Beverly Pain Management

Charles Ho Consultants

Help Manage Your Pain Through Knowledge

Spinal Stenosis
Spinal stenosis means that the spinal cord does not have enough space and is being squeezed, it is "too tight".
The spinal cord is protected with the bony cage of the spine. It is surrounded by the vertebra which consists of the vertebral body, pedicles, facet joints, and laminas. Spinal stenosis can be caused by spondylolithesis, spondylosis, disc herniations, and facet hypertrophy.
Spondylolithesis is a "slippage" of the vertebra upon one another. The vertebra are usually aligned so that each one is stacked like "Legos" so that the spinal canal is a fairly straight tube. If there is slippage, the spinal canal has a "kink" and is smaller in that area.
Spondylosis can be described as arthritis of the spine. The bony surfaces may become roughened and bone spurs may develop. These can intrude upon the spinal canal.
Disc herniations are bulgings of the disc wall into the spinal canal.
Facet hypertrophy is swelling or enlargening of the facet joints. The joints may become large enough to intrude into the spinal canal.
When spinal stenosis occurs, it squeezes upon the spinal cord. This may cause irritation of the spinal cord or ischemia of the spinal cord. The spinal cord does not like to be touched, when it becomes irritated, shooting pains may occur down the leg. Ischemia of the spinal cord means it is not receiving enough blood, this may be experienced as cramping or aching of the legs.
When experiencing the shooting pains or cramping pains, usually stopping the activity and resting are enough. Non-steroidal anti-inflammatory drugs (NSAID) can be used to decrease inflammation of the spinal cord. Neuromodulating medications are also used to decrease the irritation of the spinal cord, such as anti-seizure medications or anti-depressant medications.
If these modalities are not effective, lumbar epidural steroid injections (LESI) may be helpful. These are used to decrease inflammation and irritation of the spinal cord. LESIs may or may not be helpful depending on a case by case basis. If symptoms are severe such as weakness, loss of bowel or bladder control, surgery may be necessary. Surgery is performed to increase the space available to the spinal cord, usually a laminectomy which removes part of the bone surrounding the spinal cord. Consultation with a physician is advised regarding spinal stenosis.