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2/4 Spinal Stenosis, Vertebrae Degeneration Analgesic, Anesthesia, Cardiac, CAT,  CT Scan, Computerized Axial Tomography, Cauda equina syndrome, Corticosteroid, Degenerative, Dehiscence, Efficacy, Endoscopic, Epidural, Extension, Facet, Facetectomy, Flexion, Fluoroscope,Foramen, Foraminotomy,Fusion,Gastrointestinal, Hematoma, Hemorrhage, Herniated,Hypertrophic, Ligament,Interspinous Process Decompression (IPD), Intervertebral Disc,Lamina,Laminectomy, Laminotomy, Ligaments, Ligamentum Flavum,Lordosis, Lumbar, Lumbar Spinal Stenosis, MRI (Magnetic Resonance Imaging), Myelogram, NAIDs, Nerves, Nerve root, Neurologic, Osteophyte, Pedicle, Respiratory, Sciatica, Spinal Canal, Spinal Cord, Spinous Process, Supraspinous Ligament,Spondylolisthesis, Transfusion, Unsinate, Vascular, Vertebra,X-ray, X-Stop

Spinal Stenosis
Vertebrae Degeneration Information Frequently Asked Questions (FAQ)

 

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Spinal Stenosis and Vertebrae Degeneration
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Spinal stenosis is a medical condition where the spinal canal narrows and compresses the spinal cord and nerves. This is usually due to the natural process of spinal degeneration that occurs with aging. It can also sometimes be caused by spinal disc herniation, osteoporosis, or a tumour. Spinal stenosis may affect the cervical spine, the lumbar spine or both. Lumbar spinal stenosis results in low back pain as well as pain or abnormal sensations in the legs.

Contents

 Cervical spinal stenosis

The main causes of cervical spinal stenosis (CSS) include cervical spondylosis, diffuse idiopathic skeletal hyperostosis (DISH), or calcification of the posterior longitudinal ligament.

CSS is more common in males than females, and is mainly found in the 40-60 year age group.

Signs of CSS include spastic gait; upper extremity numbness; upper extremity, lower extremity weakness or both; radicular pain in the upper limb; sphincter disturbances; muscle wasting; sensory deficits; and reflex abnormalities in reflexes.

The best diagnostic and investigative tool is magnetic resonance imaging (MRI), while computed tomograghy (CT) is not useful.

If the problem is mild, treatment may be as simple as physical therapy and the use of a cervical collar. If severe, treatments include laminectomy or decompression.

 Lumbar spinal stenosis

The main causes of lumbar spinal stenosis (LSS) include hypertrophy of the facet joints; spondylolisthesis; diffuse idiopathic skeletal hyperostosis (DISH); and degenerative disc disease.

Usually, this condition occurs after the age of 50, and both genders are equally affected.

Signs of LSS include neurogenic intermittent claudication that causes leg pain, weakness, tingling and loss of deep tendon reflexes. With lumbar spinal stenosis, the patient's pain usually is worse while walking and will feel better after sitting down. The patient is usually more comfortable while leaning forward, such as walking while leaning on a shopping cart.

As with CSS, MRI is the best imaging procedure, though unlike with CSS, CT may be somewhat useful, and can be used if MRI is unavailable.

Treatment includes weight loss, and activity modification, such as using a walker to promote a certain posture. Epidural steroid injections may also help relieve the leg pain. If the symptoms are more severe, a laminectomy or foraminotomy may be indicated to take pressure off the spinal nerve. A new procedure, Interspinous Process Decompression (IPD) has recently been approved by the FDA in November of 2005. This procedure promises a less invasive way to treat LSS and maintains motion at the affected level.

Recent developments include several new implants used in surgery to treat the symptoms of spinal stenosis, while preserving as much normal motion in the spine as possible. Three newer technologies include the X-Stop, the Wallis, and TOPS implants. [1]. These titanium implants act to prevent extension of the stenotic segments and create slight flexion over the segment.

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Stenosis

A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. It is also sometimes called a "stricture" (as in urethral stricture).

Stenoses of the vascular type are often associated with a noise (bruit) resulting from turbulent flow over the narrowed blood vessel. This bruit can be made audible by a stethoscope. Other, more reliable methods of diagnosing a stenosis are imaging methods including ultrasound, Magnetic Resonance Imaging/Magnetic Resonance Angiography, Computed Tomography/CT-Angiography which display anatomic imaging (i.e. the visible narrowing of a vessel) and/or flow phenomena (signs of the movement of the bodily fluid through the bodily structure

 

 Causes

 Types

The resulting syndrome depends on the structure affected.

Examples of vascular stenotic lesions include:

Stenoses/strictures of other bodily structures/organs include:

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Spinal Stenosis

Spinal stenosis is any narrowing of the spinal canal that causes compression of the spinal nerve cord. Spinal stenosis causes pain and may cause loss of some body functions.

Description

Spinal stenosis is a progressive narrowing of the opening in the spinal canal. The spine is a long series of bones called vertebrae. Between each pair of vertebra is a fibrous intervertebral disk. Collectively, the vertebrae and disks are called the backbone. Each vertebra has a hole through it. These holes line up to form the spinal canal. A large bundle of nerves called the spinal cord runs through the spinal canal. This bundle of 31 nerves carries messages between the brain and the various parts of the body. At each vertebra, some smaller nerves branch out from these nerve roots to serve the muscles and tissue in the immediate area. When the spinal canal narrows, nerve roots in the spinal cord are squeezed. Pressure on the nerve roots causes chronic pain and loss of control over some functions because communication with the brain is interrupted. The lower back and legs are most affected by spinal stenosis. The nerve roots that supply the legs are near the bottom of the spinal cord. The pain gets worse after standing for a long time and after some forms of exercise. The posture required by these physical activities increases the stress on the nerve roots. Spinal stenosis usually affects people over 50 years of age. Women have the condition more frequently than men do.

Cervical spinal stenosis is a narrowing of the vertebrae of the neck (cervical vertebrae). The disease and its effects are similar to stenosis in the lower spine. A narrower opening in the cervical vertebrae can also put pressure on arteries entering the spinal column, cutting off the blood supply to the remainder of the spinal cord.

Causes and symptoms

Spinal stenosis causes pain in the buttocks, thigh, and calf and increasing weakness in the legs. The patient may also have difficulty controlling bladder and bowel functions. The pain of spinal stenosis seems more severe when the patient walks downhill. Spinal stenosis can be congenital, acquired, or a combination. Congenital spinal stenosis is a birth defect. Acquired spinal stenosis develops after birth. It is usually a consequence of tissue destruction (degeneration) caused by an infectious disease or a disease in which the immune system attacks the body's own cells (autoimmune disease). The two most common causes of spinal stenosis are birth defect and progressive degeneration of the tissue of the joints (osteoarthritis). Other causes include improper alignment of the vertebrae as in spondylolisthesis, destruction of bone tissue as in Paget's disease, or an overgrowth of bone tissue as in diffuse idiopathic skeletal hyperostosis. The spinal canal is usually more than0.5 in (12 mm) in diameter. A smaller diameter indicates stenosis. The diameter of the cervical spine ranges is 0.6–1 in (5–12 mm). Any opening under 0.5 in (13 mm) in diameter is considered evidence of stenosis. Acquired spinal stenosis usually begins with degeneration of the intervertebral disks or the surfaces of the vertebrae or both. In trying to heal this degeneration, the body builds up the spinal column. In the process, the spinal canal can become narrower.

Diagnosis

The physician must determine that the symptoms are caused by spinal stenosis. Conditions that can cause similar symptoms include a slipped (herniated) intervertebral disk, spinal tumors, and disorders of the blood flow (circulatory disorders). Spinal stenosis causes back and leg pain. The leg pain is usually worse when the patient is standing or walking. Some forms of spinal stenosis are less painful when the patient is riding an exercise bike because the forward tilt of the body changes the pressure in the spinal column. Doppler scanning can trace the flow of blood to determine whether the pain is caused by circulatory problems. X-ray images, computed tomography scans (CT scans), and magnetic resonance imaging (MRI) scans can reveal any narrowing of the spinal canal. Electromyography, nerve conduction velocity, or evoked potential studies can locate problems in the muscles indicating areas of spinal cord compression.

Treatment

Mild cases of spinal stenosis may be treated with rest, nonsteroidal anti-inflammatory drugs (such as aspirin), and muscle relaxants. Spinal stenosis can be a progressive disease, however, and the source of pressure may have to be surgically removed (surgical decompression if the patient is losing control over bladder and bowel functions. The surgical procedure removes bone and other tissues that have entered the spinal canal or put pressure on the spinal cord. Two vertebrae may be fused, to eliminate improper alignment, such as that caused by spondylolisthesis. For surgery, patients lie on their sides or in a modified kneeling position. This position reduces bleeding and places the spine in proper alignment. Alignment is especially important if vertebrae are to be fused. Surgical decompression can eliminate leg pain and restore control of the legs, bladder, and bowels, but usually does not eliminate lower back pain. Physical therapy and massage can help reduce the symptoms of spinal stenosis. An exercise program should be developed to increase flexibility and mobility. A brace or corset may be worn to improve posture. Activities that place stress on the lower back muscles should be avoided.

Prognosis

Surgical decompression does not stop the degenerative processes that cause spinal stenosis, and the condition can develop again. Nevertheless, most patients achieve good results with surgical decompression. The patient will probably continue to have lower back pain after the surgical procedure.

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 Common Spinal Disorders
Stewart G. Eidelson, M.D.
SpineUniverse Founder, Orthopaedic Surgeon
Asst. Professor - Univ. of Miami at FAU
Orthopaedic Surgery Associates
Boca Raton, FL, USA
 
 
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There are many types of back and neck disorders that affect the majority of the population in the United States. Injury, aging, general health, and lifestyle may influence the development of some conditions. Most spinal disorders are known to result from soft tissue injury, structural injury, and degenerative, or congenital conditions.

Degenerative and Congenital Disorders
Degenerative disorders may develop as a result of the normal aging process and wear and tear. Just like a mechanical device the human body is subject to wear and tear from use. However, unlike machinery, the human body has the ability to heal or attempt to repair itself.

At birth the structural integrity of the spine, heart, lungs, and other organ systems is at its peak for future development. During mid-life early microscopic changes begin to appear that indicate the spine is aging. The spine does not deteriorate just because of age. Wear and tear is also responsible. Disorders such as arthritis (arth-rye-tis), spinal stenosis (spinal sten-oh-sis), and osteoporosis (os-t-o-pour-o-sis) do not develop overnight. Degenerative diseases may take years to develop and may be associated with past injury, abuse, body structure, or congenital problems.

Arthritis affects approximately 80% of people over the age of 55 in the United States. Injury, a weakened immune system, and/or hereditary factors can trigger the onset of arthritis. There are hundreds of types of arthritis that share similar symptoms including inflammation, joint pain, and progressive deterioration of joint surfaces over time. The joints may lose normal contour, excessive amounts of fluid may build up inside the joint along with pieces of floating debris. Arthritis may affect the joints in the spine, which enable the body to bend and twist. Part of the problem may be the body's response to arthritis, which is to manufacture extra bone to stop joint movement. The extra bone is called a bone spur or bony overgrowth.

Degenerative Disorders

Spinal Stenosis, Vertebrae Degeneration Analgesic, Anesthesia, Cardiac, CAT,  CT Scan, Computerized Axial Tomography, Cauda equina syndrome, Corticosteroid, Degenerative, Dehiscence, Efficacy, Endoscopic, Epidural, Extension, Facet, Facetectomy, Flexion, Fluoroscope, Foramen, Foraminotomy,Fusion,Gastrointestinal, Hematoma, Hemorrhage, Herniated,Hypertrophic, Ligament, Interspinous Process Decompression (IPD), Intervertebral Disc, Lamina, Laminectomy, Laminotomy, Ligaments, Ligamentum Flavum,Lordosis, Lumbar, Lumbar Spinal Stenosis, MRI (Magnetic Resonance Imaging), Myelogram, NAIDs, Nerves, Nerve root, Neurologic, Osteophyte, Pedicle, Respiratory, Sciatica, Canal, Cord, Spinous Process, Supraspinous Ligament,Spondylolisthesis, Transfusion, Unsinate, Vascular, Vertebra,X-ray, X-Stop

In medical terms, the extra bone is called an osteophyte (os-t-o-fight). Osteophytes may be found in areas affected by arthritis such as the disc or joint spaces where cartilage has deteriorated. The body's production of osteophytes is a futile attempt to stop the motion of the arthritic joint and deal with the degenerative process. It never completely works. The evidence of bony deposits can be found on an x-ray. A bone spur may cause nerve impingement at the neuroforamen (nu-row for-a-men). The neuroforamen are passageways through which the nerve roots exit the spinal canal. Sensory symptoms include pain, numbness, burning and pins and needles in the extremities below the affected spinal nerve root. Motor symptoms include muscle spasm, cramping, weakness, or loss of muscular control in a part of the body.

