spinal stenosis

Spinal Stenosis 

Definition

Spinal stenosis is any narrowing of the spinal canal that causes compression of the spinal nerve cord. Spinal stenosis causes pain and may cause loss of some body functions.

Description

Spinal stenosis is a progressive narrowing of the opening in the spinal canal. The spine is a long series of bones called vertebrae. Between each pair of vertebra is a fibrous intervertebral disk. Collectively, the vertebrae and disks are called the backbone. Each vertebra has a hole through it. These holes line up to form the spinal canal. A large bundle of nerves called the spinal cord runs through the spinal canal. This bundle of 31 nerves carries messages between the brain and the various parts of the body. At each vertebra, some smaller nerves branch out from these nerve roots to serve the muscles and tissue in the immediate area. When the spinal canal narrows, nerve roots in the spinal cord are squeezed. Pressure on the nerve roots causes chronic pain and loss of control over some functions because communication with the brain is interrupted. The lower back and legs are most affected by spinal stenosis. The nerve roots that supply the legs are near the bottom of the spinal cord. The pain gets worse after standing for a long time and after some forms of exercise. The posture required by these physical activities increases the stress on the nerve roots. Spinal stenosis usually affects people over 50 years of age. Women have the condition more frequently than men do.

Cervical spinal stenosis is a narrowing of the vertebrae of the neck (cervical vertebrae). The disease and its effects are similar to stenosis in the lower spine. A narrower opening in the cervical vertebrae can also put pressure on arteries entering the spinal column, cutting off the blood supply to the remainder of the spinal cord.

Causes and symptoms

Spinal stenosis causes pain in the buttocks, thigh, and calf and increasing weakness in the legs. The patient may also have difficulty controlling bladder and bowel functions. The pain of spinal stenosis seems more severe when the patient walks downhill. Spinal stenosis can be congenital, acquired, or a combination. Congenital spinal stenosis is a birth defect. Acquired spinal stenosis develops after birth. It is usually a consequence of tissue destruction (degeneration) caused by an infectious disease or a disease in which the immune system attacks the body's own cells (autoimmune disease). The two most common causes of spinal stenosis are birth defect and progressive degeneration of the tissue of the joints (osteoarthritis). Other causes include improper alignment of the vertebrae as in spondylolisthesis, destruction of bone tissue as in Paget's disease, or an overgrowth of bone tissue as in diffuse idiopathic skeletal hyperostosis. The spinal canal is usually more than 0.5 in (12 mm) in diameter. A smaller diameter indicates stenosis. The diameter of the cervical spine ranges is 0.6-1 in (15-12 mm). Any opening under 0.5 in (13 mm)in diameter is considered evidence of stenosis. Acquired spinal stenosis usually begins with degeneration of the intervertebral disks or the surfaces of the vertebrae or both. In trying to heal this degeneration, the body builds up the spinal column. In the process, the spinal canal can become narrower.

Diagnosis

The physician must determine that the symptoms are caused by spinal stenosis. Conditions that can cause similar symptoms include a slipped (herniated) intervertebral disk, spinal tumors, and disorders of the blood flow (circulatory disorders). Spinal stenosis causes back and leg pain. The leg pain is usually worse when the patient is standing or walking. Some forms of spinal stenosis are less painful when the patient is riding an exercise bike because the forward tilt of the body changes the pressure in the spinal column. Doppler scanning can trace the flow of blood to determine whether the pain is caused by circulatory problems. X-ray images, computed tomography scans (CT scans), and magnetic resonance imaging (MRI) scans can reveal any narrowing of the spinal canal. Electromyography, nerve conduction velocity, or evoked potential studies can locate problems in the muscles indicating areas of spinal cord compression.

Treatment

Mild cases of spinal stenosis may be treated with rest, nonsteroidal anti-inflammatory drugs (such as aspirin), and muscle relaxants. Spinal stenosis can be a progressive disease, however, and the source of pressure may have to be surgically removed (surgical decompression) if the patient is losing control over bladder and bowel functions. The surgical procedure removes bone and other tissues that have entered the spinal canal or put pressure on the spinal cord. Two vertebrae may be fused, to eliminate improper alignment, such as that caused by spondylolisthesis. For surgery, patients lie on their sides or in a modified kneeling position. This position reduces bleeding and places the spine in proper alignment. Alignment is especially important if vertebrae are to be fused. Surgical decompression can eliminate leg pain and restore control of the legs, bladder, and bowels, but usually does not eliminate lower back pain. Physical therapy and massage can help reduce the symptoms of spinal stenosis. An exercise program should be developed to increase flexibility and mobility. A brace or corset may be worn to improve posture. Activities that place stress on the lower back muscles should be avoided.

Prognosis

Surgical decompression does not stop the degenerative processes that cause spinal stenosis, and the condition can develop again. Nevertheless, most patients achieve good results with surgical decompression. The patient will probably continue to have lower back pain after the surgical procedure.

