal stenosis, spinal roots populate the entire dural sac, but can still be distinguished, and some CSF is visible. 

  • Grade C: severe stenosis

Grade C spinal stenosis has no recognizable spinal roots and no visible CSF. 

  • Grade D: extreme stenosis

Grade D spinal stenosis involves no recognizable spinal roots and no epidural fat posteriorly. 

How Fast Does Spinal Stenosis Progress?

Many cases of spinal stenosis aren’t progressive. In these cases, the condition causes episodes of pain and dysfunction. However, spinal stenosis can slowly progress over time from day-to-day wear and tear.

Patients who don’t seek out immediate treatment for spinal stenosis are more likely to experience worsening symptoms over time. 

One clinical study showed that among 32 patients with lumbar spinal stenosis, after 49 months without surgery, 70% of patients had unchanged symptoms, 15% of patients’ symptoms improved, and 15% of patients worsened. 

Can I Slow The Progression of Spinal Stenosis?

You may not be able to entirely prevent the spinal stenosis from progressing. However, there are a few tactics that you can use to slow down the narrowing of the spinal canal, including:

  • A low-impact exercise routine

This may be counter-intuitive, as many people assume that they should rest and avoid physical activity with spinal conditions. However, while you should follow your doctor’s instructions for physical activity, low-impact exercise is typically beneficial for spinal stenosis patients. 

Exercise can help improve muscle strength, mobility, and balance in people with spinal stenosis pain. It also boosts circulation throughout the body, which may help deliver healing oxygen and nutrients to the irritated tissue. 

Keep in mind that certain forms of exercise, like running and weightlifting, can put excess strain on the spine. These activities may worsen spinal stenosis symptoms. So, we recommend sticking to low-impact activities, such as walking, swimming, and water aerobics.

  • Proper posture

Your posture while sitting, standing, and exercising makes a large impact on the long-term health of your spine. With this in mind, it’s particularly important for spinal stenosis patients to maintain proper posture throughout the day. 

  • While sitting, make sure that your back is straight with your shoulders back. You shouldn’t be leaning forward, and your buttocks should be touching the back of the chair. Selecting an office chair with lumbar support may help you maintain good posture throughout the work day. 
  • While standing, keep your weight on the balls of the feet with your feet shoulder-width apart. Keep your head right above the neck (not tipped forward) and don’t lock your knees. 
  • While lifting objects, bend at the hips and knees – not the waist. This means that your back should remain straight while you’re lifting. 
  • Prioritize sleep

While you sleep, your body undergoes various processes that are essential for healing.

  • For one, while you sleep, the brain stimulates the release of human growth hormone or HGH. This hormone helps to build, sustain, and repair tissue throughout the body. 
  • The body is also able to produce a higher volume of white blood cells while you sleep. This strengthens the immune system’s ability to fight foreign invaders that could sabotage your healing process. 
  • While you’re asleep, your body takes a well-deserved break. Your blood pressure falls, which allows your heart to rest throughout the night. Additionally, the hormones released during sleep relax your muscles and slow down your breathing, which can facilitate healing and decrease inflammation. 
  • Sleep is also known to benefit mental health, which can have a positive overall effect on your recovery process. This is in part due to sleep’s stress-relieving effects, as well as its ability to improve energy levels, memory, and focus. 

Can You Live With Spinal Stenosis Without Surgery?

In short, yes. Less than 5% of patients with a spinal disorder need spine surgery. There are several non-surgical treatment options available, which often are sufficient to alleviate patients’ symptoms. Additionally, especially with an early diagnosis, many patients can take measures to stop the condition from causing severe disability. 

Physical therapy, lifestyle modifications, and pain medications are often key components of non-surgical treatment plans for spinal stenosis. 

  • Physical therapy

Physical therapy can help spinal stenosis patients overcome pain, stiffness, and poor mobility. Physical therapists provide exercises to strengthen the muscles that support the spine, as well as stretches to promote flexibility. Additionally, many physical therapists offer alternative therapies, like electrical stimulation, acupuncture, and massage, to support your recovery process.

  • Lifestyle modifications

Adjusting your diet, activities, and habits may help you overcome spinal stenosis symptoms without surgery. As general guidelines, many physicians recommend focusing on hydration, quitting smoking, eating a high volume of nutrient-dense fruits and vegetables, and reducing your intake of alcohol, caffeine, red meat, processed foods, and sugars. 

  • Pain medications

Over-the-counter pain medications are often helpful for spinal stenosis patients struggling with pain management. More severe cases may require prescription medications from a physician. 

When Does Spinal Stenosis Require Surgery?

There are a few reasons why spinal stenosis may require surgery:

  • If non-surgical treatment methods fail to provide any improvement after several months, it may be an indication that the patient needs surgery. 
  • If the patient experienced neurological symptoms that point to severe or progressive spinal nerve compression, surgery may be required to avert serious complications. 
  • If spinal instability contributes to a case of spinal stenosis, specialists may recommend surgery to stabilize the spine and prevent future injury. 

What Is The Best Surgical Treatment For Spinal Stenosis?

When conservative treatment options like physical therapy, medication, and lifestyle adjustments fail to improve spinal stenosis, surgery may be considered. Decompressive laminectomy is widely considered to be the best surgical treatment for lumbar spinal stenosis. 

During a decompressive laminectomy, the surgeon removes a small portion of the lamina at the affected spinal segment. The lamina is a piece of bone covering the back of each vertebra. By removing some (or all) of the lamina, your surgeon will create more room for the spinal nerves and tissues, leading to relief from nerve compression symptoms. 

Since decompression surgery involves removing spinal structures, it can lead to instability. To avert this issue, surgeons often pair decompression with spinal fusion. 

Spinal fusion is a surgical procedure during which a bone graft is secured between the affected vertebrae. Over time, the graft will cause the vertebrae to fuse into a single bone.

While spinal fusion prevents spinal instability, it also prevents all motion at the fused segment. This can severely limit patients’ mobility.  

What Is The Latest Treatment For Severe Lumbar Spinal Stenosis?

Recent innovations in medical technology have created a path to spinal stenosis surgery without fusion. Non-fusion implants, like the TOPS System from Premia Spine, allow patients to avoid the extensive recovery process and diminished range of motion associated with fusion.  

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The TOPS procedure stabilizes the lumbar spine to reestablish a stable range of motion. It allows spinal stenosis patients to get back the ability to twist, bend, and flex the spine. For many, the TOPS System facilitates a return to day-to-day activities, as well as long-term pain relief. 

If you’ve been diagnosed with spinal stenosis, don’t hesitate to talk to your doctor about every treatment option available to you.