Osteoarthritis (OA) (os-t-o-arth-rye-tis) is the degenerative form of arthritis. It is a progressive joint disease associated with aging. Many elderly people have some degree of osteoarthritis. It may be found in the knees, hips, or other joints. Spinal osteoarthritis affects the facet joints that enable the body to bend and twist. As the facet joints deteriorate, cartilage may become inflamed and start to fray like a well-used rag. During this process cartilage (car-til-ledge) breaks away from the joint surfaces. Cartilage fragments may begin to float in the fluid that lubricates the joint. Joints stripped of their cartilage are no longer smooth slick surfaces that enable friction-free movement. Joint bones begin to rub together while trying to work. The nerve structures in the joint become irritated and cause inflammation and pain. Osteoarthritis may trigger the formation of osteophytes. As previously mentioned, these bony spurs are the body's way of dealing with the disease. In the spine, osteophytes may cause disc space to narrow. When this happens the affected intervertebral disc may collapse.

Rheumatoid Arthritis (RA) (room-ah-toyed arth-rye-tis) is a progressive form of arthritis that can be painfully destructive. RA may cause the interior joint tissues to swell and thicken. Over time the affected joint disintegrates leading to deformity. RA may appear during early middle age and is more common in women than men. The symptoms include fatigue, weakness, and loss of appetite, fever, and anemia. Upon rising joints are usually stiff, swollen, and tender. Medication is available to help relieve pain and inflammation. Regular exercise helps joints to function. Passive forms of physical therapy may help to increase joint mobility.

Ankylosing Spondylitis (an-key-low-sing spon-dee-lie-tis) is a chronic and progressive inflammatory disease of the spine. It is characterized by early sacroiliac joint (say-kro-ill-e-ak, sacrum) involvement followed by hardening of the anulus fibrosus and surrounding connective tissue along with arthritic changes in the facet joints. The disease may cause the spine to gradually lose flexibility and stiffen. The disease is hereditary.

Spinal Stenosis (spinal sten-oh-sis) Translated from the Greek language, stenosis means a narrowing of a normally larger opening, the spinal canal or neuroforamen (nu-row for-a-men, window) through which nerves exit the spinal column. This disorder is associated with aging. Some people are predisposed to spinal stenosis genetically or it may be caused by a congenital condition. If the neuroforamen are partially or completely closed, the spinal nerves become compressed or trapped. The symptoms of spinal stenosis include numbness, weakness, and sensations of burning, tingling, and pins and needles in the affected extremity such as the leg.

Spinal stenosis could be compared to wearing a pair of shoes that are a half size too small. The feet (nerves) react to the pressure by swelling (inflammation) that makes the shoes even tighter. The pain (nerve compression) can make walking difficult or impossible. Patients with spinal stenosis have found the pain eases when bending forward or sitting. Bending forward creates more space between the vertebrae that may temporarily relieve nerve compression.

Spinal stenosis may affect any part of the spine but is more prevalent in the lumbar spine. Lumbar spinal stenosis produces pain that may be felt in the buttocks, thighs, and calves when walking or standing. Cervical spinal stenosis affects the upper extremities and back. When severe, cervical spinal stenosis may affect the body from the neck down.

A CT Scan or MRI is performed to confirm that the patient's symptoms are caused by spinal stenosis. When necessary a surgical procedure called a foraminotomy (for-am-not-toe-me) is performed to enlarge the size of the window to help relieve nerve compression.

Foraminal Stenosis (foe-ray-min-al sten-oh-sis) is similar to spinal stenosis but is singled out because it primarily affects one or more vertebral foramen. In a normal spine nerve roots have enough room to slip through the foramen. However, age and disease may affect the foramen by clogging the openings with debris that trap and compress nerves. The symptoms of foraminal stenosis include numbness, weakness, and sensations of burning, tingling, and pins and needles in the affected extremity (e.g. leg). Not every stenosis is critical but if ignored, nerves may die that may cause a loss of function. Functional loss may involve the ability to feel (sensory) and move (motor). If nonsurgical treatments are unsuccessful in relieving the patient's symptoms, surgery may become an option. The procedure is called a foraminotomy.

Degenerative Disc Disease (DDD) affects the vertebral discs. During spinal flexion and extension, the discs absorb and distribute pressure and excessive stress created by movement. It is natural for some disc wear and tear to occur with age and movement.

When the spine is x-rayed the disc spaces between the vertebrae may appear narrow indicating DDD. Loss of disc hydration is one of many biochemical changes that occurs with age and may cause discs to thin, shrink, or collapse. A similar chemical change occurs as a tire ages. As the tire loses its resilience its original form is compromised. The disc may shrink in size, wrinkle, or crack. Pieces of the disc may break away (fragments) and cause nerve irritation. Thin, collapsed, or broken discs reduce the size of the neuroforamen formed between the upper and lower vertebral discs. As the neuroforamen is reduced in size, compressed nerves begin to swell and signal pain. T

The neuroforamen could be compared to brakes on a car. In this scenario the vertebral discs are the brake pads that form a cushion between the foot pedal (top vertebral body) and the wheel (bottom vertebral body). Age, abuse, and wear and tear cause the brake pads to thin or even disintegrate. What happens? The brakes squeal (pain) and may not stop the car. The driver of the car feels the affects of the faulty brakes. A normal amount of wear and tear is expected and acceptable. The same is true of the spine. With proper nutrition, regular exercise, and prevention the body can be in good shape at any age.

Osteoporosis (os-t-o-pour-o-sis) is known as the silent degenerative disease. It is labeled silent because in the early stage of the disease the patient may be free of symptoms. However, as the disease progresses, bones gradually begin to resemble a well-used sponge, thin and porous. Bone mass and density (strength) is lost.

Osteoporosis

”osteoporosis” Spinal Stenosis, Vertebrae Degeneration Analgesic, Anesthesia, Cardiac, CAT,  CT Scan, Computerized Axial Tomography, Cauda equina syndrome, Corticosteroid, Degenerative, Dehiscence, Efficacy, Endoscopic, Epidural, Extension, Facet, Facetectomy, Flexion, Fluoroscope, Foramen, Foraminotomy,Fusion,Gastrointestinal, Hematoma, Hemorrhage, Herniated,Hypertrophic, Ligament, Interspinous Process Decompression (IPD), Intervertebral Disc, Lamina, Laminectomy, Laminotomy, Ligaments, Ligamentum Flavum,Lordosis, Lumbar, Lumbar Spinal Stenosis, MRI (Magnetic Resonance Imaging), Myelogram, NAIDs, Nerves, Nerve root, Neurologic, Osteophyte, Pedicle, Respiratory, Sciatica, Canal, Cord, Spinous Process, Supraspinous Ligament,Spondylolisthesis, Transfusion, Unsinate, Vascular, Vertebra,X-ray, X-Stop

Although spinal osteoporosis is more common, osteoporosis can affect any bone in the body. It makes bones susceptible to fracture. It could be said that osteoporosis begins when the body makes more calcium withdrawals than deposits resulting in bankrupt bones. The symptoms of spinal osteoporosis include chronic pain, loss of mobility, and an alternation in appearance. Patients may look frail, bent over and shorter. Chronic pain may result from spinal muscles forced to handle the spine's load. Daily chores like making the bed, removing food from the oven, or even embracing a loved one can cause vertebrae (ver-ta-bray) to break.

Deformities may develop as the bones in the spine become more porous and weaker. Bone breakdown may eventually lead to compression and crush fractures as well as a hump back (excessive kyphosis). Loss of bone strength may cause spontaneous fracture. The patient's body weight alone may cause vertebrae to collapse leading to compressed nerves. As vertebrae collapse the patient loses height. Internal organs may be forced out of their normal position. Osteoporosis can be an insidious disease eventually causing health to deteriorate.

Osteoporosis is a normal part of aging for women and men. It is important to know the risk factors and reduce them. Smoking, alcoholism, heavy use of laxatives, stress, diabetes, menopause, inactivity, and unhealthy dieting are factors known to accelerate the progression of the disease. Women who smoke produce lower levels of estrogen. Plus smoking interferes with calcium absorption necessary for strong healthy bones. Alcoholics, women or men, usually have less bone mass because calcium absorption is hindered. Stress can be an undermining factor because it may stimulate adrenal hormone production that could cause calcium to be passed during urination.

Women are prone to osteoporosis because their bones are smaller and contain less mass than a man's bones. Additionally, during menopause estrogen levels are affected. Estrogen helps to maintain sufficient calcium in the skeletal system. Further, women usually live longer than men therefore, women have more time to develop osteoporosis. A Bone Mineral Density (BMD) test is a simple, painless, and quick noninvasive test for osteoporosis. This test measures the density of bone.

If signs of osteoporosis are found the physician may prescribe medication to help control the disease. Since it can take years for bone to gain strength, treatment may be started when the patient is in their 60s. The medication is available in several forms; pill, nasal spray, or transdermal patch. In some cases the medication helps to prevent spontaneous fractures or a broken hip or rib from a minor fall.

Regular exercise is especially important at any age for many reasons. Physical activity stimulates bone to become denser, increases circulation that nourishes bone, and helps to maintain healthy hormone levels. Weight bearing and resistance exercises such as walking build strong bones. Before starting any exercise program, see your physician.

Spinal Tumors are rare. The physician is interested in determining the cause of the tumor, if there is a past history of cancer, and relieving associated pain. If the patient's primary condition is breast or lung cancer it is possible for the cancer to metastasize (spread) to the spine. Tumors can occur in anyone without a history of disease. Fortunately not all spinal tumors are malignant (cancerous).

Johns Hopkins Health Alert

Are You a Good Candidate for Spinal Fusion?

Though increasingly used for the treatment of herniated disks and spinal stenosis, spinal-fusion surgery benefits only a small subset of patients.

The use of spinal-fusion surgery has increased drastically in recent years, from 150,000 procedures in 1993 to 300,000 in 2001. Although many long established uses exist for spinal fusion -- for the treatment of severe scoliosis, spinal tuberculosis, and vertebral fractures -- doctors are increasingly using spinal fusion to treat back pain resulting from degenerative changes in the spine, disk disorders such as herniated disks, and spinal stenosis. However, there is no convincing evidence that spinal fusion works for most patients with back pain from these conditions.

Why, despite little evidence to support it, do doctors consistently recommend spinal fusion surgery to their patients? The answer may lie in part with what some have called a “triumph of technology over reason.” Because the technology of spinal fusion has advanced enough that the surgery can be done relatively safely, surgeons may be quicker to suggest spinal fusion than they were in the past, even if the patient is not an excellent candidate for the procedure. The attitude may be that “it can’t hurt to try.”

There is some evidence, however, that spinal fusion may help a very select group of patients. According to a 2001 study published in Spine of 294 patients with chronic low back pain, back pain was reduced by 33% in patients randomized to receive spinal fusion compared with 7% in those undergoing physical therapy. However, to achieve success, the authors of this study point out that patients must be carefully selected for spinal fusion surgery and well informed about its potential outcomes.

If your doctor recommends spinal fusion for treatment of degenerative changes, a herniated disk, or spinal stenosis, how do you know if you’re actually a good candidate? First, you should have severe disability from your back pain -- for example, being unable to perform activities of daily living (such as dressing or bathing yourself) or to do your job. Second, you already should have tried conservative care -- such as self-treatment, pain relievers, and exercise -- at least for six months without success. Third, the back problem should be localized, that is, confined to a small area (one to two levels) of the spine, with no associated deformity.

