Spinal Stenosis is described as narrowing of open spaces within spine which can as a result put pressure on the spinal cord & the nerves which travel through the spine to arms & legs. Spinal stenosis is usually found to occur in the neck & lower back region. Although spinal stenosis may cause no signs or symptoms in quite a few people, others may however experience muscle weakness, numbness, tingling, pain & problems associated with normal functioning of bladder or bowel. Most often spinal stenosis is caused by wear & tear in spine region which is related to osteoarthritis. Doctors often recommend surgical intervention to create additional space for nerves or spinal cord in severe cases of spinal stenosis.
Signs & Symptoms of Spinal Stenosis
Although several people display evidence of spinal stenosis on X-rays but may not experience any signs or symptoms. However, when symptoms start occurring they gradually begin but worsen over time. Moreover, symptoms also vary depending upon the location of spinal stenosis.
Common Areas of Spinal Stenosis
- Cervical Spine – Cervical stenosis which happens in the neck region can cause weakness, numbness or tingling in hand, arm, foot or leg. While tingling in hand is one of the most common symptoms, there are many people who also report problems associated with walking & balance. Moreover, nerves to bowel or bladder may also get affected & lead to incontinence.
- Lumbar Spine – Compressed nerves in lower back region of lumbar spine can cause cramping or pain in legs when patient is walking or standing for long periods of time. This discomfort usually is found to ease when patients are bending forward or sitting down.
It would therefore be sensible for people to seek an appointment with the doctor in case they are experiencing persistent weakness, numbness or pain in arms, legs or back.
Causes of Spinal Stenosis
Though some people are born with smaller spinal canal, most cases of spinal stenosis occur when something or the other happens so as to reduce amount of space available within spine. Causes for spinal stenosis may include some of the following.
- Overgrowth of Bone – Osteoarthritis can cause wear & tear damage on spinal bones & which can prompt formation of bone spurs that grow into the spinal canal. Paget’s disease is a disease of the bone which usually affects adults & can also cause bone overgrowth in spine.
- Herniated Discs – Soft cushions which act as shock absorbers between vertebrae tend to dry as we age. Cracks in disc’s exteriors can allow some soft inner material to escape & press upon the nerves or the spinal cord.
- Thickened Ligaments – Tough cords which help hold together bones of spine can become stiff & thicken over time. Subsequently, these thickened ligaments can also bulge into the spinal canal.
- Tumors – Abnormal growths or tumors can form inside spinal cord within membranes covering the spinal cord or inside the space between vertebrae & spinal cord.
- Spinal Injuries – Major trauma including car accidents can cause fractures or dislocations of one or more vertebrae in the spinal column. Moreover, displaced bones from spinal fractures may also damage contents within the spinal canal. Swelling of adjacent tissue of operation site following back surgery can also exert pressure on nerves or the spinal cord.
Risks & Complications of Spinal Stenosis
Most people suffering from spinal stenosis have passed the age of 50 years. Cause of younger people developing spinal stenosis is typically a genetic disease which affects development of bone & muscle throughout the body. Although rare, cases of untreated spinal stenosis may progress to cause the following conditions.
- Problems with Balance
Preparing for Spinal Stenosis Initial Appointment
When family doctors suspect that a patient is having spinal stenosis, they may refer them to neurologist doctors who specialize in treating disorders of the nervous system. Patients may also be referred to spinal surgeons depending upon severity of symptoms. However, before this initial appointment patients may want to prepare answers to following list of questions which are most likely to be asked during consultation.
- When was it that you first noticed these problems?
- Has the problem worsened over time?
- Have any of your siblings or parents ever experienced similar symptoms?
- Are you having any other medical problems?
- What supplements and/or medications are you regularly taking?
Other questions which doctors commonly ask spinal stenosis patients include the following.
- Are you having pain?
- Where is pain located?
- Is there any position which eases of worsens pain?
- Do you also experience any tingling, numbness or weakness?
- Have you been feeling clumsier lately?
- Are you having any difficulty in controlling bladder or bowel movement?
- Which treatments have you already tried for this problem?
Tests & Diagnosis for Spinal Stenosis
Spinal stenosis is quite difficult to diagnose merely because its signs & symptoms closely resemble those of many other age-related conditions. However, imaging tests may be necessary in order to help pinpoint the true cause of signs & symptoms.
Common Imaging Tests for Spinal Stenosis
- X-Rays – Using small X-ray exposures to radiation can effectively reveal changes in spinal bone structure, like development of bone spurs which may eventually be narrowing the available space within the spinal canal.
- MRI – Magnetic Resonance Imaging – MRI in most cases is the preferred imaging test of choice for diagnosis of spinal stenosis. In place of X-rays, MRI makes use of a powerful magnet & radio waves so as to produce cross-section images of spine. This test can effectively detect damage to ligaments & discs as well as any presence of tumors. Most importantly, MRI can also show pressure on spinal nerves or spinal cord.
- CT Myelogram – Doctors may recommend Computerized Tomography (CT) for patients who cannot have an MRI due to associated medical reasons. This test ideally combines X-ray images which are taken from several different angles so as to produce detailed cross-section images of the patient’s body. CT scan is conducted in CT myelogram after a contrast dye is injected. This dye outlines the nerves & the spinal cord & can effectively reveal tumors, bone spurs & herniated discs.