Key terms

Computed tomography (CT) Scans — An imaging technique in which cross-sectional x rays of the body are compiled to create a three-dimensional image of the body's internal structures.

Congenital — Present before birth. The term is used to describe disorders that developed in the fetal stage.

Doppler scanning — A procedure in which ultrasound images are used to watch a moving structure such as the flow of blood or the beating of the heart.

Electromyography — A test that uses electrodes to record the electrical activity of muscle. The information gathered is used to find disorders of the nerves that serve the muscles.

Evoked potential — A test of nerve response that uses electrodes placed on the scalp to measure brain reaction to a stimulus such as a touch.

Magnetic resonance imaging (MRI) — An imaging technique that uses a large circular magnet and radio waves to generate signals from atoms in the body. These signals are used to construct images of internal structures.

Nerve conduction velocity test — A test that measures the time it takes a nerve impulse to travel a specific distance over the nerve after electronic stimulation.

Stenosis — The narrowing or constriction of a channel or opening.

Resources

Books

Berkow, Robert, editor. Merck Manual of Medical Information. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

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spinal stenosis,

narrowing of the vertebral canal, nerve root canals, or intervertebral foramina of the lumbar spine, caused by encroachment of bone on the space. Symptoms are caused by compression of the cauda equina and include pain, paresthesias, and neurogenic claudication. The condition either may be congenital or may be caused by spinal degeneration. See also spinal cord compression.

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spinal stenosis (spīˑ·nl st·nōˑ·sis),

n an abnormal narrowing of the spinal canal, nerve root canals, or intervertebral foramina of the lumbar spine; may be congenital or acquired.

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spinal

pertaining to a spine or to the vertebral column and in many instances to the spinal cord.

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spinal abscess

infection may be introduced hematologically from navel infection to a vertebral body or up the vertebral canal from an infected docking wound. Clinically there is a development of paresis over a few days then paraplegia when the abscess is in the lumbar region or quadriplegia when it is located in the cervical area.

spinal accessory nerve

see accessory nerve, Table 14.

congenital spinal stenosis

stenosis of the vertebral canal present at birth; recorded in calves.

spinal fibrocartilaginous emboli

see fibrocartilaginous embolic myelopathy.

focal symmetrical spinal poliomalacia

see focal symmetrical spinal poliomalacia.

spinal fusion

surgical creation of ankylosis of contiguous vertebrae.

spinal meninges

see meninges.

spinal meningitis

usually part of cerebrospinal meningitis. May be local related to spinal cord abscess and cause localized pain and muscle rigidity.

spinal muscular atrophy

see hereditary spinal muscular atrophy, hereditary neuronal abiotrophy of Swedish Lapland dogs.

spinal myelitis

see myelitis.

spinal myelopathy

see myelopathy.

spinal nerve

any of the paired nerves arising from the spinal cord and passing out between the vertebrae.

spinal puncture

introduction of a hollow needle into the subarachnoid space of the spinal canal, usually for the purpose of collecting a sample of cerebrospinal fluid, to introduce radiopaque material for myelography, or the injection of an anesthetic.

spinal reflex

any reflex action mediated through a center at the spinal cord.

spinal stenosis

see spinal cord compression (above).

spinal tap

see spinal puncture (above).

spinal trauma

temporary or permanent dislocation of one or more spinal vertebrae; or fracture; causes immediate flaccid paralysis caudal to injury due to spinal shock, followed by residual signs due to damage to spinal cord tissue.

spinal walking

see reflex walking.

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Patient discussion about spinal stenosis.

Q. Stenosis (spinal)surgery. What did it entail? Success rate?

A. actually this is the first time i hear of this kind of surgery! so i looked up for info about the whole phenomenon(as you can see, i'm a curious guy..:) )... i found couple of sites that talk about back surgery in general, and that surgery in particular, hope that helps:

http://www.mayoclinic.com/print/back-surgery/HQ00305/METHOD=print

http://www.spine.org/Pages/ConsumerHealth/SpineConditionsAndTreatments/CommonProblemsCorrectiveActions/CommonSurgicalProcedures/LaminectomyorLaminotomy.aspx

anyway- i hope there are people in the site that went through that procedure and can give you more info then me.

Q. what does c4-5 mild central disk bulging impinging upon cervical cord without spinal stenosis or distortion of the cord . mild righ neural foraminal narrowing from uncovertebral joint hypertropy mean

A. Well this basically means there is a very small narrowing of the cervical (your neck area) spinal canal (where the spinal cord is), however the narrowing does not cause any damage to the spinal cord, therefore probably does not cause any major symptoms involving the nerves. The c4-5 bulging part refers to the part in between the two cervical vertebras c4 and c5, in which the disc (a part in the spinal cord) is sliding a bit side-ways, but again, it does not seem to be causing any trouble.