The Bottom Line -- Although studies have not clearly shown that spinal fusion is effective for spinal degenerative changes, herniated disks, or spinal stenosis, some people with these conditions report pain relief from spinal fusion. Deciding who will benefit most from spinal fusion surgery requires a careful analysis of the patient’s particular situation -- both physical and psychological. To reduce your odds of undergoing a surgical procedure that will provide no benefit, get a second opinion before yielding to the knife. Also, many doctors now increasingly consider disk replacement as an alternative to spinal fusion.

Spinal stenosis

Provided by: MayoClinic.com

Last Updated: 03/10/2006

Introduction

Spinal stenosis is a narrowing of one or more areas in your spine — most often in your upper or lower back. This narrowing can put pressure on the spinal cord or on the nerves that branch out from the compressed areas. This can lead to a number of problems, depending on which nerves are affected. In general, spinal stenosis can cause cramping, pain or numbness in your legs, back, neck, shoulders or arms; a loss of sensation in your extremities; and sometimes problems with bladder or bowel function.

Mild symptoms of spinal stenosis are often helped by pain relievers, physical therapy or a supportive brace. In more serious cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves. Although this usually provides some relief, it can't repair damaged nerves or stop the degenerative processes that often lead to spinal stenosis. Unfortunately, even after surgery, symptoms of spinal stenosis may recur or worsen over time.

Signs and symptoms

Spinal narrowing doesn't always cause problems. But if the narrowed areas compress the spinal cord or spinal nerves, you're likely to develop signs and symptoms. These often start gradually and grow worse over time. The most common include:

  • Pain or cramping in the legs. Compressed nerves in your lower spine can lead to a condition called pseudoclaudication, false claudication or neurogenic intermittent claudication, which causes 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, but it continues if you stand upright.

    Another type of intermittent claudication (vascular claudication) occurs when there's a narrowing or blockage in the arteries in the legs.

    Although both types of claudication cause similar symptoms, they differ in two important ways: Vascular claudication becomes worse when you walk uphill and improves when you stand still. Pseudoclaudication is usually worse when going downhill and gets better when you lean forward or sit down.

  • Radiating back and hip pain. A herniated disk can compress nerves in your lumbar spine, leading to pain that starts in your hip or buttocks and extends down the back of your leg. The pain is worse when you're sitting and generally affects only one side.

    You also may experience numbness, weakness or tingling in your leg or foot. For some people, the radiating pain is a minor annoyance, but for others, it can be debilitating.

  • Pain in the neck and shoulders. This is likely to occur when the nerves in your neck are compressed. The pain may occur only occasionally or it may be chronic, and it sometimes can extend into your arm or hand. You also may experience headaches, a loss of sensation or muscle weakness.
  • Loss of balance. Pressure on the cervical spinal cord can affect the nerves that control your balance, resulting in clumsiness or a tendency to fall.
  • Loss of bowel or bladder function (cauda equina syndrome). In severe cases, nerves to the bladder or bowel may be affected, leading to partial or complete urinary or fecal incontinence. If you experience either of these problems, seek medical care right away.

Causes

Knowing more about the anatomy of your spine makes it easier to understand how spinal stenosis develops and how it can lead to various problems. The main parts of the spine include:

  • Vertebrae. Your spine is made up of 24 bones stacked on top of one another, plus the sacrum and tailbone (coccyx). Most adults have seven vertebrae in the neck (cervical vertebrae), 12 at the back wall of the chest (thoracic vertebrae) and five vertebrae at the inward curve of the lower back (lumbar vertebrae). The sacrum consists of five fused vertebrae between the hip bones. The tailbone is composed of three to five fused bones at the very end of the spine.
  • Ligaments. These tough, elastic bands of tissue help keep the vertebrae in place when you move.
  • Intervertebral disks. These elastic pads of cartilage separate the vertebrae. They keep your spine flexible and act as shock absorbers to cushion the vertebrae when you move. Each disk consists of a ring of tough fibrous tissue (annulus fibrosis) surrounding a jelly-like center (nucleus pulposus).
  • Facet joints. Located on the sides, top and bottom of each vertebra, these joints connect the vertebrae to one another and stabilize the spine while still allowing flexibility. The joints are coated with a lubricant so that they slide smoothly.
  • Spinal cord. This long bundle of nerves extends from the brain stem at the base of your skull to the second lumbar vertebra in your lower back. When the spinal cord ends, another group of nerves (cauda equina) continues down the spinal canal.

    The nerves within the spinal cord (upper motor neurons) carry messages between your brain and the nerves that go to all the parts of your body below your head. Two spinal nerves — one leading to the right side of your body and one to the left side — extend out from the spinal cord between each vertebra. The nerves exit through openings on either side of the vertebrae (intervertebral foramina).

    In all, there are 31 pairs of spinal nerves in your neck and back. Some transmit information from your body to your brain, and others send messages from your brain to your muscles, skin and other organs.

  • Spinal canal. The spinal cord passed through this channel in your spine. Normally, the spinal canal is spacious enough to accommodate the spinal cord, but degenerative changes in the spine can narrow the channel.

How spinal stenosis develops
Doctors categorize stenosis as either primary or acquired. Primary stenosis, which is relatively uncommon, is present at birth. But most people have acquired spinal stenosis, which develops later in life, usually as a result of degenerative changes in the spine that occur with aging.

The main cause of spinal degeneration is osteoarthritis, an arthritic condition that affects the cartilage that cushions the ends of bones in your joints. With time, the cartilage begins to deteriorate and its smooth surface becomes rough. If it wears down completely, bone may rub painfully on bone. In an attempt to repair the damage, your body may produce bony growths called bone spurs. When these form on the facet joints in the spine, they narrow the spinal canal.

Other factors that can cause a narrowing of the spinal canal include:

  • Herniated disk. By the time you're 30, your disks may start to show signs of deterioration. They begin to lose their water content, becoming flatter and more brittle. Eventually, the tough, fibrous outer covering of the disk may develop tiny tears, causing the jelly-like substance in the disk's center to seep out (herniation or rupture). The herniated disk presses on the surrounding nerves, causing pain in your back, leg or both. Sometimes you may also have numbness, tingling or weakness in the buttock, leg or foot on the affected side.
  • Ligament changes. Ligaments in your back can undergo degenerative changes, becoming stiff and thick over time. This loss of elasticity may shorten the spine, narrowing the spinal canal and compressing the nerve roots.

    Sometimes wear and tear on the disks and ligaments cause one lumbar vertebra to slip over another — a condition called spondylolisthesis. This often compresses the spinal nerves, leading to numbness, tingling and weakness in your legs, especially when you stand for long periods or when you walk.

  • Spinal tumors. In the spine, abnormal growths can form inside the spinal cord, within the membranes (meninges) that cover the spinal cord, or in the space between the spinal cord and the vertebrae — the most common site.

    Tumors may also spread (metastasize) to the spine or the spinal cord from other parts of the body. Primary or metastastic tumors can occur anywhere along the spine, including the sacrum and thoracic spine, where osteoarthritis is rare.

    Growing tumors may compress the spinal cord and nerve roots. This can cause severe back pain that may extend to your hips, legs or feet; muscle weakness and a loss of sensation — especially in your legs; difficulty walking or even paralysis; and sometimes loss of bladder or bowel function.

  • Injury. Car accidents and other trauma can profoundly affect the spine and spinal cord. Sometimes the spine or spinal canal may be dislocated, putting pressure on the cord and lower motor neurons. In other cases, fragments of bone from a spinal fracture may penetrate the spinal canal. Swelling of tissue after back surgery can also put pressure on the spinal cord or nerves.
  • Paget's disease of bone. Bone is living tissue engaged in a continuous process of renewal. During this remodeling process, old bone is removed and replaced by new bone. In Paget's disease, your body generates new bone at a faster-than-normal rate. This produces soft, weak bones that are prone to fractures. It can also create bones that are deformed or abnormally large.

    When unusually large bones develop in the spine, they compress the spinal cord or the nerves exiting your brain and spinal cord. The resulting pain is often severe and may radiate from your lower back into your legs. You also may experience numbness, tingling or weakness in the legs or, in some cases, double vision.

  • Achondroplasia. This genetic disorder slows the rate at which bone forms during fetal development and in early childhood. As a result, people with achondroplasia are of short stature — often no more than four feet tall when fully grown. They often have small hands and fingers and unusually short upper arms and thighs. They also have a narrow spinal canal, which puts pressure on the spinal cord.

    This can cause severe back and leg pain and may even lead to paralysis of the legs. In some cases, babies or children with achondroplasia die suddenly — often in their sleep — when compression of the upper end of the spinal cord interferes with their breathing.

Spinal Stenosis, Vertebrae Degeneration Analgesic, Anesthesia, Cardiac, CAT,  CT Scan, Computerized Axial Tomography, Cauda equina syndrome, Corticosteroid, Degenerative, Dehiscence, Efficacy, Endoscopic, Epidural, Extension, Facet, Facetectomy, Flexion, Fluoroscope, Foramen, Foraminotomy,Fusion,Gastrointestinal, Hematoma, Hemorrhage, Herniated,Hypertrophic, Ligament, Interspinous Process Decompression (IPD), Intervertebral Disc, Lamina, Laminectomy, Laminotomy, Ligaments, Ligamentum Flavum,Lordosis, Lumbar, Lumbar Spinal Stenosis, MRI (Magnetic Resonance Imaging), Myelogram, NAIDs, Nerves, Nerve root, Neurologic, Osteophyte, Pedicle, Respiratory, Sciatica, Canal, Cord, Spinous Process, Supraspinous Ligament,Spondylolisthesis, Transfusion, Unsinate, Vascular, Vertebra,X-ray, X-Stop

Between each vertebra is an elastic pad of cartilage called an intervertebral disk. The disks consist of a tough, fibrous outer covering (annulus fibrosus) and a jelly-like center (nucleus pulposus).

Spinal Stenosis, Vertebrae Degeneration Analgesic, Anesthesia, Cardiac, CAT,  CT Scan, Computerized Axial Tomography, Cauda equina syndrome, Corticosteroid, Degenerative, Dehiscence, Efficacy, Endoscopic, Epidural, Extension, Facet, Facetectomy, Flexion, Fluoroscope, Foramen, Foraminotomy,Fusion,Gastrointestinal, Hematoma, Hemorrhage, Herniated,Hypertrophic, Ligament, Interspinous Process Decompression (IPD), Intervertebral Disc, Lamina, Laminectomy, Laminotomy, Ligaments, Ligamentum Flavum,Lordosis, Lumbar, Lumbar Spinal Stenosis, MRI (Magnetic Resonance Imaging), Myelogram, NAIDs, Nerves, Nerve root, Neurologic, Osteophyte, Pedicle, Respiratory, Sciatica, Canal, Cord, Spinous Process, Supraspinous Ligament,Spondylolisthesis, Transfusion, Unsinate, Vascular, Vertebra,X-ray, X-Stop

Your back is composed of 24 vertebrae plus your sacrum and tailbone (coccyx), 31 pairs of nerves, 40 muscles, and a number of connecting tendons and ligaments. Between your vertebrae are fibrous, elastic pads of cartilage called intervertebral disks. These shock absorbers keep your spine flexible and cushion the hard vertebrae when you move.

Spinal Stenosis, Vertebrae Degeneration Analgesic, Anesthesia, Cardiac, CAT,  CT Scan, Computerized Axial Tomography, Cauda equina syndrome, Corticosteroid, Degenerative, Dehiscence, Efficacy, Endoscopic, Epidural, Extension, Facet, Facetectomy, Flexion, Fluoroscope, Foramen, Foraminotomy,Fusion,Gastrointestinal, Hematoma, Hemorrhage, Herniated,Hypertrophic, Ligament, Interspinous Process Decompression (IPD), Intervertebral Disc, Lamina, Laminectomy, Laminotomy, Ligaments, Ligamentum Flavum,Lordosis, Lumbar, Lumbar Spinal Stenosis, MRI (Magnetic Resonance Imaging), Myelogram, NAIDs, Nerves, Nerve root, Neurologic, Osteophyte, Pedicle, Respiratory, Sciatica, Canal, Cord, Spinous Process, Supraspinous Ligament,Spondylolisthesis, Transfusion, Unsinate, Vascular, Vertebra,X-ray, X-Stop

Osteoarthritis that affects the spine can cause the disks to narrow, putting pressure on the spinal cord. Bone spurs that form on the facet joints may compress the nerve roots.

