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The highly skilled and well-trained neurosurgeons at Cedars-Sinai Marina del Rey Hospital evaluate patients with spinal stenosis and provide individualized treatment advice for each patient. They can choose from the various non-surgical and surgical treatment options available. The treatment that is best for your symptoms and severity of spinal stenosis will be considered.
Spinal stenosis is a condition in which there is an abnormal narrowing of the spinal column, where the spinal cord runs. Stenosis usually occurs due to lesions or deposits inside the tube. It may affect any part of the spine, but it most commonly occurs in the lower back and neck. Spinal stenosis can exert pressure on the spinal cord and its nerves.
There are two types of spinal stenosis, namely lumbar stenosis and cervical stenosis. Lumbar stenosis is more common, although cervical spinal stenosis presents a more danger as it involves the compression of the spinal cord.
Lumbar stenosis involves compression of the spinal nerve roots in the lower back, which causes the symptoms of sciatica, such as tingling, weakness or numbness radiating from the low back into the buttocks and even the legs (particularly with activity).
Cervical spinal stenosis is even more dangerous as it compresses upon the spinal cord and leads to serious symptoms such as major body weakness or even paralysis. Spinal stenosis can develop as a result of advancing age, degenerative disc disease, and developmental problems in the spine before birth, diseases such as arthritis, scoliosis, osteoporosis and lordosis (sway back), obesity, genetics, poor body posture.
Surgery for spinal stenosis is considered when non-surgical treatments fail to bring relief or the patient is immobile. The purpose of the surgery is to alleviate the pressure on the spinal cord by increasing the space in the spinal canal. On imaging test, if the spinal cord or nerves are found to be tightly squeezed, the doctor may recommend any of the following surgeries to relieve the pressure. Surgery may be done either from the front or back of the neck. The procedure usually involves the removal of some of the disc bones and tissues that may obstruct the nerve roots. In case of patients who have severe spinal instability, spinal fusion is done in addition to decompression surgery. This involves removing a small piece of bone from the hip and grafting it onto the spine by means of metal plates and screws, which will give support and stability to the spine.
One of the following surgical procedures may be performed:
Laminectomy: In this procedure, the back portion (lamina) of the affected vertebra is removed or sometimes connected to the adjoining vertebrae by means of a metal part or a bone graft. This procedure helps in strengthening the spine.
Laminotomy: In this procedure, a hole that sufficiently relieves the pressure at a particular spot of the lamina is created.
Foraminotomy: The area where the nerve roots exit the spinal canal called foramen is enlarged to create more space.
Decompressive laminectomy: It is the most commonly performed surgery for spinal stenosis. In this procedure, the lamina of the vertebrae is removed, creating more space in the spinal canal for the nerves.
Discectomy: In this procedure, the herniated or bulging discs are removed to increase the canal space.
Laminoplasty: This procedure is carried out on the vertebrae in the neck by creating a hinge on the lamina. This, in turn, opens up space within the spinal canal. A metal part is positioned to bridge the gap in the opened section of the spine.
These surgeries are performed to create space in the spinal canal and relieve symptoms of spinal stenosis. However, after surgery, some people may face problems such as infection, tear in the membrane, a blood clot in leg and vein and other neurological defects.
The treatment for spinal stenosis may vary based on the location of the stenosis and the severity of the symptoms.
As the symptoms of spinal stenosis and the symptoms of age-related conditions are similar, diagnosis may be difficult. Imaging tests give an accurate view of the stenosis, other diagnostic procedures followed to confirm the diagnosis are:
Medical history: Your doctor will need to know about your symptoms, injuries and other health-related incidents to derive a proper diagnosis.
Physical examination: The doctor will ask you to perform certain movements.
Blood test: This is usually done to rule out other diseases such as multiple sclerosis and vitamin B12 deficiency.
These tests may include:
X-rays: X-rays can help in identifying any change in the bones such as bone spurs. These spurs may narrow the space within the spinal column.
Magnetic resonance imaging (MRI): MRI is the best imaging test that can be helpful in diagnosing different types of stenosis. This test is more accurate than X-ray as it creates clear cross-sectional images of the spine and arteries. This scan uses powerful magnetic and radio waves, and any damage to the discs or ligaments, the presence of plaques and tumors can be identified. More importantly, the MRI test can also show if there is any pressure exerted on the spinal cord or its nerves.
