What is Spinal Stenosis?
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“What is spinal stenosis?” is one of the most frequently asked questions in any spinal specialist’s office. Given that up to 95% of people develop degenerative spinal changes by age 50, it’s no surprise that spinal stenosis is a prevalent medical concern today.
Although spinal stenosis is a common back problem, many affected patients have never heard of it at the time of their diagnosis. With this in mind, we’ll provide a detailed explanation of spinal stenosis below, including the causes, symptoms, and treatments available for this prevalent condition.
Understanding Spinal Stenosis
“Stenosis” means “narrowing,” and spinal stenosis signifies an unnatural narrowing of the spinal canal. The spinal canal is the space at the center of the vertebrae that houses the spinal nerves.
This restriction of the spinal canal places pressure on the spinal nerves. It can also impact nerves that emanate from the affected vertebrae to other parts of the body. The area that’s the most commonly affected by stenosis is the lower, or lumbar, region of the spine.
What Causes Spinal Stenosis?
Spinal stenosis can be caused by a variety of factors, including:
- Chronic inflammatory, arthritic, and spinal conditions conditions
Osteoarthritis, rheumatoid arthritis, scoliosis, and herniated disc are among the medical conditions that may lead to spinal stenosis.
- The normal aging process
The spine naturally changes with age. For one, the intervertebral discs dry out, become thinner, and may begin to bulge. An injured intervertebral disc takes up additional space in the spinal canal, potentially leading to spinal stenosis.
Additionally, the aging process can cause the ligaments and/or bone in the spine to thicken or expand. When this occurs, the open space in the spinal canal becomes more limited.
Spinal stenosis is most often seen in adults above the age of 40 years, and women are affected by spinal stenosis more frequently than men.
- Heredity factors
Clinical studies have confirmed that lumbar spinal stenosis is highly genetic. This is despite the fact that spinal degeneration is widely considered to be the key contributing factor to the development of stenosis. In a 2014 study, lumbar spinal stenosis cases yielded heritability estimates of 66.9%.
Spinal Stenosis Symptoms
Symptoms of spinal stenosis can include intense back and leg pain, as well as numbness or cramping in various regions of the body. In spinal stenosis patients, loss of sensation can be extreme.
Severe Spinal Stenosis Symptoms
Lumbar spinal stenosis symptoms in severe cases may include difficulty controlling urine or bowel movements and difficulty balancing while walking. While these symptoms can sound alarming, especially if you were just diagnosed with spinal stenosis, they only occur in a small portion of spinal stenosis patients.
To illustrate this fact, let’s consider a survey conducted in 564 U.S. hospitals and general practice clinics. Out of 3,647 patients diagnosed with lumbar spinal stenosis in this survey, only 135 patients experienced bowel and bladder dysfunction.
Bowel and bladder dysfunction mainly occur in spinal stenosis patients with cauda equina lesions. The cauda equina is the collection of nerve roots located in the lower spinal cord. It facilitates movement and sensation in the legs and bladder.
Spinal stenosis can trigger cauda equina syndrome, which requires immediate diagnosis and treatment to prevent severe neurological complications.
Spinal Stenosis and Walking Problems
As we mentioned above, severe spinal stenosis can lead to walking and balance problems. However, even in its earlier stages, spinal stenosis can cause difficulty walking for extended distances.
Walking problems with lumbar spinal stenosis may include:
- Cramping, tingling, and/or numbness in the legs while walking
- Pressure in the lower back while standing upright
- Muscle weakness in the legs
- Pain in the buttocks, legs, and/or back while walking
- A foot that slaps the ground when you take a step due to weakness
Leaning forward alleviates pressure on the spinal nerves. So, spinal stenosis patients experiencing walking problems often experience relief when they sit down, crouch, lean forward, or even push a grocery cart.
If you’ve been diagnosed with spinal stenosis and are experiencing severe pain and weakness while standing or walking, reach out to your doctor immediately. You may be experiencing cauda equina syndrome.
What is Considered Severe Spinal Stenosis?