Risk factors

Age is the main known risk factor for spinal stenosis.

Also at risk are people with skeletal fluorosis, a sometimes crippling bone disease caused by high levels of fluoride in the body. Although the disease is rare in the United States, several million people worldwide have severe skeletal fluorosis.
When to seek medical advice

Many people ignore the symptoms of spinal stenosis, believing that the pain and stiffness they experience are a normal part of aging. But discomfort, especially if it interferes with your mobility, is never normal. Seek medical advice if you have pain, stiffness, numbness or weakness in your back, legs, neck or shoulders that's not related to exercise or overexertion.

Spinal stenosis is especially likely if you have leg pain that gets worse when you walk and improves when you sit or bend forward. Get immediate care if you suddenly have trouble controlling your bowels or bladder.

Screening and diagnosis

Spinal stenosis can be difficult to diagnose because its signs and symptoms are often intermittent and because they resemble those of many age-related conditions. To help diagnose spinal stenosis and rule out other disorders, your doctor will ask about your medical history and perform a physical exam that may include checking your peripheral pulses, range of motion, and leg reflexes.

You are also likely to have one or more of the following tests:

  • Spinal X-ray. Although an X-ray isn't likely to confirm that you have spinal stenosis, it can help rule out problems that cause similar symptoms, including a fracture, bone tumor or inherited defect.
  • Magnetic resonance imaging (MRI). In many cases, this is the imaging test of choice for diagnosing spinal stenosis. Instead of X-rays, an MRI uses a powerful magnet and radio waves to produce cross-sectional images of your back. The test can detect damage to your disks and ligaments, as well as the presence of tumors.
  • Computerized tomography (CT) scan. This test uses a narrow beam of radiation to produce detailed, cross-sectional images of your body, including the shape and size of your spinal canal. Because you receive more radiation from a CT scan than from a regular X-ray, you should avoid this test if you're pregnant.
  • CT myelogram. This may be the most sensitive test for detecting spinal stenosis, but because it poses more risks than either MRI or CT, it may not be your doctor's first choice. If you're contemplating surgery, however, your doctor may recommend a CT myelogram to assess the severity of the stenosis. In a myelogram, a contrast dye is injected in your spinal column. The dye then circulates around your spinal cord and spinal nerves. A myelogram can show herniated disks, bone spurs and tumors.
  • Bone scan. In this test, a small amount of a radioactive material that attaches to bone is injected into vein in your arm. The material emits waves of radiation that are detected by a gamma camera. The camera then produces images of your bones. In a sense, a bone scan is the opposite of a standard X-ray, in which radiation passes through your body to create an image on film. A bone scan can detect a number of bone disorders, but often can't distinguish among them. For that reason, it's usually performed with other tests.
  • Other diagnostic procedures. Sometimes your doctor may inject you with a spinal nerve block or epidural steroids. If your symptoms improve after the injection, spinal stenosis is likely the cause of your discomfort. The problem with this approach is that a negative finding doesn't mean you don't have spinal stenosis.

Complications

Depending on which nerves are compressed, spinal stenosis may cause a loss of feeling in your arms, hands, feet or legs. As a result, cuts or wounds may become seriously infected because you're not aware of them. In addition, spinal stenosis sometimes interferes with bowel or bladder function — a problem that can affect your quality of life.

Although treatment can relieve symptoms of spinal stenosis, it doesn't stop degenerative changes. Some of these changes, such as muscle atrophy, may be permanent, even after the pressure is relieved.

Treatment

Many people with spinal stenosis can be effectively treated with conservative measures. But if you have disabling pain or your ability to walk is severely impaired, your doctor may recommend spinal surgery. Acute loss of bowel or bladder function is usually considered a medical emergency and requires immediate surgical intervention.

Nonsurgical treatments
Before considering surgery, your doctor is likely to recommend trying one or more of the following for at least three months:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These include over-the-counter and prescription medications such as aspirin, ibuprofen (Advil, Motrin, others) or indomethacin (Indocin) to reduce inflammation and pain. Although they can provide real relief, NSAIDs have a "ceiling effect" — that is, there's a limit to how much pain they can control.

    If you have moderate to severe pain, exceeding the recommended dosage won't provide additional benefits. What's more, NSAIDS can cause serious side effects, including stomach ulcers that may bleed. If you take these medications, talk to your doctor so that you can be monitored for problems.

  • Analgesics. This group of pain relievers includes acetaminophen (Tylenol, others). Analgesics don't reduce inflammation, but they can effectively treat pain. Yet chronic overuse of acetaminophen can cause kidney and liver damage. Drinking alcohol increases your risk of serious side effects.
  • Nonproprietary drugs. Nonprescription supplements such as chondroitin sulfate and glucosamine, either alone or in combination, have shown positive effects on osteoarthritis. But it's not yet known whether they're effective at treating or preventing osteoarthritis of the spine. Talk to your doctor if you're interested in these supplements — they may interfere with other medications you're taking, especially warfarin (Coumadin).
  • Rest or restricted activity. Moderate rest followed by a gradual return to activity may improve symptoms. Walking is usually the best exercise, especially for people with neurogenic claudication, but biking is also recommended because it keeps your back in a flexed position rather than in an extended one.
  • Physical therapy. Working with a physical therapist can build up your strength and endurance and help maintain the flexibility and stability of your spine.
  • A back brace or corset. This helps provide support and may especially benefit people who have weak abdominal muscles or degeneration in more than one area of the spine.
  • Epidural steroid injections. In some cases, your doctor may inject a corticosteroid medication into the spinal fluid around your spinal cord and nerve roots.

    Corticosteroids suppress inflammation and can be especially helpful in treating pain that radiates down the back of your leg — in fact, a single dose may provide significant relief. But because corticosteroids can cause a number of serious side effects, the number of injections you can receive is limited, usually to no more than three in one year.

Surgery
The goal of surgery is two-fold: to relieve pressure on the spinal cord or nerves, and to maintain the integrity and strength of your spine. This can be accomplished in several ways, depending on the cause of the problem. The most common surgical procedures include:

  • Decompressive laminectomy. In this procedure, your surgeon removes all of the lamina — the back part of the bone over the spinal canal — to create more space for the nerves and to allow access to bone spurs or ruptured disks that may also be removed. A laminectomy is often performed through a single incision in your back (open surgery), although in some cases, your surgeon may use a laparoscopic technique. In that case, a tiny camera and surgical instruments are inserted through several small incisions, and your surgeon views the operation on a video monitor.

    Laparoscopic back surgery is complex and requires great skill and is not appropriate for many people with spinal stenosis. When done properly, however, you're likely to have less pain and to recover from surgery more quickly with this technique. Risks of laminectomy include infection, a tear in the membrane that covers the spinal cord at the site of the surgery, bleeding, a blood clot in a leg vein, decreased intestinal function (paralytic ileus) and neurological deterioration.

  • Laminotomy. In this procedure, just a portion of the lamina is removed to relieve pressure or to allow access to a disk or bone spur that's pressing on a nerve. The risks are the same as for laminectomy.
  • Fusion. This procedure may be performed on its own or at the same time as laminectomy. It's used to permanently connect (fuse) two or more vertebral bones in your spine and may be especially indicated when one vertebra slips over another. To fuse the spine, small pieces of extra bone are needed to fill the space between two vertebrae. This may come from a bone bank or from your own body, usually your pelvic bone. Wires, rods, screws, metal cages or plates also may be used, especially if your spine is unstable or the operation takes place to correct a deformity.

Back surgery can relieve pressure in your spine, but it's not a cure-all. You may have considerable pain immediately after the operation, and you might continue to have pain for a period of time. For some people, recovery can take weeks or months and may require long-term physical therapy. What's more, surgery won't stop the degenerative process, and symptoms may return — sometimes within just a few years.

Prevention

You can't always prevent age-related changes in your back, but the following steps can help keep your spine and joints as healthy as possible:

  • Exercise regularly. This helps maintain strength and flexibility in your spine, joints and ligaments. For the best results, combine aerobic activities such as walking and biking with weight training and stretching. Toning and stretching before exercise can help reduce wear and tear on your back. It also reduces your risk of injury by warming up your muscles and increasing your flexibility. Strength training can make your arms, legs and abdominal muscles stronger, which takes stress off your back.

    If you're not used to exercise, start out gradually and increase the duration and intensity of your workout as you become stronger. Aim for at least 30 minutes of moderate exercise on most days.

  • Use good body mechanics. Being conscious of how you sit, stand, lift heavy objects and even how you sleep can go a long way toward keeping your back healthy.

    To minimize stress when you sit, choose a seat that supports your lower back. If necessary, place a pillow or a rolled towel in the small of your back to maintain its normal curve.

    When you drive, adjust your seat to keep your knees and hips level, and move the seat forward to avoid overreaching for the pedals.

    Before you lift something heavy, decide where you'll place it and how you'll get there. Pushing is safer than pulling. Always bend your knees so that your arms are level with the object. Avoid lifting overhead.

    For the best sleep posture, choose a firm mattress. Use pillows for support, but don't use one that forces your neck up at a severe angle.

  • Maintain a healthy weight. Extra weight puts additional stress on your joints and bones.
 
 
 

Glossary of Terms Defined Below.

Analgesic, Anesthesia, Cardiac, CAT or CT Scan (Computerized Axial Tomography), Cauda equina syndrome, Corticosteroid, Degenerative, Dehiscence, Efficacy, Endoscopic, Epidural, Extension, Facet, Facetectomy, Flexion, Fluoroscope,Foramen, Foraminotomy,Fusion,Gastrointestinal, Hematoma, Hemorrhage, Herniated,Hypertrophic, Ligament,Interspinous Process Decompression (IPD), Intervertebral Disc,Lamina,Laminectomy, Laminotomy, Ligaments, Ligamentum Flavum,Lordosis,Lumbar, Lumbar Spinal Stenosis, MRI (Magnetic Resonance Imaging), Myelogram, NAIDs, Nerves, Nerve root, Neurologic, Osteophyte, Pedicle, Respiratory, Sciatica, Spinal Canal, Spinal Cord, Spinous Process, Supraspinous Ligament,Spondylolisthesis, Transfusion, Unsinate, Vascular, Vertebra,X-ray, X-Stop

Analgesic: A drug that alleviates pain without causing loss of consciousness.

Anesthesia: A drug that blocks pain impulses from nerves. With general anesthesia you are unconscious, or asleep. With local anesthesia you are conscious, or awake.

Cardiac: Near, of, or relating to the heart.

