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. Treatment 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. |