SPINAL STENOSIS: LUMBAR AND CERVICAL
Spinal stenosis is a narrowing of the spinal canal, which places pressure on the spinal cord. If the stenosis is located on the lower part of the spinal cord it is called lumbar spinal stenosis. Stenosis in the upper part of the spinal cord is called cervical spinal stenosis.
Causes of Spinal Stenosis?
Spinal stenosis is usually caused by general wear and tear that occurs during a lifetime. As a person ages, the discs located between each bone in the spine start to shrink, and the bones and ligaments start to thicken due to arthritis and chronic swelling. Spinal stenosis can also occur due to previous injuries, inherited conditions, trauma, or tumors of the spine.\
Symptoms of Lumbar Spinal Stenosis
Patients with lumbar spinal stenosis present with cramping or pain in the back, buttocks, thighs, or calves with decreased walking tolerance and weakness. In the lumbar spine, symptoms often increase when walking short distances and decrease when the patient sits, bends forward or lies down.
Symptoms of Cervical Spinal Stenosis
Patients with cervical spinal stenosis usually have numbness in the neck, shoulders, or arms that leads to cervical myelopathy. Severe cases of stenosis can also cause bladder and bowel problems.
Non-surgical Treatment of Spinal Stenosis
• Medications, including non-steroidal anti-inflammatory drugs to reduce swelling and pain, and pain killers to relieve pain.
• Epidural steroid injections can help reduce swelling and treat acute pain that radiates to the hips or down the leg. This pain relief may be temporary.
• Rest or restricted activity
• Physical therapy and/or prescribed exercises to help stabilize the spine, build endurance and increase flexibility.
Surgical Treatment of Spinal Stenosis
Severe cases of stenosis often require surgery. The goal of the spinal stenosis surgery is to relieve pressure on the spinal cord or spinal nerve by widening the spinal canal.
1. Decompressive laminectomy in which the roof of the vertebrae is removed to create more space for the nerves.
2. Laminotomy: When only a small portion of the lamina is removed to relieve pressure on the nerve roots
3. Foraminotomy: When the area where the nerve roots exit the spinal canal is removed to increase space over a nerve canal.
4. Medial Facetectomy: When part of the bony structure in the spinal canal is removed to increase the space
5. Anterior Cervical Discectomy and Fusion : The cervical spine is reached through a small incision in the front of the neck. The intervertebral disc is removed and replaced with a small plug of bone, which in time will fuse the vertebrae.
6. Cervical Corpectomy: When a portion of thevertebra and adjacent intervertebral discs are removed for decompression of the cervical spinal cord and spinal nerves. A bone graft, and in some cases a metal plate and screws, is used to stabilize the spine.
7. Laminoplasty: A posterior approach in which the cervical spine is reached from the back of the neck and involves the surgical reconstruction of the posterior elements of the cervical spine to make more room for the spinal canal.
If nerves were badly damaged before the surgery, the patient may still have some pain or numbness after the surgery, or there may be no improvement at all. Also, the degenerative process of spine will continue, and pain or limitation of activity may reappear a few years after surgery. Most doctors will not consider surgical treatment of spinal stenosis unless several months of non-surgical treatment methods have been tried. Since all surgical procedures carry a certain amount of risk, patients are advised to discuss all treatment options with their doctor before deciding which procedure is best.