CAT or CT Scan (Computerized Axial Tomography): a test that uses X-rays and computer analysis to depict the three-dimensional pictures of the inside of your body.
Cauda equina syndrome: The cauda equina is a bundle of nerves at the bottom of the spinal cord. Cauda equina syndrome is severe compression of the cauda equina resulting in loss of bowel or bladder function, loss of sensation in the buttocks and groin, and weakness in the legs.
Corticosteroid: A medicine that reduces swelling, or inflammation.
Degenerative: Undergoing degeneration: growing less healthy over time.
Dehiscence: A rupture or splitting open, as of a surgical wound, or of an organ or structure to discharge its contents.
Efficacy: Ability to be effective, effectiveness.
Endoscopic: An instrument for examining visually the interior of a bodily canal or a hollow organ such as the colon, bladder, or stomach.
Epidural: Located on or over the dura mater.
Extension: Bending backward, standing upright.
Facet: Flat surfaces where two vertebrae meet and articulate (move) forming a joint.
Facetectomy: An operation to remove part of the facet. To prevent a degenerated facet from pinching a nerve.
Flexion: Bending forward, or sitting.
Fluoroscope: A device equipped with a screen on which the internal structures of an opaque object, such as the human body, may be continuously viewed as images created by the differential transmission of x-rays through the object.
Foramen: A natural opening or passage in bone for nerves and blood vessels.
Foraminotomy: An operation to make the foramen larger. To provide more space for the nerves and blood vessels.
Fusion: An operation to permanently join the vertebrae together.
Gastrointestinal:
Of or relating to the stomach and intestines
Hematoma: A localized swelling filled with blood resulting from a break in a blood vessel.
Hemorrhage: Excessive discharge of blood from the blood vessels; profuse bleeding.
Herniated: Of or relating to a bodily structure that has protruded through an abnormal opening in the wall that contains it.
Hypertrophic: A nontumorous enlarged organ or tissue as a result of an increase in the size rather than the number of constituent cells:Interspinous Ligament: Spinal ligament which extends from one spinous process to the other.
Interspinous Process Decompression (IPD): An operation in which an implant, called the IPD, is placed between your spinous processes.
Intervertebral Disc: Tissue found between the bones of the spinal column, called verterbrae. The discs help cushion the spine from stress during everyday activities (i.e., walking, bending, sitting, etc.)
Lamina: A part of a vertebra. For each vertebra, two lamina connect the pedicles to the spinous processes — forming the roof of the spinal canal.
Laminectomy: An operation to remove the lamina. The purpose is to allow more room for the spinal cord and nerves.
Laminotomy: An operation to remove part of the lamina. This is done to allow more room for the spinal cord and nerves.
Ligaments: A band of tissue linking two bones in a joint.
Ligamentum Flavum: Any of a series of ligaments of yellow elastic tissue connecting the laminae of adjacent vertebrae from the axis to the sacrum.
Lordosis: An abnormal forward curvature of the spine in the lumbar region.
Lumbar: The lower part of the spine between the ribs and hipbones.
Lumbar Spinal Stenosis: A degenerative spinal disease that causes narrowing of the spinal canal. This narrowing pinches the nerves and causes pain symptoms.
MRI (Magnetic Resonance Imaging): a test that uses a combination of radio waves and magnetic fields to create detailed pictures of the inside of your body.
Myelogram: A diagnostic procedure in which a dye is injected into the spinal canal before an X-ray is performed. The dye makes the spinal canal and nerve roots easier to see on X-ray film.
NAIDs: Non-steroidal anti-inflammatory drugs.
Nerves: Fibers containing nerve cells that send messages between the brain and the rest of the body.
Nerve root: The start of the nerve as it leaves the spinal cord (and passes through the foramen).
Neurologic: Of or relating to neurology.
Osteophyte: A bony outgrowth on the edge of a vertebra, also known as a bone spur.
Pedicle: A part of a vertebra. It connects the lamina with the vertebral body.
Respiratory: Of, relating to, used in, or affecting respiration.
Sciatica: Pain along the sciatic nerve usually caused by a herniated disk of the lumbar region of the spine and radiating to the buttocks and to the back of the thigh.
Spinal Canal: The bony channel that contains the spinal cord.
Spinal Cord: A bundle of nerves that carries messages between the brain and the rest of the body.
Spinous Process: A part of the vertebra. A spinous process protrudes from each vertebra. The spinous processes create the “bumps” you feel in the middle of your back.
Supraspinous Ligament: Spinal ligament that passes over and attaches to the tips of the spinous processes.
Spondylolisthesis: A condition in which one vertebra slips forward in relation to the vetebra below it.
Transfusion:The transfer of whole blood or blood products from one individual to another.
Unsinate: Bent at the end like a hook; unciform.
Vascular: Containing vessels that carry or circulate blood through the body.
Vertebra: A bone of the spinal column. There are five (5) lumbar vertebrae.
X-ray: A test that uses radiation to produce pictures of the inside of the body.
X-Stop : A titanium implant that fits between the spinous processes.

 
Misspelled words used to find this page 5 of 10.foamen, folameign, formen, foramiegn, foraen, folamiegn, foramn, foramin, folamin, folamen, franem, phranem, foranem, foramem, foramne, foraemn, formaen, foarmen, froamen, oframen, forame, oramen, fran1motomy, phran1motomy, foran1motomy, foranimotomy, foramimotomy, foraminotoym, foraminotmoy, foraminootmy, foramintoomy, foramiontomy, foramniotomy, foraimnotomy, formainotomy, foarminotomy, froaminotomy, oframinotomy, foraminotom, foraminotoy, foraminotmy, foraminoomy, foramintomy, foramiotomy, foramnotomy, forainotomy, forminotomy, foaminotomy, framinotomy, oraminotomy, foraminotomy, fusion, fusiom, fuchon, fuchun, fushun, fution, fuson, fusun, fs1on, phs1on, fus1on, fusino, fusoin, fuison, fsuion, ufsion, fusio, fusin, fuion, fsion, usion, gastrointesinal, gatrointestinal, gastrointestinal, gastrointestnal, gasrointestinal, gastrointestial, gastointestinal, gastrointestinl, gastrintestinal, gastrontestinal, gastroitestinal, gastroinestinal, gastrointstinal, gastrointetinal, gstrointestinal, gastroingestinal, gastrointestinar, gastroingestinar, gastlointestinal, gastloingestinal, gastlointestinar, gastloingestinar, gastro1ntest1na1, gastro1ntest1nal, gastroimtestinal, gastrointestinla, gastrointestianl, gastrointestnial, gastrointesitnal, gastrointetsinal, gastrointsetinal, gastroinetstinal, gastroitnestinal, gastronitestinal, gastriontestinal, gastorintestinal, gasrtointestinal, gatsrointestinal, gsatrointestinal, agstrointestinal, gastrointestina, astrointestinal,hematoma, hmatoma, heatoma, hemtoma, hemaoma, hematma, hematoa, henatoma, hematoam, hematmoa, hemaotma, hemtaoma, heamtoma, hmeatoma, ehmatoma, hematom, ematoma, hemorrhage, hemorrhae, hemorage, hmorrhage, heorrhage, hemrrhage, hemorrage, hemorrhge, hemorhage, hemolrhage, hemolhage, h3norhag3, h3morhag3, hemorrhaeg, hemorrhgae, hemorrahge, hemorhrage, hemrorhage, heomrrhage, hmeorrhage, ehmorrhage, herniaed, herniated, herniatd, hernaited, helniated, helnaited, hrniated, heniated, heriated, hernated, hernited, hern1ated, hermiated, herniatde, herniaetd, hernitaed, herinated, henriated, hreniated, ehrniated, herniate, erniated, hpertrophic, hipeltrophik, hipertrophec, hypertrophic, hiportrophic, hypertrophyk, hypeltlophik, hypurtrofik, hypertlofec, hypurtrophic, hypertrofec, hyertrophic, hipertlophik, hipurtrophec, hiportrofic, hypurtrophyk, hypertrophyc, hyportrophik, hypurtrofic, hypeltrofec, hyprtrophic, hipertrophyc, hiportrophec, hipeltrophic, hyportrophyk, hypurtrophyc, hyportrofik, hypurtlophic, hipertrofyc, hypetrophic, hipurtrophyc, hypertrophec, hipeltrophec, hipeltrofic, hypeltrophyk, hyportrophyc, hypeltrophik, hypurtlofic, hipertrofec, hyperrophic, hiportrophyc, hyportrophec, hipertlophec, hipertlophic, hypertlophyk, hypeltrophyc, hypeltrofik, hypurtrophec, hyportrofyc, hypertophic, hipeltrophyc, hypeltrophec, hipertrophik, hipertlofic, hipertrophic, hypertlophyc, hypertlophik, hypurtlophec, hyportrofec, hypertrphic, hipertlophyc, hypertlophec, hipertrofik, hipurtlophic, hipertrofic, hypurtlophyc, hypertlofik, hypertrophik, hypurtrofyc, hypertrohic, hipertrophyk,
Cervical Stenosis
The word stenosis refers to any passage in the body that is more narrow than it should typically be, for example a narrowed blood vessel (aortic stenosis for instance) or a narrowed spinal canal (spinal stenosis). Cervical stenosis means that the opening in the cervix (the endocervical canal) is more narrow than is typical. In some cases, the endocervical canal may be completely closed.

Symptoms

According to the Nezhat Medical Center,[1] "symptoms depend on whether the cervical canal is partially or completely obstructed and on the patient's menopausal status. Pre-menopausal patients will have a build up of blood inside the uterus which causes sporadic bleeding and pelvic pain. Patients also have an increased risk of infertility and endometriosis."

Impact

Cervical stenosis may impact natural fertility by impeding the passage of semen into the uterus. In the context infertility treatments, cervical stenosis may complicate or prevent the use of intrauterine insemination (IUI) or in vitro fertilization (IVF) procedures.[2]

Causes of cervical stenosis

Cervical stenosis may be present from birth or may be caused by other factors:

  • Trauma to the cervix[3]
  • Repeated vaginal infections[3]
  • Cervical cancer[1]

Treatment

Treatment of cervical stenosis involves opening or widening the cervical canal. The condition may improve on its own following the vaginal delivery of a baby.[4] Cervical canal widening can be termporarily achieved by the insertion of dilators into the cervix. If the stenosis is caused by scar tissue, a laser treatment can be used to vaporize the scarring.[5] Finally, the surgical enlargement of the cervical canal can be performed by hysteroscopic shaving of the cervical tissue.[6]

Misspelled words used to find this page 6 of 10. hyportlophec, hipurtrophik, hiportlophic, hipurtrophic, hyportlophyc, hypurtlophik, hypertrofik, hypurtrofec, hypertropic, hypertrofyc, hypeltlophec, hiportrophik, hipeltlophic, hipurtrofic, hypeltlophyc, hyportlophik, hypurtrophik, hypertlofyc, hypertrophc, hypeltrofyc, hyportlofic, hypeltlophic, hypertrofic, hypeltlofic, hyportrophic, hyportrofic, hypeltrophic, hypeltrofic, hypertlophic,ligamet, ligament, lgament, liament, ligment, ligaent, ligamnt, rigament, ligamant, rigamant, 11ganemt, l1ganemt, liganemt, ligamemt, ligametn, ligamnet, ligaemnt, ligmaent, liagment, lgiament, ilgament, ligamen, igament, 1ntersp1nous, interspinous, imterspinous, interspinosu, interspinuos, interspionus, interspnious, intersipnous, interpsinous, intesrpinous, intrespinous, inetrspinous, itnerspinous, niterspinous, interspinou, interspinos, interspinus, interspious, interspnous, intersinous, interpinous, intespinous, intrspinous, inerspinous, iterspinous, nterspinous, process, plocess, percess, porcess, proces, ploces, perces, porces, prcess, proess, procss, pocess, proc3s, procses, proecss, prcoess, rpocess, decomprssion, decompression, decompresson, decompressin, decompressiom, dcompression, decompresiom, deompression, decomplessiom, decmpression, decomplesiom, decopression, decomression, decompession, decompretion, decomplestion, decompresion, decompletion, decomplession, decomplesion, decompresshun, decompreshun, decomplesshun, decompleshun, decomprestion, d3conpr3s1om, d3compr3s1om, d3compr3s1on, decompres1on, decompressino, decompressoin, decompresison, decomprsesion, decomperssion, decomrpession, decopmression, decmopression, deocmpression, dceompression, edcompression, 1ntervertebra, intervertebra, imtervertebra, intervertebar, interverterba, intervertbera, interveretbra, intervetrebra, intervretebra, interevrtebra, intevrertebra, intrevertebra, inetrvertebra, itnervertebra, nitervertebra, intervertebr, interverteba, intervertera, intervertbra, interverebra, intervetebra, intervrtebra, interertebra, intevertebra, intrvertebra, inervertebra, itervertebra, ntervertebra,disc, disk, dysc, desc, d1sc, dics, dsic, idsc, amina, ramina, lamia, lamea, ramea, lamai, ramia, ramai, lamna, ramna, amiegna, ameigna, amina, 1an1ma, lan1ma, lanima, lamima, lamian, lamnia, laimna, lmaina, almina, lamin, laina, lmina, laminectmy, laminectomy, laminectoy, laminectomie, lminectomy, raminectomie, lainectomy, lamnectomy, lamiectomy, laminctomy, laminetomy, laminecomy, raminectomy, 1an1mectomy, lan1mectomy, lanimectomy, lamimectomy, laminectoym, laminectmoy, laminecotmy, laminetcomy, lamincetomy, lamienctomy, lamniectomy, laimnectomy, lmainectomy, alminectomy, laminectom, aminectomy, 1an1motomy, lan1motomy, lanimotomy, lamimotomy, laminotoym, laminotmoy, laminootmy, lamintoomy, lamiontomy, lamniotomy, laimnotomy, lmainotomy, alminotomy, laminotom, laminotoy, laminotmy, laminoomy, lamintomy, lamiotomy, lamnotomy, lainotomy, lminotomy, aminotomy, laminotomy, ligamet, ligament, lgament, liament, ligment, ligaent, ligamnt, rigament, ligamant, rigamant, rigaments, ligamants, rigamants, ligaments, ligamnts, ligamets, ligamens, lgaments, liaments, ligments, ligaents, 11ganemts, l1ganemts, liganemts, ligamemts, ligamenst, ligametns, ligamnets, ligaemnts, ligmaents, liagments, lgiaments, ilgaments, igaments, ligamenum, rigamentom, ligamentum, rigameignchum, ligamiegntem, ligamentm, ligamantom, ligamentem, ligamiegnchum, rigamiegntem, ligameigntum, rigamantom, rigamentum, rigamiegnchum, ligamiegntom, rigameigntum, lgamentum, rigamentem, rigamiegntom, ligameigntem, liamentum, ligamantum, ligamenchum, rigameigntem, ligmentum, ligamantem, rigamenchum, ligameigntom, ligaentum, rigamantum, ligamanchum, rigameigntom, ligamntum, rigamantem, rigamanchum, ligamiegntum, ligametum, ligamentom, ligameignchum, rigamiegntum, 11ganemtum, l1ganemtum, liganemtum, ligamemtum, ligamentmu, ligamenutm, ligametnum, ligamnetum, ligaemntum, ligmaentum, liagmentum, lgiamentum, ilgamentum, ligamentu, igamentum, flaum, fraum, flaom, fraom, flavum, fravum, flavom, fravom, favun, phavun, f1avun, flavun, flavmu, flauvm, flvaum, falvum, lfavum, flavu, flavm, flvum, favum, lavum, lordosis, lordosys, rordosis, rordosys, loldosis, loldosys, roldosis, roldosys, lordocys, lorredoecis, lodosis, lorredousee, loldousis, loldoesee, lorredosys, lorredosee, loldosee, lordoesys, rordocys, lorredoucis, lorosis, lorredousus, loldousee, loldoesus, rorredosys, lorredosus, roldosee, rordoesys, loldocys, lordoecys, lordsis, rorredousis, loldousus, roldoesis, lordoesis, rorredosis, lordocee, loldoesys, roldocys, rordoecys, lordois, lordoecis, roldousis, lordousis, lordoesee, rorredosee, rordocee, lordousys, lordosus, loldoecys, lordoss, rordoecis, lorredoesis, lordousee, lordoesus,

