Stenosis

General

Spinal stenosis is a narrowing of the nerve canal spaces within your spine, which can put pressure on your spinal cord and/or the nerve roots that branch off the spinal cord. Spinal stenosis occurs most often in the neck and lower back. About 75% of cases of spinal stenosis occur in the low back (lumbar spine). In most cases, the narrowing of the spine associated with stenosis compresses the nerve root, which can cause pain along the back of the leg. This type of stenosis is called “lateral canal stenosis” or simply lateral stenosis. Less frequently the spinal cord becomes compressed and this is called “central canal stenosis.”

While some people have no signs or symptoms, spinal stenosis can cause pain, numbness, muscle weakness, and problems with bladder or bowel function.

Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to aging. Abnormal spinal biomechanics can cause abnormally high weight bearing points in the spine that will lead to thickening of that bone and ligaments in an effort to better support the load. As a consequence, however, the nerve canals sometimes narrow as the thickening takes place.

In addition to degenerative changes, some people are born with a more narrowed spinal canal, which predisposes them to stenosis later in life. Any other change in the spine that happens to reduce the amount of space available for the nerve tissue to exist can cause stenosis and may include injury, bone spurs, spondylolisthesis, Paget’s disease, herniated discs, expanding infection, tumor, vertebral fractures or dislocations.

Most people with spinal stenosis have passed the age of 50. When younger people develop spinal stenosis, the cause is typically a genetic disease affecting bone and muscle development throughout the body. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves. There are many treatment options that may prove effective prior to surgery and should be explored at Novocur Pain Management Clinics.

Symptoms

Many people have evidence of spinal stenosis on x-rays, but have no signs or symptoms. When symptoms do occur, they often start gradually and worsen over time. Symptoms vary, depending on the location of the stenosis:

  • In the neck. Narrowing in the upper (cervical) spine can cause numbness, weakness or tingling in a leg, foot, arm or hand. In severe cases, nerves to the bladder or bowel may be affected, leading to incontinence.
  • In the lower back. Compressed nerves in your lower (lumbar) spine can cause pain or cramping in your legs when you stand for long periods of time or when you walk. The discomfort usually eases when you bend forward or sit down.
Treatment

  • A chiropractor may offer manipulation to increase mobility of the spinal segments which may improve symptoms. They may also offer spinal traction to increase the space available between spinal segments to take pressure off the nerve tissue. A physical therapist can teach you exercises that may help:
    • Build up your strength and endurance
    • Maintain the flexibility and stability of your spine
    • Improve your balance
  • Pharmacological Intervention. Novocur may use any of a number of medications to control the pain associated with spinal stenosis. The following categories of medicines may be employed:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) help relieve pain and reduce inflammation. Some NSAIDs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve), are available without prescription.
    • Muscle relaxants. Medications such as cyclobenzaprine (Amrix, Flexeril) can calm the muscle spasms that sometimes occur with spinal stenosis.
    • Nightly doses of tricyclic antidepressants, such as amitriptyline, can help ease chronic pain.
    • Anti-seizure drugs. Some anti-seizure drugs, such as gabapentin (Neurontin, Gralise) and pregabalin (Lyrica), are used to reduce pain caused by damaged nerves.
    • Drugs such as oxycodone (Oxycontin, Percocet, others) and hydrocodone (Lortab, Vicodin, others) contain substances related to codeine and can be habit-forming.
  • Epidural Steroid Injection .Your nerve roots may become irritated and swollen at the spots where they are being pinched. Injecting a corticosteroid into the epidural space around that constriction can help reduce the inflammation and relieve some of the pressure.

Spinal Cord Stimulators .The nerve pain in legs or arms from stenosis may be treated with neurostimulation from a spinal cord stimulator. This last resort treatment represents a new and effective treatment, which replaces the pain with pleasant vibration sensations.

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