Narrowing of the spaces in the spinal causes pressure on your nerve roots located in the spinal canal and this phenomenon is called spinal stenosis. Wear and tear related to aging is the most common cause of this medical condition.
Cartilages present on the bones are damaged due to the constant wear and make bones rub against each other. Our body naturally responds to this by developing bones and eventually ends up in bone overgrowth. These overgrown bones intrude into the space of the spinal cord.
Abnormal growths, thickening in ligaments, Paget’s disease, osteoarthritis, trauma to the spine, and herniated discs are among other common causes of this problem. In rare cases, it can arise due to some birth defects in the back and known as congenital spinal stenosis. However, aging still remains the biggest reason for this medical condition and is mostly seen in people over 50 years. Weakness in the legs and back pain are general symptoms of this.
Spinal Stenosis Diagnosis And Treatment Options
Firstly, patients undergo a physical examination to understand the functionality of the body parts. Pain doctors may prescribe some diagnostic tests such as CT scans, MRI scans, X rays to get the exact idea about the problem.
Unfortunately, there is not any cure for this problem; however, a wide range of treatment for spinal stenosis available that help to ease symptoms. Your pain doctor can recommend you to try over-the-counter (OTC) medications as they can be useful for reducing the pain. If that does not work, you may be given higher doses of medications.
Furthermore, doctors can try cortisone injections for some patients. These anti-inflammatory drug injections ease pain by reducing inflammation. However, the effects of them can be temporary and you should not take them more than 3 times a year as it weakens the tissues in the spine.
Movement of the body parts is essential to maintain overall health. When suffering from conditions like spinal stenosis, you might feel that exercising can worsen the pain; however, pain management specialists recommend gentle stretching exercises 3 to 5 times every day. If you are not habitual to exercises, start slowly. Practice stretching for a few minutes a day. When you are prepared, make sure you exercise for 30 minutes at least thrice a week. If you struggle, you can try exercising in a swimming pool as water buoyancy makes it easy to move your body parts in full range.
There are several benefits of regular exercising such as improved body movements, flexibility, and balance. It leaves a positive impact on both mental and physical health. You can have a word with your pain doctor or therapist to understand the exercising techniques to strengthen the abdominal and back muscles. They are the ones who can guide you on exercising with safety measures. In severe cases, they can also suggest using a back brace for additional support. If you feel the pain is deepening even after maintaining all the necessary safety measures, reach out to your doctor.
Apart from exercises, you can try physical therapy. It is great for loosening the muscles in the back area and offers much-needed relaxation. Manual manipulation can also be a good option for you. However, it is vital to have a discussion about this with your doctor to understand if it will suit your specific pain condition.
Generally, every spinal stenosis treatment program has a unique physical therapy and exercise plan. Inactivity can worsen the pain for spinal stenosis patients and this is why exercising and therapies are crucial. Pain specialists recommend to start slowly and gradually work on building strength and tolerance.
Modifications In Activities
Patients must stay away from the activities that aggravate the pain. Instead, they should adopt the ones that offer relief. For example, lumbar spinal stenosis patients feel relaxed when they lean forward, lay down, or sit. Therefore, they can try the following modifications to their every activity:
- Use a recliner chair instead of a straight back chair
- You can try stationary biking instead of walking. Biking while slightly leaning towards the handlebars can offer relaxation.
- Avoid walking upright. You can use a walker to lean forward while walking.
- You can use a back or neck brace to avoid painful movements in the spine.
Note that a brace can cause deconditioning of the muscles in the neck and back area if used excessively. Therefore, make sure to rely on that for a limited time only. Overusing it can worsen the spinal pain and lessen the support.
Epidural Steroid Injections
With the help of contrast dye and x-ray, this method focuses on injecting a needle into the spinal canal. It then injects the corticosteroid into the affected region. This helps in preventing inflammation in the spinal cord and nerve roots.
Steroid injections can be a great option for spinal stenosis patients even though their effects are mostly temporary. Doctors may continue this course for those patients who showed progress with it. This treatment is great when continued with physical therapy programs and exercises.
There have been some instances of severe side effects of epidural steroid injections. This makes it very critical to consult a reputable medical professional before going for this treatment.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and Acetaminophen (Tylenol) are the most common medications used for spinal stenosis patients.
NSAIDs are anti-inflammatory and they lessen the inflammation in the affected area leading to relief. You can buy these medications over the counter or through the prescription given by your doctors. Celecoxib. Naproxen, ibuprofen, and aspirin are the most commonly available NSAIDs for spinal stenosis.
On the other hand, Acetaminophen (Tylenol) works through the spinal cord and brain, our central nervous system, to ease the pain. Patients can purchase it over the counter or via prescription given by the doctors.
Patients suffering from intense nerve-related pain can be prescribed a short-term course of opioid medication. It may be beneficial to those who face frequent painful episodes related to this condition. Some pain doctors can advise you to take nerve desensitizing medications and muscle relaxants. A common example of such medicines is gabapentin.
These all are the non-surgical treatment for spinal stenosis. When these do not work or patients experience increased neurological deficits like weakness or numbness, surgical treatments can be your best option. Such surgeries focus on decompressing the spinal cord and nerve to encourage faster healing and functioning. The following are the types of surgical treatments for spinal stenosis.
Discectomy and Fusion
Spinal stenosis is often caused due to the narrowing in intervertebral foramen that occurs as the result of disc degeneration. The space between the discs keeps collapsing in this and may lead to intense pain. Surgery can help reduce disc generation and fuse the adjacent vertebrae.
The Intervertebral foramen is where spinal nerves leave the spinal canal. In foraminotomy, a small part of the intervertebral foramen is surgically removed. Doctors can also go for partial removal of disc-related bone spurs and soft tissues if any of these is reducing the space for spinal nerves near or within the foreman.
Even though this is a more invasive treatment option for spinal stenosis than Laminectomy (we will come to this), it is not recommended for patients with severely widespread spinal stenosis.
Laminectomy is performed to remove the bony protrusion placed at the back of vertebrae and 2 laminae that links them. Generally, arch’s primary task is to protect the back of the spinal cord. This surgery focuses on decompressing the space in the spinal cord and nerve roots by removing the vertebral arch partially. If the spinal stenosis is extensive and widespread, removal of one or more facet joints is possible.
This is one of the most common surgical treatments of spinal stenosis and often comes with the fusion of adjacent vertebrae. While it helps to maintain stability, it is not required for all patients.
This procedure is very rare in spinal stenosis patients. It involves the total removal of the vertebral region and nearby discs located below and above. Doctors may recommend this when the spinal stenosis is widespread in more than one vertebral level or spinal degeneration is severe and has a fracture.
Interspinous Process Spacers
This type, a medical professional uses different devices to decompress the spinal canal. It involves the implantation of such devices into the spinal cord, especially adjacent spinous processes. Doctors prefer using local anesthesia instead of general anesthesia before implantation of such devices.
Microendoscopic surgery is performed through a tube to combat spinal stenosis. It reduces the trauma to soft tissues and promotes quicker recovery. A very few surgeons count on this surgery due to the limited visualization and complexities involved.
Even though spinal stenosis cannot be cured 100%, you have many options to achieve relaxation and relief from its symptoms. Most of the medical professionals count on basic (non-surgical) treatments at first. However, if they do not work, you may try surgical treatments for better results.
Most spinal stenosis patients live a healthy and active life. With the help of following the guidelines given by their doctors and protecting their spinal cord from any injury, patients can lead a pain-free life. Changes in activities can also provide great relaxation in such cases.