Spinal Stenosis

Spinal stenosis: Narrowing of the spaces in the spine, resulting in compression of the nerve roots or spinal cord by bony spurs or soft tissues, such as disks, in the spinal canal. This occurs most often in the lumbar spine (in the low back) but also occurs in the cervical spine (in the neck) and less often in the thoracic spine (in the upper back) ... Read more at Medterms or Wikipedia 
Spinal Stenosis & Back Pain

Lumbar Spinal Canal Stenosis
Lumbar Spinal Canal Stenosis: A Common Cause of Back and Leg Pain - describes the condition of narrowing in the space in the lower spine that carries nerves to your legs.
familydoctor.org


Pain Management: Spinal Stenosis
Pain Management: Spinal Stenosis ...in the low back (lumbar spine. In most cases, the narrowing of the spine associated with stenosis compresses the sciatica nerve, which
www.webmd.com

Spinal Stenosis - Information About Back Pain
Spinal stenosis is a common cause of back and leg pain. Spinal stenosis is a narrowing of the canal in which the spinal cord travels. Spinal stenosis can cause pinched
orthopedics.about.com
 
What You Should Know: Spinal Stenosis
Misspelled words used to find this page 7 of 10. rorredosus, loldocee, rordousys, rordosus, lordoucys, lordocis, loldoecis, lorredoesee, lordousus, rordoesis, lorredocis, lordocus, loldousys, loldosus, rordoucys, rordocis, lordoucis, lorredoesus, rordousis, rordoesee, rorredocis, rordocus, lorredoesys, roldosus, loldoucys, loldocis, rordoucis, rorredoesis, rordousee, rordoesus, lorredocys, loldocus, lorredousys, lordosee, lorredoecys, roldocis, loldoucis, lrdosis, lorredousis, rordousus, loldoesis, rorredocys, lorredosis, rordosee, lorredoucys, lumbar, lumber, lumbahr, lumbahl, rumbahr, rumbahl, rumbar, lumbal, rumbal, lumba, rumba, lumbah, rumbah, lumbra, lumbla, rumbra, rumbla, 1unbar, lunbar, lumabr, lubmar, lmubar, ulmbar, lumbr, lumar, lubar, lmbar, umbar, spinal, spiegnal, spiegnar, speignal, speignar, spynal, spinar, spynar, spyna, spina, speigna, spiegna, pinal, pinar, pynal, pynar, peignal, peignar, piegnal, piegnar, sp1na1, sp1nal, spimal, spinla, spianl, spnial, sipnal, psinal, spinl, spial, spnal, sinal. stenosis, stenosys, stenocys, stenosus, senosis, stnosis, steosis, stensis, stenois, stenoss, stenocis, stenosee, stenocee, stenocus, stenousee, stiegnoucis, stiegnosus, steignoucis, steignosus, stenousus, stiegnocys, stiegnoesis, steignocys, steignoesis, stenoecis, stiegnoecys, stiegnoesee, steignoecys, steignoesee, stenoucis, stiegnoucys, stiegnoesus, steignoucys, steignoesus, stenoecys, stiegnosys, stiegnousis, steignosys, steignousis, stenoucys, stenoesis, stiegnoesys, stiegnousee, steignoesys, steignousee, stenoesys, stenoesee, stiegnousys, stiegnousus, steignousys, steignousus, stenousys, stenoesus, stiegnocis, stiegnosis, steignocis, steignosis, stenousis, stiegnoecis, stiegnosee, steignoecis, steignosee, stenos1s, stemosis, stenossi, stenoiss, stensois, steonsis, stneosis, setnosis, tsenosis, stenosi, tenosis, mir, mil, mri, rmi, lmi, nr1, nri, magnetic, mgnetic, manetic, magetic, magntic, magneic, magnetc, magnetik, magnitik, magnitic, magnedic, magnedik, nagmet1c, nagmetic, magmetic, magnetci, magneitc, magnteic, magentic, mangetic, mganetic, amgnetic, magneti, agnetic, resonance, lesonenc, reonance, resnance, resoance, resonnce, resonace, resonane, resonanc, resonenc, lesonanc, rsonance, resonence, resonanse, resonense, lesonance, lesonence, lesonanse, lesonense, resomance, resonanec, resonacne, resonnace, resoannce, resnoance, reosnance, rseonance,

Sunday, January 09, 2005

Chiropractic injury, spinal stenosis, cauda equina syndrome

> I am looking for any information on Cauda Equina Syndrome and how it is conected with and or caused by chiropractic
> manipulation (rotational thrust). Any information would be greatly appreciated.
>
> THANK YOU -- JIM
>It's unlikely, though not impossible. The lower end of the spinal cord, the cauda equina (horse's tail), below L1-2, is rather forgiving towards herniated discs. Since the nerves are now individual (there no longer being a solid, massive spinal cord, as above L1), they can be pushed aside easier, rather than being compressed. But it can happen. If the herniation is large enough and central enough, the whole works can get compressed, resulting in serious problems that need to be tackled ASAP. A quick trip straight to the ER is imperative. Let a real doctor (MD!) examine you. A couple hours too long and some very important bodily functions can be gone or handicapped forever! Better safe than sorry.

If this sounds like I'm trying to scare you, well....., I'm just trying to make sure that no one thinks they can wait till the next day. Then it really can be too late.....:-((( But, as in many things medical, how soon surgical intervention is called for is controversial. Check out the links below.

Now I've gone and assumed that you are familiar with the symptoms. Here's a list:

"Cauda equina syndrome (CES) has been defined as low back pain, unilateral or usually bilateral sciatica, saddle sensory disturbances, bladder and bowel dysfunction, and variable lower extremity motor and sensory loss."

"Complications: Residual weakness, incontinence, impotence, and/or sensory abnormalities are potential problems if therapy is delayed."
http://www.emedicine.com/emerg/topic85.htm

A manipulation is contraindicated whenever there is the least suspicion of a possible herniated disc. This is the MD & PT viewpoint. Why chiropractors don't seem to respect this is a question you'll need to ask them. There is no proof that a manipulation can reduce a herniated disc, but there is plenty of risk for making it larger. So, while unlikely, it is certainly not impossible. The risk of it happening with chiropractors is in direct proportion to their generally strong tendency to use manipulation in every imaginable and unimaginable situation, regardless of what MDs & PTs might consider contraindications.

The Cauda Equina Syndrome is a form of spinal stenosis - Lumbosacral Stenosis. Whether the hole is too small, or the contents become too large, the result is the same.

Here's a case history from my own practice:
Spinal Stenosis after HVLA (High Velocity Low Amplitude thrust)

Immediately after getting a referral from his doctor, a young (23 yrs.) man ("Jack"), phoned my clinic a Friday noon in 1995 to make an appointment, ASAP. He had never been to a PT (or chiropractor) before. He was in pain, but I just couldn't squeeze him in and gave him a time on Monday afternoon. When "Jack" showed up on Monday, I could see in his face that something was terribly wrong. When he opened his mouth, I could have finished his sentence and said "You've been to a chiropractor, haven't you?". But I resisted the temptation. I'd experienced the situation enough times before.
He said: "I've done something wrong. You mustn't tell my doctor."
I reassured him that I had a duty to respect the confidentiality between therapist and patient. He seemed to relax a little, and told me his story.
That very morning, at work, he had pulled very hard and quickly on a handle that was stuck. He immediately felt a sharp pain and a snap/pop sound from an area between his right shoulder blade and spine (approximately in the T1-T3 area). The pain continued, so he left work and went directly to his GP, who examined him, gave him a prescription for a mild painkiller, and wrote a referral to a PT, whereafter Jack phoned me, and got the appointment for Monday.
He still had so much pain (still in the same area, no where else) Saturday morning, that his family and friends urged him to go to a chiropractor, who was on call during the weekend. (The local chiros take turns holding open during weekends.) He drove to the one that was open, about 12 miles away.

The chiro examined him, told him that his vertebra was "out of joint", and needed to be "put back in place". He was "adjusted" manually in the neck and the upper-/midthoracic vertebral region. Jack said that he immediately felt a far worse pain there where he already had pain, as well as in the midline of his back where he'd been adjusted upper-/midthoracic, plus he immediately began to feel tingling in both hands and both feet.
When he described these symptoms, I could feel the hair rise on my neck and head, and goosebumps forming!! This combination of symptoms is rare and a bad omen.

I examined him carefully to hopefully exclude my worst fears of a vertebral fracture. My examination being inconclusive in the absence of an x-ray (It's not even certain that an x-ray taken so soon would have revealed a hairline fracture, if there had been one. Therefore I would consider an HVLA, acute, as contraindicated.)

I did a neurologic exam. I'd never seen these symptoms in both over- and underextremities at the same time before. His sense of touch, on the palms of his hands and the soles of his feet, was reduced. He had a lot of palpatory soreness in his right rhomboids and right levator scapula, and was fixed in the area between his shoulderblades. A real case of muscle guarding. His neck was a little stiff as well. He complained about his gait: his sensation was disturbed enough that the floor felt "wrong" when he walked. But his balance was otherwise OK.

After getting his permission, I immediately phoned his doctor, explained his symptoms and recommended an x-ray, and if possible an MR scanning. The doctor didn't need to see him, but phoned the hospital immediately and ordered it for the next day. His doctor phoned me three days later, since he felt I deserved to hear the result as soon as possible.

The x-ray revealed no fracture, but the MR showed massive swelling of the spinal cord (causing a spinal stenosis) in the upper thoracic area and a hematoma, possibly with blood (x) in the spinal fluid ((x) - I'm not sure I remember correctly here). Jack was given a sick-leave and received no more treatments from me. Time would hopefully take care of the problem.

About seven months later, I literally bumped into Jack as I came out the door of my bank. Fortunately neither of us got hurt! I asked him how he was doing. He was still on sick-leave, or more precisely, it resulted in him getting fired from his job (there is a 120 sick-day rule in Denmark, after which you can, but not necessarily, get fired). He had a little less pain, but the sensation on the palms of his hands and the soles of his feet felt like "cotton wool". A sad outcome with a nearly unchanged scenario.