Patients may have what’s considered a severe case of lumbar spinal stenosis if they experience a loss of physical function or are disabled as a result of the stenosis. Additionally, physicians may classify a case of spinal stenosis as severe if the patient doesn’t respond to several months of non-surgical treatment.
Severe spinal stenosis typically requires surgery for symptom relief. After spinal stenosis surgery, patients generally experience restored function and improved quality of life.
Can Spinal Stenosis Be Treated At Home?
Patients experiencing symptoms of spinal stenosis need to receive a medical evaluation and diagnosis. This ensures that any troubling symptoms are promptly addressed before causing lasting complications.
With that said, after receiving a diagnosis, many patients with early spinal stenosis can manage their symptoms with at-home care. Paired with physical therapy and physician-recommended lifestyle changes, at-home treatment can significantly improve spinal stenosis symptoms.
Along with heat/cold therapy, exercises for spinal stenosis are among the most widely-recommended at-home treatment for this condition. Spinal stenosis exercises can be done at home to strengthen the spine’s stabilizing muscles and improve range of motion. Your physical therapist may give you a specific exercise regimen to complete at home based on your personal needs.
What Is The Best Treatment For Spinal Stenosis?
Many treatments for spinal stenosis are available, including medications, physical therapy, and, as we mentioned above, exercises for stretching the spine.
Physical therapy is often highly successful in treating spinal stenosis. Your physical therapist may implement a combination of therapies including massage, stabilization methods, heat/cold therapy, exercises, and acupuncture to help you overcome your symptoms.
Spinal Stenosis Surgery
For patients with moderate to severe spinal stenosis who don’t respond to conservative spinal stenosis therapy, spinal decompression surgery may be an option.
In spinal decompression surgery, the back surgeon reestablishes the proper diameter of the spinal canal at the affected area. To accomplish this, the surgeon will remove bony elements that have grown towards the spinal canal and are impinging on the nerves.
There are a few different spinal decompression procedures. The most common of these procedures for spinal stenosis is laminectomy, which involves removing some or all of the lamina. The lamina is the section of bone that covers the back of the spinal canal.
Am I a Candidate For Spinal Decompression?
You may not be a candidate for spinal decompression surgery as a treatment for spinal stenosis if:
- You’re currently pregnant
- You have already had spinal fusion
- You have vertebral fractures
- You’re experiencing pain from a previous failed spinal surgery
- You’ve already had an artificial disc or spinal implant placed
- You’ve already undergone more than one spinal surgery and haven’t recovered properly
Typically, spinal fusion back surgery is performed in conjunction with the decompression procedure. Spinal fusion involves turning two or more adjacent vertebrae into one bone. This is done by placing bone graft material in between the vertebrae, then securing them with screws and rigid rods.
Fusion restores stability but eliminates the natural mobility between the vertebrae. The fusion of the vertebrae is permanent and typically diminishes patients’ ability to move, stretch, and rotate the torso.
The Risk of Reoperation After Spinal Fusion
Clinical research has shown that spinal fusion has a higher reoperation rate than spinal decompression alone. With this in mind, patients must carefully consider the risk of reoperation before undergoing decompression with fusion.
One reason why spinal fusion may lead to reoperation is the risk of adjacent segment disease. This complication of spinal fusion occurs when the vertebrae above and below the fused segment undergo added pressure. This leads to a faster rate of degeneration in these vertebrae.
Patients with adjacent segment disease may start to experience back pain, reduced range of motion, and neurological symptoms. These uncomfortable and potentially debilitating symptoms can create the need for corrective spinal surgery.
What Is The Latest Treatment For Spinal Stenosis?
Many modern spinal stenosis patients are concerned over the risks of decompression surgery with spinal fusion. This has led to an increased interest in alternative treatments that alleviate spinal stenosis symptoms without the risks associated with fusion.
Patients who haven’t responded to conservative treatments can now consider non-fusion spinal implants as a spinal stenosis treatment option. These implants are designed to alleviate nerve compression while stabilizing the spine. As a result, patients can experience relief from spinal stenosis without reduced mobility from fusion.
