Spinal Stenosis

Disease Awareness Page for R3 Stem Cell – Spinal Stenosis

Spinal Stenosis

Spinal stenosis is a medical condition characterised by the narrowing of the spinal canal of the bones of the back (vertebras). The narrowing may be due to several factors, including wear and tear of the cartilages in-between the joints of the back, as well as disc herniations. Spinal stenosis mostly occurs at the neck and back, and less commonly at the chest and buttock area of the spinal column. It causes symptoms like muscle weakness and back pain, even though some individuals may have the condition without any symptoms.

The spinal canal and spinal nerves

In the human body, there are 33 vertebrae (bones of the back), and they run from the base of the skull to the buttocks. They articulate with one another and form the intervertebral joints. Each of these vertebrae has a space behind them called the spinal canal. The spinal cord passes through is space. The bones have a double function—providing a house for the spinal cord while keeping it from injury.

At the level of each intervertebral joint, spinal nerves leave the spinal cord to supply muscles and skin in the body. In conditions like spinal stenosis, the spinal canal narrows, compressing the spinal nerves as they leave the spinal cord. Other conditions can also cause this, like arthritis and spondylolisthesis (more on these later).

As mentioned earlier, the two most common forms of spinal stenosis are cervical stenosis and lumbar stenosis. They are common because these parts of the vertebrae see the most movement. All bodily movements occur at the neck and the lumbar region. There is very little movement at the chest because of the rib cage. 

These movements in the neck and lower back are what makes them so vulnerable to spinal stenosis. They also make them vulnerable to other conditions like spondylolisthesis (a condition in which one vertebrae bone shifts over another) or spondylolysis (a condition in which there is a fracture of a part of the vertebrae).  

Causes of spinal stenosis

Even though movement at the intervertebral joints predisposes these areas to stenosis, they are not a direct cause. Several individuals go their whole lives without ever experiencing a narrowing of the spinal canal. Spinal stenosis is caused by factors like:

• Age
• Spinal arthritis
• Rheumatoid arthritis
• Disc hernia/slipped disc. A disc hernia is a condition in which the softer and more flexible core of the intervertebral disc bulges out into the spinal canal and compresses the nerves.
• Weak spinal ligaments
• Osteophytes. Osteophytes are small bony growths that appear along the edges of the vertebrae.
• Tumours
• Trauma
• Spondylolisthesis

The influence of age in spinal stenosis

Spinal stenosis is most common in older people. As we age, our body ages as well. This means that the ligaments that support the intervertebral joints get thicker, harder and weaker. Additionally, the intervertebral disc (a disc made of cartilage that separates two vertebral bones) becomes smaller and less flexible. All these causes a reduction in the space in the spinal canal, and a compression of the spinal nerves. 

How common is it, and who is at risk?

There are several sources of information on the prevalence of spinal stenosis. According to a source, approximately 250,000 to 500,000 residents of the United States have symptoms that point to spinal stenosis. This means that one in every 1000 people over the age of 65, and 5 in every 1000 persons over the age of 50 have spinal stenosis.

Spinal stenosis is similar to conditions like rheumatoid arthritis and Sacroiliac joint pain in that the older a person gets, the more likely they are to develop it. However, it can happen to young people as well since their spinal canal is equally susceptible to narrowing. It is most common in younger people who have had trauma or were born with the condition that narrows their spine.

One of the rarer risk factors of spinal stenosis is scoliosis. This is a condition in which the spine takes an abnormal S-shaped sideways curve. In addition to leading to spinal stenosis, it can also lead to arthritis in the spine and other joints as well, as well as several muscular abnormalities.

There are also factors that do not increase your chances of getting scoliosis but can worsen the symptoms. They are

• Obesity
• Diabetes
• Sedentary lifestyle
• Osteoporosis

What are the symptoms of spinal stenosis? 

The symptoms of spinal stenosis are usually felt in the muscles, as well as the nerves of the people affected. Because it is most common in the low back, one of the major symptoms is low back pain. It may also be felt in the buttocks and leg. However, the nature of the pain is variable, changing from individual to individual. It can be:

• A sharp stabbing pain
• Shooting pain
• Tingly sensation
• Burning sensation
• Numbness
• Pain that radiates along the course of a particular nerve to the feet

These types of pain are also felt in cases where the stenosis affects the neck vertebra. The only difference is that the pain is felt along the arms instead of the legs.

Besides pain, other symptoms felt by individuals who have spinal stenosis are:

• Muscle weakness (in the legs or arm)
• Balance problems
• Reduced range of motion

Several of the symptoms felt in spinal stenosis are increased with standing and walking, and reduced when you sit down. If left unattended, the symptoms of spinal stenosis can lead to 

• Urinary and bowel incontinence or complete loss of control
• Paralysis

How is it diagnosed?

The normal procedure for diagnosing back conditions involves physical examination, history taking and imaging tests. Some symptoms of spinal stenosis, like a reduced range of motion and pain, can be detected using physical tests. However, so many other conditions (arthritis, pudendal neuralgia, sciatica and so on) present with the same symptoms and so, it is impossible to make a diagnosis of spinal stenosis on that alone. However, a physical exam can help pinpoint the area of the impairment. 

History can only identify risk factors like trauma and causes rheumatoid arthritis. It too cannot diagnose the condition. The diagnosis of spinal stenosis is mostly made via imaging scans.

An MRI can be used to view the vertebral joints and identify the canals of the spinal nerves that are reduced. It can also detect disc hernias, osteophytes and ligament thickness. With these images, an accurate diagnosis of spinal stenosis can be made.

Another method of diagnosing spinal stenosis is to conduct a nerve block. Once the affected spinal joints have been identified, a small volume of anaesthetic is injected into the area to numb the nerves. This can help confirm the area involved in the diagnosis.

How is it treated?

Even though spinal stenosis does not have a cure, there are several interventions that can be carried out to help individuals who have the condition. The interventions are aimed at controlling the condition, preventing its progression, reducing pain, and improving the overall quality of life of the individuals with the condition.

The treatment options available are:

Physiotherapy 

Several types of research show that physiotherapy interventions are successful in the management of spinal stenosis. Exercises prescribed by a physiotherapist can help to increase the range of motion around the area affected, improve flexibility, and even strengthen the muscles around the area.

Activity and lifestyle modification

Activities that can aggravate or increase the pain felt are usually avoided. It is important to note that some activities actually relieve the pain, like bending forward. These are recommended and even incorporated into the exercise routine.

Medication

Analgesics can also be prescribed to manage the pain associated with spinal stenosis.  Some narcotic medications might also be prescribed for short term pain use. They are especially effective with nerve related pain. Muscle relaxers can also be prescribed.

Learn More about ongoing clinical studies sponsored by R3 Stem Cell HERE.

References 

“Spinal Stenosis”. National Institute of Arthritis and Musculoskeletal and Skin Diseases. 11 April 2017. Retrieved 19 December 2017.

“Spinal Stenosis”. National Institute of Arthritis and Musculoskeletal and Skin Diseases. 11 April 2017. Retrieved 19 December 2017.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591458/ 

https://emedicine.medscape.com/article/1913265-overview#a6 

https://www.healthline.com/health/spinal-stenosis 

https://www.spine-health.com/conditions/spinal-stenosis/spinal-stenosis-symptoms-and-diagnosis     

https://www.ncbi.nlm.nih.gov/pubmed/20231787 

https://www.physio-pedia.com/Lumbar_spinal_stenosis 

https://academic.oup.com/ptj/article/93/12/1646/2735353 

https://www.ncbi.nlm.nih.gov/pubmed/11552356