--End of story--


We use different glasses

This experience tells me something about one of the most significant differences between the PT and chiropractic profession's ways of approaching things. And most definitely the chiropractor mentioned above. We are educated to see the neuromusculoskeletal system through different glasses. Our perceptions/assumptions are often fundamentally different. PTs and MDs have basically the same glasses on. Chiros have a very different set on.

The chiro above started with the assumption that there was a subluxation, and adjusted it. The problem was seen primarily as a joint problem. Ergo, Fix it! In my eyes a very "apparat/fejl" (Danish for "apparatus/defect") viewpoint. Ironically, this is exactly what alternative medicine practitioners accuse the established health care system of doing: treating people like machines.

I would also have started with an assumption. I would assume, with few, rare exceptions, that vertebra don't get out of joint. (I've lived and worked in Greenland, where about 30% of all Eskimos have a congenital spondylolisthesis. There my assumption allowed for more exceptions!! And HVLA would certainly not be considered as a treatment.)

In Jack's case, I would have suspected the pain and sound to be from a pulled muscle (rhomboids, levator scapulae), probably with some torn fibers, resulting in massive muscle cramping/spasm, causing fixed movement segments in the thoracic vertebral column. Pain would come from torn muscle fibers, cramped muscles, compressed intervertebral joints, etc..


Even if the major cause of pain were from a joint, a distinct possibility, I would start with the muscles in the area as the factor sustaining the joint in an unfortunate condition, whether relating to joint position or mobility/stability. (So the old "hen or egg first" argument would often be irrelevant for me.) My initial treatment would be local cooling during the first 24-48 hrs. Thereafter a progression including moist heat, massage, stretching, joint mobilizing (no HVLA), McKenzie and strength excercises. The progression being from treatment of pain, then, as pain lessens, treatment of impairment leading to full, normal, pain-free function. The ultimate goal of instruction and treatment would be self-reliance and lack of dependence on me as a therapist.
If it were possible to locate a small area with so intense pain that manual treatment would be too uncomfortable, representing the torn fibers, I might use ultrasound there (1 MHz, 3 watts, pulsating, for 4-7 minutes (depending on the size of the area), the patient's sensation of pain acting as a guide: The patient must feel no discomfort from the ultrasound).
I, too, would treat "defects in the apparatus" (they do exist....;-), but would look more broadly at it, treating first that which is under the patient's active control and capable of reaction to conscious and subconscious factors - the muscles. (I would treat the joint as a passive factor.) After the muscles are warmed up, stretched and less tense, the joint would be prepared for careful joint mobilization. After this, it's almost impossible to do a HVLA and get a "pop" sound.
The causative factor in a fixed joint is gone, ergo, the fixation often disappears by itself. I don't need to use "violent measures" on a joint that is held in a vice-like grip by tense, cramped muscles. They just need to be gently persuaded to let go. The joint will then return to its natural, neutral position. And that position is not something for me to determine. The joint just might happen to be naturally - genetically or pathologically - crooked. So I just let it find its timeworn natural position.
Paul Lee, PT

Misspelled words used to find this page 8 of 10.ersonance, esonance, imaging, iaging, imging, imaing, imagng, imagig, imageing, imageint, imageigng, imageeigng, imageignt, imageeignt, imagiegng, imageiegng, imagiegnt, imageiegnt, imagint, 1nag1mg, inagimg, imagimg, imagign, imagnig, imaigng, imgaing, iamging, miaging, imagin, maging, myelgram, myelogram, myeloram, myleogram, myelogam, myeloglam, myelogrm, myleoglam, myerogram, myeroglam, melogram, mylogram, myeogram, nye1ogram, nyelogram, myelogrma, myelogarm, myelorgam, myelgoram, myeolgram, meylogram, ymelogram, myelogra, yelogram,miads, maids, na1ds, naids, naisd, nadis, niads, anids, nerve, nelve, nerves, nelves, merves, nervse, nerevs, nevres, nreves, enrves, nervs, neres, neves, nrves, erves, nerve, nelve, merve, nerev, nevre, nreve, enrve, root, route, rout, loot, lout, rot, wrought, lot, roto, orot, neurologik, neurologic, neurorogik, nurologic, neulologik, nerologic, neulorogik, neuologic, neurlogic, neuroogic, neurolgic, neuroloic, neurologc, neurorogic, neulologic, neulorogic, neuro1og1c, neurolog1c, meurologic, neurologci, neuroloigc, neurolgoic, neuroolgic, neurloogic, neuorlogic, neruologic, nuerologic, enurologic, neurologi, eurologic, ousteophyte, osteopyte, osteophyte, oesteofyght, ousteophite, osteophte, osteofyte, ousteofyght, oesteofyte, osteophye, osteophyght, oesteofite, osteophite, osteofyght, ousteofyte, osteofite, oteophyte, ousteofite, osteophight, oseophyte, oesteophyght, osteofight, ostophyte, oesteophight, oesteophyte, ostephyte, ousteophyght, oesteophite, osteohyte, ousteophight, osteophyet, osteophtye, osteopyhte, osteohpyte, ostepohyte, ostoephyte, osetophyte, otseophyte, soteophyte, osteophyt, steophyte,pediel, pedicel, pedicl, peticel, peticer, peticle, pedisel, pediser, pdicel, petisel, peicel, petiser, pedcel, pedicle, pedycel, pedycle, pedicer, pedycer, peticul, pdicle, peicle, pedcle, pedile, pedice, pedicul, pedycul, peticre, pedicre, pedycre, ped1c1e, ped1cle, pedilce, pedcile, peidcle, pdeicle, epdicle, edicle, respiratory, respiraterie, respyratolie, respiratry, resperatoly, respyraterie, lespiratolie, respiratoy, lesperatory, lespiraterie, respilatolie, respiratorie, rspiratory, lesperatoly, respilaterie, respiratery, respyratorie, repiratory, resperatery, respylatory, respyratery, lespiratorie, resiratory, lesperatery, respylatoly, lespiratery, lespyratorie, respratory, resperatorie, lespylatory, lespyratery, respilatorie, respiatory, resperatolie, respylatery, respilatery, lespilatorie, respirtory, lesperatorie, respylatorie, lespilatery, respiratolie, respiraory, resperaterie, resperatory, respilatoly, respyratory, lespilatoly, lespiratory, lespyratory, respilatory, lespilatory, respiratoly, respyratoly, lespiratoly, lespyratoly, respiraor, respirator, resperator, lespiratur, respiratr, resperatol, lespyratur, respirater, resperatur, respilatur, respyrater, rspirator, lesperator, lespilatur, lespirater, repirator, lesperatol, respylator, lespyrater, resirator, lesperatur, respylatol, respilater,

Spinal Stenosis

A condition due to narrowing of the spinal cord causing nerve pinching which leads to persistent pain in the buttocks, limping, lack of feeling in the lower extremities, and decreased physical activity.

Mission Statement

The purpose of this website is to provide information about the current standard of care in the diagnosis and treatment of symptomatic lumbar spinal stenosis to people with spinal symptoms, medical health care providers and researchers. While every effort has been made to provide balanced, factual information a visit to this site is not an acceptable substitute for a professional medical consultation. Furthermore, while it is advisable to become active in the learning and decision making process regarding your own health care, none of the treatment modalities discussed within this site are recommended without the advice of a state licensed health care practitioner.
The Silent Epidemic

The most common indication for surgery in persons aged over 60 in the United States is Lumbar Spinal Stenosis (LSS). Currently, it is estimated that as many as 400,000 Americans, most over the age of 60, may already be suffering from the symptoms of lumbar spinal stenosis [The American Association of Neurological Surgeons (AANS) and The Congress of Neurological Surgeons (CNS)] and this number is expected to grow as members of the baby boom generation begin to reach their 60s over the next decade.
According to the U.S. Census Bureau, people over 60 will account for 18.7% of the domestic population in 2010 versus 16.6% in 1999. According to the United Nations' Population Division, Department of Economic and Social Affairs, the trend is global with the number of persons aged 60 years or older estimated to be nearly 600 million in 1999 and is projected to grow to almost 2 billion by 2050, at which time the population of older persons will be larger than the population of children (0-14 years) for the first time in human history. The majority of the world's older persons reside in Asia (53 per cent), while Europe has the next largest share (25%).
The prevalence of musculo-skeletal disorders and the cost to treat them led the World Health Organization and the United Nations to declare 2000-2010 be the Decade committed to improving quality of life to people with bone and joint disease and injuries throughout the world.

Lumbar spinal stenosis is a condition due to narrowing of the spinal cord causing nerve pinching which leads to persistent pain in the buttocks, limping, lack of feeling in the lower extremities, and decreased physical activity.

More specifically, there are several different forms of lumbar spinal stenosis.


The most common is degenerative stenosis, occurring in virtually the entire adult population as a result of the natural process of aging. It is a degenerative narrowing of the spinal canal, nerve root canals and/or intervertebral foramina caused by bone and/or ligament hypertrophy in local, segmental or generalized regions. The narrowing results in compression of spinal nerves and nerve roots, causing a constellation of symptoms, including lower back pain, neurogenic claudication and lower extremity pain.

Congenital lumbar stenosis is relatively rare and usually presents at an early age, often between 30 and 40. Acquired LSS is more common and generally develops when patients are in their 60s or older. It is a puzzling condition that can neither be predicted nor prevented. It does not distinguish by sex, race, or ethnicity. Nor is it associated with any particular occupation or any particular body type.

Misspelled words used to find this page 9 of 10. resprator, resperater, respylatur, lespilater, respiator, lesperater, lespylator, respiratur, respirtor, respylater, respyratur, lespyratol, respilatol, respyrator, lespilatol, lespirator, lespyrator, respilator, lespilator, respiratol, respyrato, sciatia, sciatica, siatica, scatica, scitica, sciaica, sciatca, sceatica, scaitica, sceatic, sciatic, sceatik, siatic, scatic, scitic, sciaic, sciatc, sciatik, scaitik, scaitic, sc1at1ca, sciatiac, sciatcia, sciaitca, scitaica, sicatica, csiatica, ciatica, canal, canar, cana1, camal, canla, caanl, cnaal, acnal, cord, cored, chord, corred, cold, corde, codr, crod, ocrd, spious, spynius, spinous, spiegnos, speignous, spinois, spinos, spiegnoos, speignos, spinis, spinus, spiegnius, speignoos, spynois, spynous, spiegnus, speignius, spynis, spynos, spiegnois, speignus, spiniis, spynus, spiegniis, speignois, spyniis, spinoos, spiegnis, speigniis, sinous, spynoos, speignis, spnous, spinius, spiegnous, sp1nous, spimous, spinosu, spinuos, spionus, spnious, sipnous, psinous, spinou, pinous, process, plocess, percess, porcess, proces, ploces, perces, porces, prcess, proess, procss, pocess, proc3s, procses, proecss, prcoess, rpocess, suplaspinius, suplaspynous, supraspinous, suplaspynius, suplaspynos, supraspinos, suplaspynus, supraspinus, supraspinoos, supraspynous, supraspynoos, supraspynos, suplaspinoos, supraspynus, suplaspynoos, suplaspinous, supraspinius, suplaspinos, supraspynius, suplaspinus, supraspiegnis, supraspiegnius, suplaspeignius, suplaspiniis, supraspinois, suplaspiegnois, supraspiegnus, suplaspeignus, supraspeignous, supraspinis, spraspinous, suplaspiegnous, supraspeignois, supraspeignos, supraspynois, suraspinous, suplaspiegnos, supraspeigniis, supraspeignoos, supraspynis, supaspinous, suplaspiegnoos, supraspeignis, supraspeignius, suplaspinois, suprspinous, suplaspiegnius, suplaspeignois, supraspeignus, suplaspinis, suprapinous, suplaspiegnus, supraspiegnous, suplaspeignous, suplaspynois, suprasinous, supraspiegnois, supraspiegnos, suplaspeignos, supraspiniis, supraspnous, supraspiegniis, supraspiegnoos, suplaspeignoos, supraspyniis, supraspious, suprasp1nous, supraspimous, supraspinosu, supraspinuos, supraspionus, supraspnious, suprasipnous, suprapsinous, suprsapinous, suparspinous, surpaspinous, spuraspinous, uspraspinous, supraspinou, upraspinous, ligamet, ligament, lgament, liament, ligment, ligaent, ligamnt, rigament, ligamant, rigamant, 11ganemt, l1ganemt, liganemt, ligamemt, ligametn, ligamnet, ligaemnt, ligmaent, liagment, lgiament, ilgament, ligamen, igament,spondyloristehsis, spondilolistehsys, spondylolisthesis, spondylolistheis, spondlolisthesis, spondyloristhecee, spondilolisthesee, spondyloristehcis, spondiloristehsis, spondylolistehsus, spondilolisthesis, spondylolisthess,

