Spinal Stenosis
Spinal Stenosis refers to the condition in which the spinal cord and its exiting nerve roots are compressed by the bones and soft tissues of the spine.
The usual cause of this compression is arthritis, but in essence, it is the natural aging process. As the joints and discs of the spine wear, bone spurs called osteophytes are created. As discs wear out, they become narrower, making the holes for the nerves smaller. Finally, with this process, an overgrowth of the covering of the spine called the Ligamentum Flavum occurs. These factors in combination can tightly compress the spinal nerves.
The result of this is that the nerves do not get the blood supply they need and cannot transmit information as they usually do.
What you may feel is a combination of pain, heaviness of the legs, numbness, and weakness. Often these symptoms worsen with activity.
A good analogy is if you put a tourniquet around your arm. It would be uncomfortable. If you then kept squeezing open and shutting your hand, your arm would get painful, numb, tingling, etc. The same thing happens when your spine is being compressed.
What Treatments Exist?
There are several treatments for Spinal Stenosis:
Exercise: Exercise has been shown to increase blood flow and improve the utilization of oxygen. Both of these help relieve the pain and disability associated with Spinal Stenosis. Pool exercise is especially good as it takes the weight off of the spine, allowing you to do more exercise with less pain. Often a course of physical therapy under the guidance of a good therapist can significantly speed your recovery.
Non-steroidal, Anti-inflammatory Medications: These medications (ie: Ibuprofen, Relafen, Lodine, Voltaren, Naprosyn, DayPro, etc.) can decrease pain and inflammation. Patients may react differently to each of these medications. Often patients need to try several before the best one is found. Some new medications only need to be taken once or twice a day and are easier on your stomach.
Epidural Steroids: You may be given an injection of a steroid around the nerves, which are being squeezed. A steroid is the most powerful anti-inflammatory medication. Through this injection, a small amount of the most powerful medication is inserted exactly where your problem occurs. An x-ray machine is utilized to easily place the medication in the exact location. While this does not “cure” the problem, it can quickly calm it down, occasionally for many months. Often, when combined with a therapy program, this improvement can be nearly permanent. If needed, these injections can be repeated periodically.
Surgery: This is the last resort for Spinal Stenosis and the only “cure” available. The operation for Stenosis is generally called a decompression, or a laminectomy. In this operation the surgeon removes the bone/disc and soft tissue that is determined to be compressing the spinal nerves. Care needs to be taken not to injure the nerves or remove too much structural support from the spine. Hospitalization after surgery can last four to seven days. Success of the surgery is usually related to the severity of the compression and a patient’s general medical condition.