Stenosis

What is stenosis?

Spinal stenosis occurs when spaces within your spine, known as the foramen, begin to narrow, thus putting pressure on the nerves that run through your spine. This process is gradual and takes place over a period of time.

In general, there are two types of spinal stenosis:

  • Cervical stenosis (occurs in your neck)
  • Lumbar stenosis (occurs in your lower back)

Spinal stenosis is more commonly seen in individuals aged 50 and above. Research has shown that spinal stenosis affects approximately 1 in 1000 individuals above the age of 65 and 5 in 1000 individuals above the age of 50 [1]. Lumbar stenosis is especially common among the elderly and is one of the most common reasons for performing spinal surgery at an older age [2].

Spinal stenosis is frequently associated with other conditions such as spinal arthritis, which is the inflammation of the joints in your spine.

the-neurology-practice-stenosis

Image depicting spinal stenosis. Taken from: https://www.mayoclinic.org/-/media/kcms/gbs/patient-consumer/images/2015/08/03/12/53/mcdc7_spinal_stenosis-6col.jpg

Cervical stenosis vs Cervical radiculopathy vs Cervical myelopathy

Cervical stenosis should not be confused with cervical radiculopathy or cervical myelopathy.

  • Cervical stenosis occurs when space within your spine narrows and as a result, puts pressure on the nerves that run through your spine
  • Cervical radiculopathy occurs when the nerve roots are compressed or damaged
  • Cervical myelopathy occurs when the spinal cord itself is compressed

How will having spinal stenosis affect me?

There are various ways in which having spinal stenosis may affect you in your daily life. Firstly, you may find it difficult and painful to move around. As a result, this may bring discomfort and inconvenience to your life, especially if there is a job or event that requires you to move around often.

In addition, having spinal stenosis may also negatively affect your mental health. Stress, anxiety and depression may be amplified by chronic back pain resulting from your spinal stenosis.

What does having spinal stenosis feel like?

Restricted mobility. If you have spinal stenosis, you may find moving, walking around and lifting heavy objects tiring and painful. Your arms and hands may feel unusually weak as well. Simple actions such as turning around may also become difficult.

Chronic pain and discomfort. With spinal stenosis, you will likely experience a burning or shock-like pain in your neck or lower back that shoots down your arms, buttocks and legs. In addition, you may feel a numbness and tingling sensation in both your hands.

Headaches and dizziness. As nerves in your spine are compressed, this may result in headaches and dizzy spells. You may also find yourself unable to keep your balance. This symptom is especially characteristic of cervical stenosis.

Bladder and bowel dysfunction. In rare cases, you may not be able to control your bladder or bowel movements as a result of spinal stenosis. You may also find yourself frequenting to the toilet more than usual.

What are the causes and risk factors of spinal stenosis?

Aging. The most common cause of spinal stenosis is wear-and-tear due to aging. As you age, parts of your body naturally begin to degenerate, including your spine. This aging process may therefore result in thickened ligaments, herniated discs (a condition whereby the inner portion of the disc in the spines protrudes through the outer ring) and bony projections (also known as bone spurs) which narrow the forman and press on your spinal nerves, resulting in spinal stenosis.

Spinal injuries. Trauma and injury to the spine may fracture or displace a bone in the spine, damaging the surrounding nerves. In addition, swelling of tissues near the spine may also press on nearby nerves, causing spinal stenosis.

Tumours. Abnormal growths such as tumours within or near the spine may also press on and damage the spinal nerves.

Other medical conditions. These may include:

  • Congenital spinal deformities such as scoliosis, which causes the spine to curve sideways
  • Genetic diseases which affect bone and muscle development in the body

The biggest risk factors for spinal stenosis are age and family history. If you are above the age of 50 and have a family member with spinal stenosis, you are at a higher risk of developing this condition.

How can I prevent myself from getting spinal stenosis?

As spinal stenosis is often caused by natural wear-and-tear of the spine that comes with age, there is no foolproof way to completely prevent spinal stenosis. However, some ways to reduce your risk of spinal stenosis include:

  • Exercising regularly. Exercising helps to strengthen your back muscles and keep your spine flexible. Some sports that are good for the spine include swimming and yoga.
  • Maintaining a good posture. Bad postures can create gradual changes to the natural curves of your spine. Thus, keeping your back straight while sitting down and sleeping on a firm mattress that adequately supports your spine may help to reduce your risk of spinal stenosis.

How is spinal stenosis diagnosed?

Medical examination. When visiting a doctor, your doctor will most likely conduct a thorough medical examination and several tests before definitively diagnosing you with spinal stenosis. Your doctor may ask you about your medical history, family history and test your strength and reflexes.

Imaging. In addition, your doctor may make use of spinal imaging such as X-Ray, MRI and CT scans to have a detailed look at the spine and surrounding nerves. This will allow your doctor to locate any damaged or compressed nerves which may be causing your spinal stenosis.

Nerve conduction studies. During a nerve conduction study, your doctor will attach electrode patches onto your body. These patches will then produce electrical impulses, allowing your doctor to measure how fast impulses travel through your nerves. This will help your doctor to differentiate spinal stenosis from other potential neuropathic conditions that may be mimicking your symptoms.

How is spinal stenosis treated?

Physiotherapy. There are several ways in which spinal stenosis can be treated, the first of which being physiotherapy. For this, your doctor will likely refer you to a physiotherapist. Although not a cure, physiotherapy is important in helping you to remain active and build strength in your back.

Epidural steroid injections. Alternatively, your doctor may make use of epidural steroid injections. This is a minimally invasive procedure whereby your doctor, with the guidance of X-ray imaging, will first carefully insert a needle into a fat-filled area between the bone and the protective sac of the spinal nerves within your spine. Your doctor will then inject a medicine to help reduce pain and inflammation in your spine.

Surgery. Lastly, your doctor may opt to treat your spinal stenosis surgically.

If you are currently suffering from chronic back pain or think that you may be experiencing spinal stenosis, visit a doctor and seek medical attention immediately.

References

  1. K Hsiang, J. (2020a, March 26). What is the prevalence of spinal stenosis?Medscape.com; Medscape. https://www.medscape.com/answers/1913265-68823/what-is-the-prevalence-of-spinal-stenosis#:~:text=Approximately%20250%2C000%2D500%2C000%20US%20residents
  2. Szpalski, M., & Gunzburg, R. (2003). Lumbar spinal stenosis in the elderly: an overview. European Spine Journal, 12(Suppl 2), S170–S175. https://doi.org/10.1007/s00586-003-0612-1
  3. K Hsiang, J. (2020b). Spinal Stenosis: Practice Essentials, Anatomy, Pathophysiology. EMedicine. https://emedicine.medscape.com/article/1913265-overview
  4. MD, B. B. (2019, November 25). What Is Spinal Stenosis? Spine-Health. https://www.spine-health.com/conditions/spinal-stenosis/what-spinal-stenosis