Spinal stenosis


Spinal stenosis

Description, Causes and Risk Factors:

Your spine, or backbone, consists of the column of 33 bones and tissue that extends from your skull down to your pelvis. Providing the support of your head and body, your backbone encloses and protects a cylinder of nerve tissues, called the spinal chord. The 33 bones in your spine are called vertebrae (one is called a vertebra). The upper 24 vertebrae join together like links in a chain. In between each vertebra is an intervertebral disk, a band of cartilage that acts as a shock absorber between the vertebrae. When someone has a "slipped disk," he or she has an intervertebral disc that has slipped out of position, thus causing friction between two vertebrae and extreme pain from nerves being exposed. The lowest nine vertebrae are fused (joined) together in two groups, forming the sacrum and coccyx.

The cervical vertebrae (C1-C7) are the seven vertebrae that form the upper part of your spine, between the skull and the chest.

The thoracic vertebrae (T1-T12) are the 12 bones between your neck and your lower back. Thoracic vertebrae have cup-shaped surfaces called facets, in which the ribs rest and connect to the spine. These 'joints' help the ribs to move up and down during breathing.

The lumbar vertebrae (L1-L5) are the five largest and strongest of all vertebrae. They are found in your lower back between the chest and hips. The strong muscles of the back are attached to the lumbar vertebrae.

Your sacrum and coccyx are the bones found at the base of your spine. The triangular sacrum — made up of five vertebrae fused together—supports the spine and connects it to the pelvis. Your coccyx, or tailbone, is formed from four fused vertebrae and has little function.

The vertebral foramen is the hollow part of the vertebrae where the spinal chord (nerve tissues) attaches to your brain and sends signals all over your body.

Spinal stenosis is the narrowing of your spinal canal and nerve root canal along with the enlargement of your facet joints. Moist commonly it is caused by osteoarthritis and your body's natural aging process, but it can also develop from injury or previous surgery. As the spinal canal narrows, there is less room for your nerves to branch out and move freely. As a result, they may become swollen and inflamed, which can cause pain, cramping, numbness or weakness, in your legs, back, neck, and arms.

The risk of developing spinal stenosis increases in those who:

• Are born with a narrow spinal canal.

• Are female.

• Are 50 years of age or older.

• Have had previous injury or surgery of the spine.

Conditions that can cause spinal stenosis include:

• Osteoarthritis and osteophytes (bony spurs) associated with aging.

• Inflammatory spondyloarthritis.

• Spinal tumors.

• Trauma.

• Paget's disease of the bone.

• Previous surgery.

Symptoms:

Your symptoms may include: numbness, weakness, cramping, or pain in the legs and thighs; radiating pain down the leg; abnormal bowel and/or bladder function; decreased sensation in the feet causing difficulty placing the feet when walking; loss of sexual function; and/or partial or complete leg paralysis.

Diagnosis:

When you first experience pain, consult your family doctor. Your doctor will take a complete medical history to understands your symptoms, any prior injuries or conditions, and determine whether any lifestyle habits are causing the pain. Next physical exam is performed to determine the source of the pain and test for any muscle weakness or numbness.

Additional tests conducted to confirm and assess the diagnosis may include:

• An X?ray of the spine to check for abnormalities in the bones of the back including osteoarthritis, bone spurs and obvious narrowing of the spinal canal.

• A computed tomography (CT) scan to take images of the bony architecture of the back. This helps to evaluate the spinal canal.

• A magnetic resonance imaging (MRI) scan of the spine to make pictures of soft tissues such as the spinal cord and the spinal nerves inside the back.

• An EMG which may show active and chronic neurological changes.

• A myelogram is a specialized x-ray where dye is injected into the spinal canal through a spinal tap. An x-ray fluoroscope then records the images formed by the dye. Myelograms can show a nerve being pinched by herniated disc, bony overgrowth, spinal cord tumors, and spinal abscesses. Regular x-ray of the spine only gives a clear picture of bones.

Treatment:

Although there is no known cure for spinal stenosis, various therapies are available, one of the most important being exercise. Keeping the hip adductors and abductors, quadriceps and hamstrings from developing atrophy helps increase stability and the ability to walk.

Medications such as nonsteroidal antiinflammatories (NSAIDs) also may be appropriate and helpful in pain relief. Cortisone injections into the epidural space, the area around the spinal cord, can afford tremendous temporary or permanent relief to people suffering this disorder.

Holistic therapies: Some patients want to try holistic therapies such as acupuncture, acupressure, nutritional supplements, and biofeedback. These treatments for spinal stenosis may help.

Under severe circumstances, surgery to correct this disorder may be appropriate. However, adequate decompression of the neural elements and maintenance of bony stability are necessary for a good surgical outcome for patients with spinal stenosis. Decompression laminectomy, which is the removal of a build?up of bony spurs or increased bone mass in the spinal canal, can free space for the nerves and the spinal cord. Spinal fusion to fuse two vertebrae together to provide stronger support for the spine almost always follows a decompression laminectomy.

Several studies report that surgical treatment produces better outcomes than non?surgical treatment in the short term. However, results tend to deteriorate with time. Lumbar decompressive surgery can be complicated by epidural hematoma, deep venous thrombosis, dural tear, infection, nerve root injury and recurrence of symptoms.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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