Spinal Stenosis
Spinal stenosis refers to the narrowing of the spinal canal. In the cervical spine, common causes include ossification of the posterior longitudinal ligament (OPLL), diffuse idiopathic skeletal hyperostosis (DISH), disc-osteophytes or congenital stenosis.
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What is Spinal Stenosis?
Spinal stenosis happens when the spaces in the spine narrow and create pressure on the spinal cord and nerve roots.
The spinal cord is a bundle of nerves that comes out of the base of the brain and runs down the center of the spine. The nerve roots branch out from the cord. The narrowing usually occurs over time and involves one or more areas of the spine:
- The spinal canal, the hollow space in the center of each vertebrae (bones in the spine that protect the spinal cord); the spinal cord and nerve roots run through the spinal canal.
- The canals at the base or roots of nerves branching out from the spinal cord.
- The openings between vertebrae, through which nerves leave the spine and go to other parts of the body.
There are many different structures in the anatomy of the back that work together to support your body. There are four regions of the spine:
- Cervical spine.
- Thoracic spine.
- Lumbar spine.
- Sacrum and coccyx.
Spinal stenosis most commonly develops in the lumbar spine and cervical spine. In the lumbar spine, common causes disc herniation, thickening of the ligament flavum and hypertrophy of the facet joints. CT and MRI are commonly performed to evaluate the severity of spinal stenosis so that a treatment plan can be properly formulated.
Types of Spinal Stenosis
Cervical stenosis
Cervical stenosis is a condition in which the neck area of your spine is narrow. This can damage the spinal cord or result in pinched nerves as they exit the spinal canal.
Lumbar spinal stenosis
Lumbar spinal stenosis is when the lower back area of your spine is narrow, compressing the nerves from the lower back into the legs. This degenerative condition tend to more often affect people aged 60 and older.
Frequently Asked Questions
What are the symptoms?
There are several factors that can contribute to the narrowing of the spinal canal, which leads to spinal stenosis. Normal vertebral canal provides sufficient room for the spinal cord. However, due to age-related changes in the spine, injury or congenital conditions can cause narrowing of the spaces.
Overall, spinal stenosis symptoms can include:
- Intermittent pain and discomfort, as opposed to continuous pain
- Pain that starts during activities like walking or cycling and also when standing upright (in the case of lumbar stenosis)
- Tingling or weakness in a hand, arm or foot
- Issues with walking and balance
What are my treatment options?
Spinal stenosis can be a painful and frustrating condition for people who are used to having an active lifestyle. With that said, most cases can easily be treated. Some of the treatment options include:
- The use of non-steroidal anti-inflammatory drugs (NSAIDs)
- Cortisol injections into the spinal column
- Physical therapy and exercise
- Surgical treatments include:
- Laminectomy
- Foraminotomy
- Spinal Fusion
How is it diagnosed?
Your doctor will ask more about your health history and risk factors in order to better understand the underlying causes of your condition.
Following which they may conduct one of the following tests:
- An X-ray to show how the shape of your vertebrae has changed.
- An MRI to create a 3-D image of your spine, this is done to look for any tumors, growths, and even damage to discs and ligaments.
- A CT scan is also able to show any damage to soft tissue as well as issues with your bones. This is done with the help of dye injected into your body.
Targeted Procedures
Lumbar Disc Microsurgery
This minimally invasive technique is used to remove the herniated portion of intervertebral disc. It is 95-98% effective in eliminating leg pain (sciatica) caused by nerve root compression. The procedure is performed through a small incision on the back.
The procedure usually involves:
- 1) Lamina opening: after creating small incision directly over the herniated disc, the surgeon creates a small window in the lamina (the bone covering the spinal canal). The pinched nerve roor and the herniated disc can been seen through this opening.
- 2) Spinal nerve moved: the surgeon uses a nerve retractor to gently move the spinal nerve away from the herniated disc.
- 3) Herniation removed: The herniated portion of the disc is removed, eliminating pressure on the nerve root. Only the damaged portion of the disc is removed, leaving any healthy disc material to retain its function as a shock absorber between the vertebrae.
Laminectomy
This procedure is performed through an incision on the lower back. The surgeon removes a section of bone, called the lamina, from one or more vertebrae. This relieves pressure on the nerve roots caused by stenosis (narrowing of the spinal canal).
The steps usually involve:
- 1) Removing the spinous process: First the surgeon removes the spinous process (the back portion of the vertebrae that protrudes furthest from the back of the spine). These are the bones that you feel when you touch the middle portion of your lower back.
- 2) Removing the Lamina: the surgeon removes the lamina (the portion of the vertebra that covers the nerve roots). Removing the damaged the lamina opens up the spinal canal, taking pressure off the nerves.
- 3) Clearing bone fragments: There may have some remnant fragments that pinch the nerve roots as they exit the spinal canal in the nerve foramina.
Spinal Fusion
Why choose spinal fusion?
Spinal fusion is a type of spine surgery performed to promote stability at a diseased motion segment. This usually involves removal of the lamina (portion of the vertebrae that covers the spinal cord). Removing the lamina relieves pain and pressure. Subsequently, screws and rods are inserted. Bone grafts are added to the sides of the spine. The grafted bone will then fuse to the spine.
Is it suitable for me?
You may be a candidate for spinal fusion if you have signs and symptoms of spinal instability. These may include pain, weakness or numbness of the hands and feet.
MIS TLIF
The goal of this procedure is to stabilise the spine, minimising low back and leg pain. This procedure stops the motion of the affected disc level by placing screws, rods and bone graft to promote the two vertebrae to become one bone (spinal fusion).
Typically two 2-3 cm incisions are made on either side of the lumbar spine. After the incisions are made, a minimally invasive approach is made down to the vertebral body using dilating tubes. The surgeon then ensures that spinal screws are securely placed into the vertebral body of spine. Live x-ray and live nerve monitoring are used to ensure that the screws are placed accurately.
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