Diagnosis of Spinal Stenosis

The following methods of diagnosing Lumbar Spinal Stenosis are used by doctors to rule out other conditions once symptoms that could possibly be caused by Lumbar Spinal Stenosis are present. A combination of any or all of the methods shown to the left of this message may be used by a licensed medical practioner to ensure proper diagnosis. This information should be used to increase understanding of the process of diagnosis Lumbar Spinal Stenosis, and in no way substitute for a consultation with a doctor.
Medical History

The doctor will inquire about medical history, specifically for any known injuries, conditions, or general health problems that could indicate the explanation for the symptoms the patient is describing. Whether that's spinal stenosis or another ailment.
Physical Examination    The doctor will examine:

  1. The extent of the patient's hindered movement
     
  2. The amount of pain due to the patient bending their back backwards
     
  3. The loss of extremity reflexes which could be linked with numbness or weakness.

Tests

Various technical tests are ordered by the doctor in order to be sure the patient is afflicted with spinal stenosis. Including:

  • MRI (Magnetic Resonance Imaging)
  • MRI (Magnetic Rennosance Imaging)

    A powerful magnet creates energy that creates signals which are detected by a scanner and interpreted by a computer. This produces many cross section images of the back and or a three dimensional view. It is particularly useful for finding damage or disease of soft tissues such as the disks between vertebrae or ligaments. It shows the spinal cord, nerve roots, and surrounding spaces, as well as enlargement, degernation, or tumors.

    Example:

    Spinal Stenosis, Vertebrae Degeneration Analgesic, Anesthesia, Cardiac, CAT,  CT Scan, Computerized Axial Tomography, Cauda equina syndrome, Corticosteroid, Degenerative, Dehiscence, Efficacy, Endoscopic, Epidural, Extension, Facet, Facetectomy, Flexion, Fluoroscope,Foramen, Foraminotomy,Fusion,Gastrointestinal, Hematoma, Hemorrhage, Herniated,Hypertrophic, Ligament,Interspinous Process Decompression (IPD), Intervertebral Disc,Lamina,Laminectomy, Laminotomy, Ligaments, Ligamentum Flavum,Lordosis, Lumbar, Lumbar Spinal Stenosis, MRI (Magnetic Resonance Imaging), Myelogram, NAIDs, Nerves, Nerve root, Neurologic, Osteophyte, Pedicle, Respiratory, Sciatica, Spinal Canal, Spinal Cord, Spinous Process, Supraspinous Ligament,Spondylolisthesis, Transfusion, Unsinate, Vascular, Vertebra,X-ray, X-Stop

  • CAT (Computerized Axial Tomography)

    X rays are passed through the back at different angles, recieved by a scanner, and then processed by a computer. This created a series of cross sectional images and/or three dimensional views of the parts of the back showing the shape and size of the spinal canal, its contens, and structures surrounding it.

    Example:

    Spinal Stenosis, Vertebrae Degeneration Analgesic, Anesthesia, Cardiac, CAT,  CT Scan, Computerized Axial Tomography, Cauda equina syndrome, Corticosteroid, Degenerative, Dehiscence, Efficacy, Endoscopic, Epidural, Extension, Facet, Facetectomy, Flexion, Fluoroscope,Foramen, Foraminotomy,Fusion,Gastrointestinal, Hematoma, Hemorrhage, Herniated,Hypertrophic, Ligament,Interspinous Process Decompression (IPD), Intervertebral Disc,Lamina,Laminectomy, Laminotomy, Ligaments, Ligamentum Flavum,Lordosis, Lumbar, Lumbar Spinal Stenosis, MRI (Magnetic Resonance Imaging), Myelogram, NAIDs, Nerves, Nerve root, Neurologic, Osteophyte, Pedicle, Respiratory, Sciatica, Spinal Canal, Spinal Cord, Spinous Process, Supraspinous Ligament,Spondylolisthesis, Transfusion, Unsinate, Vascular, Vertebra,X-ray, X-Stop

  • Myelogram

    A liquid dye that x-rays cannot penetrate is injected into the spinal column. It then circulates around the spinal cord and nerves, which appear as white objects against bone on an x-ray film. This can show pressure on the spinal cord or nerves from herniated disks, bone spurs, or tumors.

    Example:

    Spinal Stenosis, Vertebrae Degeneration Analgesic, Anesthesia, Cardiac, CAT,  CT Scan, Computerized Axial Tomography, Cauda equina syndrome, Corticosteroid, Degenerative, Dehiscence, Efficacy, Endoscopic, Epidural, Extension, Facet, Facetectomy, Flexion, Fluoroscope,Foramen, Foraminotomy,Fusion,Gastrointestinal, Hematoma, Hemorrhage, Herniated,Hypertrophic, Ligament,Interspinous Process Decompression (IPD), Intervertebral Disc,Lamina,Laminectomy, Laminotomy, Ligaments, Ligamentum Flavum,Lordosis, Lumbar, Lumbar Spinal Stenosis, MRI (Magnetic Resonance Imaging), Myelogram, NAIDs, Nerves, Nerve root, Neurologic, Osteophyte, Pedicle, Respiratory, Sciatica, Spinal Canal, Spinal Cord, Spinous Process, Supraspinous Ligament,Spondylolisthesis, Transfusion, Unsinate, Vascular, Vertebra,X-ray, X-Stop

    -Bone Scan

Radioactive material is injected, and then attaches itself to the bone especially in areas where bone is actively breaking down or being formed. This detects fractures, tumors, infections, and arthritis, but cannot detect one disorder from another. Therefore, a bone scan is performed along with other scans.

Example:

Spinal Stenosis, Vertebrae Degeneration Analgesic, Anesthesia, Cardiac, CAT,  CT Scan, Computerized Axial Tomography, Cauda equina syndrome, Corticosteroid, Degenerative, Dehiscence, Efficacy, Endoscopic, Epidural, Extension, Facet, Facetectomy, Flexion, Fluoroscope,Foramen, Foraminotomy,Fusion,Gastrointestinal, Hematoma, Hemorrhage, Herniated,Hypertrophic, Ligament,Interspinous Process Decompression (IPD), Intervertebral Disc,Lamina,Laminectomy, Laminotomy, Ligaments, Ligamentum Flavum,Lordosis, Lumbar, Lumbar Spinal Stenosis, MRI (Magnetic Resonance Imaging), Myelogram, NAIDs, Nerves, Nerve root, Neurologic, Osteophyte, Pedicle, Respiratory, Sciatica, Spinal Canal, Spinal Cord, Spinous Process, Supraspinous Ligament,Spondylolisthesis, Transfusion, Unsinate, Vascular, Vertebra,X-ray, X-Stop

Treatments

Currently, there are two major options for the treatment of lumbar spinal stenosis. The more conservative approach is a combination of rest, support devices, physical therapy, and pain medications. This treatment is normally given over the initial months after diagnosis in hope that it will correct the problem without requiring more drastic measures. When the pain/discomfort continues, a surgical procedure is discussed and pursued if the patient and their physician think it will improve the patient's quality of life.

Conservative Treatment

This non-surgery means of treating lumbar spinal stenosis is often used in the early stages after diagnosis or when severe/progressive nerve involvment is not present. The treatment includes NAIDs (non-steroidal anti-inflammatory drugs), analgesics (Tylenol), epidural steroid injections, restricted activity, physical therapy, and a lumbar brace/corset.

NAIDs

Non-steroidal anti-inflammatory drugs, such as: ibuprofen, aspirin, acetaminophen and naproxen sodium, are often recommended to patients suffering from lumbar spinal stenosis, but oral steroids and narcotics are generally contraindicated.12,13

Anti-inflammatory agents are prescribed based on the theory that inflammation within the affected tissues is a major cause of pain. The most comprehensive studies to examine NSAIDs have looked at the various medications in combination with bed rest. Based on these studies, no single drug appears to be superior to any other. 9,14,15

One double-blind, placebo-controlled trial of piroxicam (feldene) showed that a greater amount of pain relief in the treatment group was evident only during first few days of back pain; however, after 2 weeks, more of the untreated group had returned to work.16

Analgesics

Analgesics are pain medications which are prescribed to attempt to relieve some of the pain caused by LSS. Most pain can be treated with nonprescription medications like aspirin, ibuprofen, naproxen or acetaminophen.

Surgical Procedures

Surgery is currently the only treatment designed and proven to provide long term relief from lumbar spinal stenosis. It is normally recommended only after conservative treatments fail. There are several different operations that can be performed in order to correct LSS. A neurosurgeon determines which operation, or combination of operations, is most effective for a specific patient by reviewing test results, medical history, and examinations.

Surgery is only recommended when the patient meets the following conditions:

  • There is weakness or numbness in the legs.
  • It is difficult to walk or stand.
  • Medication and physical therapy are ineffective.
  • The patient is in reasonably good health.
  • Leg pain limits normal activity, lowering quality of life.


Surgical options include the following:

Laminectomy

Decompressive laminectomy is the most common surgery performed in order to correct lumbar spinal stenosis. The goal of this operation is to create more room for the nerve root that has been encroached upon by the facet joints of the vertebra. Because the LSS symptoms are created by the compression of the nerve root, uncompressing the root relieves the symptoms.

The procedure begins with a small incision in the lower back of the patient, three to five inches long. The surgeon then removes the lamina (the roof of the vertebrae). He makes an incision in the ligamentum flavum and gets a visual of the compressed nerve. He looks for the cause of the compressed nerve. The cause could be:

  • Hypertrophic facet capsules
  • Osteophytes
  • Uncinate spurs
  • Protruding disc materials

Once all of the compressing materials have been removed, the remaining muscles and ligaments are sutured in order to promote faster healing after the operation.

Following the operation, the patient stays in the hospital for one to three days. Normally it takes several weeks to recover from this operation enough to perform physical activities, but the length of time to recover is mostly based on the patient's age and physical condition prior to surgery.

Indications

The indications for surgical decompression of LSS are not clearly defined.23,24  Most agree that surgery is elective, except in the rare instance of cauda equina syndrome or rapidly progressing neurologic deficits.  Surgery is performed to improve the quality of life for individuals who have disabling back and leg pain, and significant limitations in walking tolerance.14,22,30,31,32, Variations in reported decompressive surgery rates across geographic regions in the United States suggest that there still exits considerable uncertainty among physicians regarding the appropriate indications for decompressive laminectomy.24,25,26,27, Generally, surgery is pursued once conservative treatments have failed.

Larequi-Lauber and associates33 evaluated the appropriateness of surgical indications in 328 consecutive patients undergoing laminectomy for lumbar spinal stenosis or disc herniation. The authors used the consensus of a panel of experts to determine the appropriateness criteria and concluded that 38% of patients had inappropriate indications for surgery. The most common reason for a classification of inappropriate was insufficient preoperative duration of conservative treatment.

Surgery is clearly indicated in cases of acute cauda equina syndrome or with rapidly deteriorating neurologic status, but these cases are rare.34,35,36 Cauda equina syndrome is in fact the only absolute indication for decompressive laminectomy.37

Risks

Decompressive laminectomy is considered a relatively invasive surgical procedure, especially when accompanied by a fusion. Deyo et al used the ICD-9-CM codes to compile complications from lumbar spine procedures including decompressive laminectomy.38,39,40 These included:

  • Death
  • Operative hemorrhage
  • Hematoma
  • Gastrointestinal problems
  • Urinary tract problems
  • Respiratory complications
  • Cardiac problems
  • Postoperative infections
  • Central nervous system problems
  • Wound dehiscence
  • Peripheral vascular problems
  • Transfusion problems

Other authors in defining complications for decompressive laminectomy procedures have cited one or more of the following:

  • Pain
  • Infection
  • Dural tears
  • Bleeding
  • Neurological deficit
  • Re-operations
  • Functional Disability

Success Rates

With success rates reported between 2