CT myelogram: A CT scan combined with a myelogram provides an excellent picture of the nerve details when performed during the examination of back pain. CT myelogram involves the injection of a radiographically opaque dye that gets absorbed into a sac present around the nerve roots. The CT scan shows how the bone is affecting the nerve roots. CT myelogram is a sensitive test to detect nerve impingement and can identify even minute scratches or injuries.
Computer axial tomography: This is more often used for the diagnosis of spinal stenosis. X-rays are projected and the cross-sectional image is viewed on a monitor.
Most people with spinal stenosis have crossed the age of 50. When it occurs in younger people, it may be due to a genetic disease affecting bone and muscle development throughout the body.
Advancing age is a major risk factor for lumbar spinal stenosis because it is associated with spinal degeneration.
Another risk factor is osteoporosis as this disease can cause compression and fracture of the lumbar vertebrae. The size of the spinal canal and the degree of impingement of the surrounding ligaments and bones into the spinal canal is an important risk factor.
Most of the time, spinal stenosis develops when there is a reduction in the amount of space available within the spinal column. Causes of spinal stenosis may include the following:
Overgrowth of bone: Growth of spinal bones into the spinal canal may decrease the space. This may happen due to wear and tear damage that occurs from osteoarthritis of the spinal bones. A bone disease called Paget’s disease can cause bone overgrowth in the spine thereby reducing the space in the spine.
Herniated disks: The soft pads that act as shock absorbers between the vertebrae may dry up as we advance in age. Due to cracks on the outer surface of the disk, some of the material may part away and exert pressure on the spinal cord and its nerves.
Thickened ligaments: The ligaments that hold the bones of the spine together may thicken and become stiff over a period of time. These thickened ligaments can swell into the spinal canal.
Tumors: Sometimes, abnormal cancerous growth can develop inside the space between the spinal cord and vertebrae or within the membranes that cover the spinal cord. People born with a small spinal canal are vulnerable to this type of disorder.
Spinal injuries: Accidental trauma can cause dislocations or fractures of one or more vertebrae. Broken bone due to a spinal fracture can damage the spinal canal. Surgery may also lead to swelling of adjacent tissues, which exerts pressure on the spinal cord and its nerves.
The alterations in the shape and size of the spinal canal are a major cause of cervical stenosis. Normally, these changes occur in elderly people above the age of 50. Advancing age results in bulging of the spongy discs that lie in between the bones of the spine. The ligaments that connect the spinal bones may thicken or get destroyed resulting in excessive growth of bones into the joints. These conditions can decrease the space in the spinal canal, which eventually leads to cervical spinal stenosis.
Hot or cold therapy: Application of heat or ice packs on the affected area, neck or low back can relieve the symptoms of spinal stenosis to a certain extent.
Lifestyle changes: Adopting healthy lifestyle habits contribute to preventing spinal stenosis. As age advances, your spinal bones are subjected to continual wear and tear. Some measures could help in preventing the wear and tear of the spine, and thus spinal stenosis.
Diet: You should avoid or decrease the intake of red meat, salt, sugar, solid fats and refined grains. Eat plenty of fruits and vegetables. Low-fat milk and dairy products may be consumed.
Physical exercises: Regular physical exercise can help in controlling body weight by burning excess fat. It also helps in improving the flexibility of your body.
Avoid smoking: Research has found that smoking weakens the inter-vertebral discs and causes back pain, which in turn contracts the spinal canals. In addition, smoking decreases bone density and makes it vulnerable to vertebral fractures.
Maintain a healthy weight: Your spine supports the entire body weight and allows the forward and backward movement of your body. Increased weight compresses the intervertebral discs in the spine, because of which the chance of developing spinal stenosis increases.
Improve flexibility: Practicing flexibility and stretching exercises daily can strengthen the ligaments in the spine and reduce the risk of undergoing disc and ligament degeneration.
If you have low back pain, numbness and weakness in your legs, feel free to consult our spinal surgeons at Cedars-Sinai Marina del Rey Hospital.
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Jared Ament, M.D., M.P.H.See Profile »
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