Spinal Stenosis

WHAT CAUSES SPINAL STENOSIS?

Spinal stenosis usually occurs as a person ages. Disks in the back/spine become drier and bones and ligaments of the spine thicken or grow larger and begin to bulge. This can be caused by arthritis or degeneration of the discs.

Spinal stenosis may also be caused by:

° Arthritis of the spine, usually in middle-aged or older people

° Bone diseases, such as Paget disease

° Defect or growth in the spine that was present from birth

° Herniated or slipped disk, which often happened in the past

° Injury that causes pressure on the nerve roots or the spinal cord

° Tumors in the spine

SYMPTOMS

Symptoms of spinal stenosis include pain, numbness, cramping or weakness in the back, buttocks, thighs, calves, or in the neck, shoulders or arms. Symptoms are more likely to be present or get worse while standing or walking. They often lessen or disappear when one is seated or leans forward. Most people with spinal stenosis cannot walk for long periods of time. More serious symptoms include:

° Difficulty or poor balance when walking

° Problems with urination or bowel movements

Unfortunately, symptoms of spinal stenosis often worsen slowly over time. Most often, symptoms will be on one side of the body, but may involve both legs.

EXAMS AND TESTS

During a physical exam, your doctor will try to find the location of the pain and figure out how it affects your movement. You maybe asked to:

° Sit, stand and walk. While walking, you may be asked to stand on your toes and then your heels.

° Bend forward, backward and sideways.

° Lift your legs straight up while lying down. If the pain is worse when you do this, you may have sciatica, especially if you also feel   numbness or tingling in one of your legs.

Your doctor may also move your legs in different positions, including bending and straightening your knees. This is to check your strength and ability to move.

To test nerve function, the doctor uses a rubber hammer to check your reflexes. To test how well your nerves sense feeling, the doctor may touch your legs with a pin, cotton swab or feather.

A brain and nervous system (neurologic) examination can help confirm leg weakness and decreased sensation in the legs. The following tests may be done:

° EMG

° Spinal MRI or spinal CT scan

° X-ray of the spine

TREATMENT

Your doctor and other health professionals can help you manage your pain and keep you as active as possible.

° Your doctor may refer you to a physical therapist, who can teach you stretches and exercises to strengthen your back muscles.

° Massage therapy, acupuncture and chiropractic care may be helpful.

° Cold packs and heat therapy may relieve   painful flare-ups.

Treatments for back pain that has been caused by spinal stenosis include:

° Medication

° Cognitive behavioral therapy (talk therapy), which can help you better understand your pain and teach you how to manage back pain.

° An epidural spinal injection (ESI), which involves injecting medicine directly into the space around   your spinal nerves or spinal cord.

Spinal stenosis symptoms often become worse over time, but this may happen slowly. If the pain does not respond to other treatments, or if you lose movement or feeling, you and your doctor can discuss the need for surgery to relieve pressures on the nerves or spinal cord.

Surgery may include removing a bulging disc, removing part of the vertebra bone or widening the opening where your spinal nerves are. After some surgeries the surgeon may fuse some of the spine bones to make your spine more stable.

WHEN TO CONTACT A MEDICAL PROFESSIONAL

Call your healthcare provider if you have symptoms of spinal stenosis. If you experience one or more of the following symptoms, you may need prompt attention:

° Difficulty or poor balance when walking

° Worsening numbness and weakness of a limb

° Problems controlling urination or bowel movements

° Problems urinating or having a bowel movement

OUTLOOK [PROGNOSIS]

Many people with spinal stenosis are able to be active with the condition, although they may need to make some changes in their activities or work. Rarely, changes caused by pressure on the nerves may be permanent, even if the pressure is relieved.