The TOPS™ System For Spinal Stenosis
Today, a new implantable device allows the surgeon to decompress and stabilize the spine while preserving the spine’s range of motion: the TOPS™ System, developed here at Premia Spine.
How Does TOPS™ Work For Spinal Stenosis?
The TOPS™ System works for spinal stenosis by replacing the tissues removed during spinal decompression. The implant is designed to be placed at a single level between L2 and L5 in the lower spine. These segments are the most commonly affected by spinal stenosis.
Once positioned, the TOPS™ System allows movement in all directions. It simultaneously blocks sheer forces on the lower spine, which helps prevent injury after spinal stenosis surgery.
TOPS™ System Results
Clinical studies show the TOPS™ System provides better outcomes than spinal fusion. In a seven-year study for TOPS™ in the management of lumbar spinal stenosis, the device maintained clinical improvement and radiologic stability, preserved spinal motion, and prevented degeneration.
Physician and patient testimonials demonstrate that the TOPS™ System provides excellent outcomes for spinal stenosis patients and allows patients to retain mobility at the operative segment. Additionally, patients experience symptom relief long after the TOPS™ System procedure.
We encourage patients with persistent back pain to consult with a spinal specialist and learn more about all of the available treatment options.
“What is spinal stenosis?” is one of the most frequently asked questions in any spinal physician’s office. Spinal stenosis is a common back problem, but many affected patients have never heard of it before they are given the diagnosis. Symptoms of spinal stenosis can include intense pain inside the back of the legs and numbing or cramping in various regions of the body. The loss of sensation that spinal stenosis patients experience can be extreme.
Here at Premia Spine we focus on advanced surgical treatments for spinal stenosis and related spinal disorders, including bone spurs, or facet arthrosis, and slipped disc, or spondylolisthesis. We’re excited to share information about these conditions – conditions that affect up to 70 percent of all people at some point in their lives – through our blog. An explanation of spinal stenosis is a good place to start.
“Stenosis” means “narrowing,” and spinal stenosis signifies an unnatural narrowing of the spinal canal, the space at the center of the vertebrae that houses the spinal nerves. This narrowing puts pressure on the nerves, and on nerves that emanate from the affected vertebrae to other parts of the body. The most commonly affected area is the lower, or lumbar, region of the spine. The neck, or cervical region of the spine, can also exhibit a narrowing; these conditions are called lumbar spinal stenosis and cervical spinal stenosis respectively.
Spinal stenosis can be caused by a variety of factors, including heredity, chronic inflammatory and arthritic conditions, and the normal aging process. In fact, it is most often seen in adults above the ages of 45 years; women are affected by spinal stenosis more frequently than men. The severity is related to the extent of the narrowing and of any attendant spinal problems, such as bone spurs, slipped discs, pinched nerves, spondylolisthesis, or sciatica. A neurosurgeon, orthopedic surgeon or any physician specializing in spinal disorders can diagnose spinal stenosis based on radiographs and X-rays.
Many treatments for spinal stenosis are available, including medications and physical therapy, including exercises for stretching the spine. For patients with moderate to severe spinal stenosis who do not respond to conservative spinal stenosis therapy, spinal decompression surgery may be an option. In spinal decompression procedures, the back surgeon reestablishes the proper diameter of the spinal canal at the affected area by removing bony elements that have grown towards the spinal canal and are impinging on the nerves. Typically, spinal fusion back surgery is performed in conjunction with the decompression procedure. Spinal fusion involves connecting two or more adjacent vertebrae with screws and rigid rods. Fusion restores stability but eliminates the natural mobility between the vertebrae.
Today a new implantable device allows the surgeon to decompress and stabilize the spine while preserving the spine’s range of motion: the TOPS™ System, developed here at Premia Spine. Clinical studies show the TOPS System provides better outcomes than spinal fusion. We encourage patients to consult with a physician who specializes in spinal medicine and to educate themselves about treatment options.