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Spinal Stenosis (Lumbar and Cervical)

Cervical Stenosis

Cervical spine refers to neck portion of spine, and cervical spine conditions may result from overuse injuries, trauma and certain diseases. Cervical stenosis refers to narrowing of the spinal canal that protects the spinal cord and its branching nerves. The condition causes neck pain radiating to arms and hands, numbness or weakness in the legs. This condition causes cervical myelopathy and cervical radiculopathy. The abnormal pressure placed on the spinal cord causes damage and results in spinal cord dysfunction. This condition is known as myelopathy. Cervical radiculopathy occurs when the nerve root connecting the spinal cord is injured or pinched as they exit the spinal canal. Myeloradiculopathy occurs when there is damage to the spinal cord and nerve roots.

Causes

Cervical stenosis it develops after age 50, as a consequence of aging and spinal wear and tear. Some patients have a history of back injury or trauma. Different disorders can cause nerve compression, such as:

  • Thickening of spinal ligaments
  • Osteophytes (bony overgrowths)
  • Bulging or herniated discs
  • Degenerative disc disease

Symptoms

Some people have no symptoms; they are asymptomatic. However, the symptoms may gradually develop and worsen over time. The common symptom of cervical stenosis is mild to intense neck pain. Other symptoms include:

  • Problems with gait and balance
  • Clumsy hand coordination
  • Upper extremity pain and weakness
  • Numbness, tingling, pins and needles sensation
  • Bladder and bowel problems
  • Rarely, loss of function (paraplegia)

Cervical spinal stenosis is usually diagnosed based on your medical history, physical and neurological examination, and diagnostic tests such as x-rays, CT or MRI scans, or myelography.

Cervical stenosis may be treated with conservative treatment approaches such as use of pain medications, physical therapy, steroid injections, or acupuncture. In chronic cases, surgery may be required to treat the condition. Surgery is considered for patients in whom the pain is not responding to conservative treatment.

Lumbar stenosis

Lumbar stenosis is the compression of spinal nerves caused by narrowing of spinal canal and it is one of the common causes of low back pain. Spinal stenosis can also affect the spine in neck region. The symptoms include back pain, burning or aching type of pain in buttocks that radiates to the legs (sciatica), weakness in the legs or "foot drop”. One of the causes for spinal stenosis is the ageing and other causes include Paget’s disease, achondroplasia, spinal tumours and spinal injuries. As age advances the chances of developing osteoarthritis, disc degeneration and thickening of ligaments may increase and these conditions cause spinal stenosis.

Lumbar spinal stenosis may be treated with conservative treatment approaches such as use of pain medications, physical therapy, steroid injections, or acupuncture. In chronic cases, surgery may be required to treat the condition.

Nonsurgical Treatment

  • Physical therapy: Physical Therapy involves stretching exercises, massage, and lumbar and abdominal strengthening.
  • Anti-inflammatory medications: Non-steroidal anti-inflammatory drugs (NSAIDs) initially provide pain relief and also reduce swelling.
  • Steroid injections: Cortisone steroid injections are given around the nerves or in the "epidural space” to decrease swelling and pain.
  • Acupuncture: Acupuncture can be helpful in cases where the pain is less severe.
  • Chiropractic manipulation: Chiropractic manipulation can be done in some cases but not when there is co-existing osteoporosis or herniated disc because these cases increase the symptoms or cause injuries.

Surgical Treatment

Surgery is considered for patients in whom the pain and weakness is causing debilitation such as inability to walk for a long time. The two main surgical procedures to treat lumbar spinal stenosis are laminectomy and spinal fusion.

  • Laminectomy: This procedure involves removal of the bone, bone spurs, and ligaments that compress the nerves.
  • Spinal fusion: In this procedure, two or more vertebrae are permanently fused together.