In cases where there is not enough room in the spinal canal for the spinal nerves, stenosis occurs. In an effort to create the space it needs, the spine places pressure on the disc that is creating a bulge. This causes the ligaments to thicken or joints to enlarge. Pain often results, especially after prolonged standing and a weak feeling in the legs may be experienced.
Degenerative disc disease is the primary contributing factor to the development of stenosis, however narrowing of the spinal canal may be genetic. Differences in stability, density and size of the spine may result in reduced space for the spinal structures as well as added pressure.
It is more likely that spinal health in other areas will fail when one area of the spine is injured. Scoliosis, osteoarthritis, rheumatoid arthritis, spinal tumors and trauma may encourage the development of stenosis.
Possible symptoms of stenosis include a deep aching in the low back, buttocks and thigh, and intense numbness or pain in the legs and sometimes the shoulders.
Walking and exercise can bring on symptoms. If you have stenosis, you may notice that sitting sometimes relieves pain, bending over or flexing the spine forward may also bring relief. As a result, people with stenosis may walk with a hunched over posture and find that their pain worsens when bending backward. Severe cases of stenosis will display more serious symptoms such as loss of bowel and bladder function and loss of feeling in an arm/leg.
Evaluation of back and neck pain requires a physician experienced in diagnosing spinal conditions. The work-up begins with a detailed history and physical examination. Your medical history helps your doctor understand your back and neck pain, and the influence of your lifestyle in contributing to your pain.
During your physical exam, your neurosurgeon examines your spine and neurological system to pinpoint the source of pain. Simple tests for flexibility and muscle strength may also be conducted. Diagnostic tests may be ordered to confirm the location and source of your pain.
The first step is usually a set of X-rays. X-rays show the bones (vertebrae) of the spine.
Magnetic Resonance Imaging (MRI)
Magnetic Resonance Imaging (MRI) uses a magnetic field and radio waves to generate highly-detailed pictures of the inside of your body. The MRI depicts soft tissues of the muscle and discs as well as nerves. These images help your neurosurgeon provide a more accurate diagnosis. This type of imaging is very safe and usually pain free. In most cases, injections are not required. However, in some situations, a contrast agent may be needed to enhance the ability of the MRI to see into your body.
Myelogram Followed by CT
A myelogram determines any decreases or blockages in the flow of cerebral spinal fluid (CSF) around your spinal column. It is used to diagnose a bulging disc, tumor or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into your lower back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected and a series of X-rays taken. Once the myelogram is completed, you are sent for a CT scan.
Intrathecal CT determines blockages or flow of cerebral spinal fluid around the spinal column. A local anesthetic is injected into the lower back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected. This procedure is followed by a CT scan, which takes a series of detailed pictures of the spinal area.
Electrical testing of the nerves and spinal cord may be performed before, during and after surgery. These tests, called Electromyography (EMG) or Somato Sensory Evoked Potentials (SSEP), assist your neurosurgeon in understanding how your nerves or spinal cord are affected by your condition.
Bone Scan with SPECT
Bone imaging is used to detect infection, malignancy, fractures and arthritis in any part of the skeleton. Bone scans are also accurate for finding lesions for biopsy or excision. The uses of single-photon emission tomography (SPECT) techniques contribute significantly to the diagnostic accuracy of the scan. A small amount of radioactive material (tracer) is used to visualize all the bones in your body. Approximately three hours after the tracer has been injected into a vein, a scan takes place.
Discography is a procedure used to determine the internal structure of your disc. It is performed by using a local anesthetic and injecting a dye into your disc under X-ray guidance. An X-ray and CT scan are performed to view the appearance of the disc composition to determine if its structure is normal or abnormal. In addition to your disc appearance, your doctor will note if you have pain with this injection.
Spinal injections partnered with posture changes can control the symptoms for a long period of time in most cases. Stenosis may be treated successfully without surgery, in some cases though, surgery may be required in order to create more space around the nerves.
Flexing forward and bending over may relieve pain. Taking anti-inflammatories, especially ibuprofen, may be beneficial. If you are allergic to ibuprofen, acetaminophen may be taken for pain.
Stretches and movements that extend the spine may be incorporated into a physical therapy program. Injections may be used to reduce inflammation and control pain symptoms. Try our home remedy exercises provided. Do not continue if they cause an increase in pain or symptoms.
As an alternative to traditional treatment, a surgeon may use a new spinal instrument known as X-stop. The surgeon installs the device as a brace between the vertebral segments. X-stop surgery can be done in half the time, and is less invasive and less risky than traditional surgery.
A procedure known as a laminectomy is the most common surgery to treat stenosis. This helps create more space for the surrounding spinal nerves.