The human spine has a complex structure. While load bearing is largely handled by the anterior vertebral bodies and spinal discs, our ability to twist and bend backward and forward is secured by the posterior facet joints. The vertical canal that is created in the center of the spine by the vertebral arches, which join the vertebral bodies, facet joints and spinous processes, is known as the spinal canal. This canal acts as a safe conduit for the spinal cord and nerve roots, which exit the spine in pairs (one to the left and one to the right) at the level of each disc through openings known as the neural foramina. A narrowing of the spinal canal is referred to as spinal stenosis. A narrowing of the lateral openings for the nerve roots is referred to foraminal stenosis.What causes spinal stenosis?
Spinal stenosis usually develops as we age and as the structures in our spines begin to show signs of wear and tear. The lumbar spine is most commonly affected because it is responsible for carrying the lion's share of the body's weight. The cervical spine and the thoracic spine are less often affected. Narrowing of the spinal canal may be caused by various changes that may occur as we age:
- Bone thickening and bone spurs protruding into the canal
- Osteoarthritis in the facet joints and their accompanying enlargement (facet hypertrophy)
- Thickening and hardening of bands that support the spine (ligamentum flavum hypertrophy)
- Synovial cysts in the facet joints
- Chronic disc herniation
- Spondylolisthesis
What are the typical symptoms of spinal stenosis?
The narrowing of the spinal canal can put pressure on the spinal cord and the nerves that branch out from the neural foramina. This can cause back pain and pain that extends down into the legs as far as the calves. The pain associated with spinal stenosis ultimately causes disability as it increasingly limits a person's capacity to tolerate normal activities. One typical sign of the disorder is a steady reduction in the distance that one is able to walk before needing to take a rest. Indeed, spinal stenosis is one of the main causes of a condition known intermittent claudication (pain with walking). Sensory disturbances, lameness, and loss of muscle strength in the legs may also occur.
How is Spinal Stenosis Diagnosed?
To diagnose spinal stenosis your doctor will ask you questions about your symptoms and carry out a comprehensive physical examination. You may also be required to undergo a neurological examination. Any of various imaging procedures may then be used to complete the diagnosis. These include myelography (a procedure in which a liquid contrast medium is injected into the spine before x-rays are taken), computed tomography (CT) and magnetic resonance imaging (MRI).
What treatment options are available for spinal stenosis?
Conservative Treatment
Less pronounced cases of spinal stenosis and foraminal stenosis can often be treated without surgery. This usually involves extensive physical therapy and medication to alleviate the pain.
Such conservative approaches can be supported by forms of minimally invasive pain therapy to eliminate immediate pain and disability. At our clinic, these forms of minimally invasive pain therapy are carried out on an in-patient basis.
Surgical Treatment
Surgery should be carried out whenever neurological symptoms are present. These include lameness, numbness and loss of function (especially loss of bowel or bladder function). Surgery should also be carried out whenever the pain limits your capacity to participate in normal activities, such as walking and working. The aim of surgery is usually to decompress nerve roots or bundles by removing tissue protruding into the spinal canal or otherwise expanding the volume of the spinal canal. Regrettably, the outcomes of surgical intervention, which usually requires external fixation, are often disappointing. Many patients continue to experience back pain. Many others enjoy no more than temporary relief. Added to this is the fact that many procedures preclude other surgical options.
For this reason, we use a step-by-step, escalating approach at our clinic to treating spinal stenosis. The type and extent of the surgical intervention is always adapted to the individual patient. The procedures are minimally invasive and therefore involve changes that do not limit future treatment options.
- Surgical Options for Spinal Stenosis
- Interventional pain therapy
- Disc-FX
- Interspinal spacers (X-Stop, Maxx-Spine, Coflex)
- Open micro-surgical decompression
Follow-up treatment in the case of surgery is usually elaborate and time consuming, although this, too, will depend on the cause and extent of the stenosis, the degree of the neurological changes involved and the particular form of surgery selected. It will also involve a battery of out-patient, in-patient and home-based measures (e.g. physical therapy). Temporary external fixation may be required in individual cases.
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