Spinal stenosis is a condition characterized by narrowing of the spinal canal, a tubular structure which encloses the spinal cord. Narrowing of the spinal canal leads to compression of the spinal cord and the accompanying nerve roots; this, ultimately leads to the development of pain and muscle weakness.
Spinal stenosis is commonly found in elderly and mostly affect the cervical region (upper neck) or lumbar region (lower back).
Spinal Stenosis as a degenerative illness in the human vertebrae causing compressed spine nerves medical concept as a 3D illustration. Credit: Lightspring / Shutterstock
What causes spinal stenosis?
Spinal stenosis can be either congenital (i.e. present from birth) or acquired later due to conditions such as inflammatory disorders, endocrinopathies, calcium disorders and infections. Bone overgrowth, herniated disks, thickened ligaments, and spinal injuries are some common reasons for spinal canal narrowing.
Compression of the vascular structures leads to reduced blood supply to the spinal cord, which leads to symptoms such as severe pain, weakness and loss of sensation.
What are the risk factors for the development of spinal stenosis?
A multitude of factors have been associated with the development of spinal stenosis. Age is the number one risk factor for this condition. Genetics, physical trauma and presence of comorbid conditions - such as osteoarthritis and bone disorders, are some other risk factors which can lead to the development of this degenerative disease. Cigarette smoking and obesity and loss of muscle tone are also associated with spinal stenosis.
How is spinal stenosis diagnosed?
A medical history and physical check-up are the initial steps for diagnosis; however, doctors usually rely on imaging techniques for accurate diagnosis. Imaging tests such as X-ray, computed tomography (CT) scan and magnetic resonance imaging (MRI) may be employed to get a clear clinical picture of the condition.
X-rays can detect bony spurs or bony projections which are causing stenosis. A CT scan and or MRI can provide a cross-sectional picture of the spine and detect damaged disks and ligaments. They are also useful to detect tumors, which may cause spinal canal narrowing. MRIs can help to detect even minute details of the image and are thus used to detect compressed nerve.
What are the treatment options for spinal stenosis?
Treatment strategy for spinal stenosis is decided after assessing the severity of the condition. The location of the stenosis also plays a key role in deciding the appropriate treatment.
Pharmacological agents such as nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics may be used to provide temporary relief from spinal stenosis. Antidepressants can be used for chronic pain. Anti-seizure drugs are used to relieve pain caused by damaged nerves.
Steroid injections can help to decrease the inflammation and reduce pain. However, repeated use of steroids is associated with long-term adverse effects; hence expert consultation is a must in such cases.
Physical therapy, under the supervision of a therapist, can also be beneficial to build muscle strength and improve spine function.
Surgery may be considered in patients who are severely affected and who don’t respond to any of the above treatments. The main goal of surgery is widening the spinal canal and relieving the pressure on the spinal cord. Surgery should be promptly initiated in patients with severe symptoms to avoid permanent nerve damage. Laminectomy, laminotomy and laminoplasty are some common surgical options which can help preserve the nerve function and prevent long-term damage.
Percutaneous image-guided lumbar decompression (PILD) is a non-invasive procedure which may help patients suffering from lumbar stenosis. The procedure is preferred in patients intolerant to medications and physical therapy. PILD involves the removal of thickened ligament with the help of specially designed instruments. This leads to widening of the spinal canal and helps to decrease nerve compression.
Alternative therapies such as acupuncture and chiropractic have also been observed to improve symptoms in spinal stenosis patients.
With growing research, novel innovative techniques are being explored to treat spinal stenosis. Various clinical studies are studying the use of regenerative medicine or stem cells to treat spinal stenosis. Trials are also evaluating the role of gene therapies.