Treatment & Drugs for Spinal Stenosis
Type of treatment which a patient would receive for spinal stenosis would eventually vary depending upon the severity of signs & symptoms & location of spinal stenosis.
Medications for Spinal Stenosis
Doctors prescribe a range of medications in order to control pain which is associated with spinal stenosis.
- NSAIDs – Non-steroidal anti-inflammatory drugs which are commonly known as NSAIDs help reduce inflammation & relieve pain which is common to osteoarthritis. Quite a few NSAIDs like naproxen (Aleve) & ibuprofen (Motrin IB, Advil) are also available without any prescription.
- Muscle Relaxants – Medications like cyclobenzaprine (Fexmid, Amrix) can effectively calm muscle spasms which occasionally occur in spinal stenosis patients.
- Antidepressants – Nightly doses of tricyclic antidepressants like amitriptyline are also found to help ease chronic pain in spinal stenosis cases.
- Anti-Seizure Drugs – Some anti-seizure drugs like pregabalin (Lyrica) & gabapentin (Horizant, Gralise, Neurontin) are usually used to reduce pain which is caused by damage to nerves among spinal stenosis patients.
- Opioids – These are drugs which contain codeine-related substances like hydrocodone (Zohydro, Norco) & oxycodone (OxyContin, Percocet) are generally habit-forming.
Therapy for Spinal Stenosis
It is quite common that people suffering from spinal stenosis become less active in an effort to reduce pain caused by this ailment. However, this will eventually lead to muscle weakness & can even result in more pain. Therefore, a physical therapist can eventually teach exercises to spinal stenosis patients & which may help them build up & maintain the following physical factors.
- Improvement in balance
- Maintaining stability & flexibility of spine
- Build up on endurance & strength
Steroid Injections for Spinal Stenosis
Nerve roots of spinal stenosis patients may become swollen & irritated at spots where they are routinely being pinched. Injecting corticosteroids into this space & around the constriction can effectively help reduce inflammation & relieve some pressure. However, one should be careful as steroid injections do not work for everyone, & moreover repeated use of steroid injections can also weaken nearby bones & connective tissue. Therefore, only a few injections are suggested to be given in a year.
Surgical Intervention for Spinal Stenosis
Surgery for spinal stenosis may be considered when more conservative treatments have proved unsuccessful or when the symptoms of the disease are disabling the patient. The goal of surgery is however to relieve pressure on the nerve roots or spinal cord by effectively creating more space within the spinal canal. Some of the common surgical intervention procedures for spinal stenosis are listed below.
- Laminectomy – This procedure removes lamina or the back part of the vertebra which is affected by spinal stenosis. Nevertheless, in some cases this vertebra may also be required to be linked to adjoining vertebrae with metal hardware & bone graft (which is known as spinal fusion) so as to maintain strength of spine.
- Laminotomy – This surgical procedure is designed to remove only a portion of lamina by typically carving a hole which is just big enough to relieve pressure within a particular spot.
- Laminoplasty – This is a surgical procedure which is only performed on vertebrae located in the neck region. It is meant to open up space within the spinal canal by creating a hinge on lamina. For this purpose metal hardware is used to bridge the gap in the open section of spine.
In most spinal stenosis cases calling for surgery, these space-creating surgical interventions help reduce symptoms of the ailment. However, some patient’s symptoms either remain the same or even get worse after the operation. Surgical risks involved with these operations include infection, neurological deterioration, a blood clot in leg vein & a tear in membrane which is covering the spinal cord.
Lifestyle & Home Remedies for Spinal Stenosis
Following home treatments are also helpful in managing spinal stenosis symptoms.
- Hot or Cold Packs – Particularly, some symptoms associated with cervical spinal stenosis may be relieved by application of heat or ice packs to neck region.
- Pain Relievers – These are over-the-counter medications like naproxen (Aleve) & ibuprofen (Motrin IB, Advil) which can help reduce inflammation & pain.
- Canes or Walkers – Apart from providing stability to spinal stenosis patients, these assistive devices can effectively help relieve pain by allowing patients to bend forward while walking.
- Diet & Nutrition – Shedding excessive weight will eventually reduce load-bearing stress which is exerted on lumbar spine.
Affordable Treatment for Spinal Stenosis in India
Apart from surgical intervention management of spinal stenosis symptoms go a long way in living with this medical condition. Moreover, spinal stenosis at times requires a multidisciplinary approach for treatment to be effective. Finding a medical facility providing many things under one roof will therefore be very useful. With rising costs of healthcare services in the western world, India has emerged as an excellent global medical tourism destination providing high quality of medical procedures at comparatively low costs than they are available in other parts of the globe. IndianMedTrip which is associated with the top surgeons & best internationally accredited hospitals in the country is one of the globally reputed fastest growing healthcare tourism companies based in South Asia providing a wide spectrum of affordable medical solutions to international patients. IndianMedTrip seamless services which begin with the first telephonic conversation go on to identify the best doctor, ideal hospital facility & assist in obtaining medical visas, warm reception at airport on arrival, convenient travel, comfortable budget or luxury accommodations, scheduled treatment & procedures without waiting periods, exotic recuperative vacations, follow-up checks & to a successful farewell when healthy patients head back home.