Surgical Management of Spinal Stenosis
Edited By: Richard J. Bransford, M.D.
Last updated Friday, December 23, 2005
Review of the conditionCharacteristics of Individuals with central spinal stenosis (either the
cervical, thoracic spine, or lumbar spine) will present with symptoms of
claudication (aching in the legs) or
myelopathy (damage to the spinal cord itself). These symptoms can vary from
aching in the legs to loss of bowel and bladder or sexual control to balance
and coordination issues.
Patients with foraminal stenosis (tightening of the nerve
roots as they are trying to exit the spinal cord) usually present with symptoms
referred to as radiculopathy. These symptoms are localized to a particular area
of the arms or legs and can manifest as weakness, burning, numbness, aching, or
sciatica (pain radiating down the leg).Types The first differentiation that needs to be made is whether
there is central stenosis or foraminal stenosis. Central stenosis is tightening in the spinal
canal of the spinal cord. Foraminal
stenosis is tightening of the openings of the exit points for each nerve as it
is exiting the spinal column.
The second thing that must be determined is what is causing
the central or foraminal stenosis. There are many causes, including arthritis,
disc herniations, spondylolisthesis (malalignment of vertebral bodies), spine
curvature (scoliosis), fracture, tumor, or infection.
Similar conditions Spinal stenosis usually does not cause back or neck pain,
although these symptoms may be associated with the condition, depending on the
cause. Spinal stenosis usually does not have back pain as its main symptom. In
addition, stenosis must be differentiated from degenerative disc disease.Incidence and risk factors Spinal stenosis can have many causes. It is most commonly seen in the elderly with
arthritis or in younger people as a result of a disc herniation.
Approximately 250,000-500,000 Americans have symptoms of
spinal stenosis due to degeneration. This represents about 5 of every 1,000
Americans over 50.
The prevalence of symptomatic
herniated lumbar disc is about 1 to 3 percent, depending on age and sex. The
highest prevalence is among people age 30 to 50, with a male to female ratio of
2:1. In people ages 25 to 55, about 95 percent of herniated discs occur in the
lower lumbar spine. Diagnosis Spinal stenosis can usually be determined with a thorough
clinical history and examination of the patient. It is then confirmed with an MRI (Magnetic
Resonance Image) or a CT (Computerized Tomography) with dye injected around the
spine. Either one of these will show the problem. X-rays can be helpful in
suggesting the cause of the problem, however, since the nerves, spinal cord,
and discs do not show up on x-ray, this is not a definitive study.
Medications Medications can help spinal stenosis and often the symptoms
will resolve of their own accord, or go through waxing and waning periods. This
comes back to the cause of the stenosis. Sometimes medication is all that is
needed, but sometimes the actual cause of the stenosis needs to be managed more
aggressively. Anti-inflammatories and muscle relaxants are usually the first
line of treatment.
As a more invasive option, steroids and local anesthetics
can be injected around the site of the problem. These are usually administered
by a physiatrist or an anesthesiologist. Such injections can provide lasting
relief and can occasionally be all that is needed.
Exercises Usually exercises are not beneficial for spinal stenosis. It
is very important to maintain good core strength with strong back and belly
muscles, as well as flexibility of the legs and trunk. These will be beneficial
in avoiding many of the causes of spinal stenosis in the first place, but once
a person has stenosis, these usually cannot reverse the cause.Possible benefits of laminectomy, decompression, fusion Stenosis can be improved with surgery by providing a larger
opening or canal for the nerves and spinal cord. Surgery is usually beneficial
in alleviating the pain and weakness caused by the nerves being pinched.
Sometimes the canal can be enlarged with something as simple
as a laminectomy in which the roof of bone on the back in removed to allow the spinal
cord to have more room. This is one of the simplest operations to alleviate
these symptoms.
If the stenosis is caused by a disc herniation, then
sometimes all that is needed is a discectomy in which part of the disc is
removed.
If the stenosis is caused by spine instability or fracture
or tumor, sometimes a spine reconstruction, such as a fusion needs to be done along
with the decompression or laminectomy or discectomy. Otherwise further problems
may develop.
With these surgical approaches, most people do well in
recovering use of their limbs and in relieving the symptoms of pain, burning,
tingling, or numbness.Surgery for at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 (outside the Seattle area: 800-440-3280) to make an appointment.
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