Spinal Stenosis

A typical scenario of spinal stenosis is an individual, usually an elderly person, complaining of excruciating back pain while bending backwards, along with pain, tingling and numbness on the legs. They feel comfortable leaning forward while sitting, walking or climbing stairs. But walking downhill, which requires the body to incline backwards for maintaining balance, is particularly distressful.

Stenosis is caused by narrowing of the spinal canal in the vertebral column in the neck and lower back area, putting pressure on the spinal cord and nerves that supply the arms and legs. Any disorder that causes loss of curvature of the spine (scoliosis) or produces pressure on nerves and soft tissue, compresses or stretches ligaments may lead to stenosis.

Causes
Normal aging – Degeneration of vertebral joints, ligaments and discs due to everyday wear-and-tear calcifies the supporting soft tissues, leading to thickening and thus, narrowing of the spinal canal.

Heredity/congenital – Some people are simply born with a narrower canal.

Arthritis – In old people, osteoarthritis causes bone thinning and collapse of the vertebra. Sometimes, small bone spurs, called osteophytes, can also narrow the canal.

Rheumatoid Arthritis – In a young person, inflammation and enlargement of the joint can give rise to spinal stenosis.

Tumor/growth around spine – A tumor or growth around the spine may lead to compression, displacement and bone resorption, leading to disruption of the spinal space.

Trauma -- Trauma or fracture of the spinal column may also cause stenosis.

Symptoms   
*Back pain, as well as pain in the legs and buttocks.
*Reduced mobility and limited flexibility of the spine.
*Falling, imbalance and clumsiness during movement.
*Difficulty in walking due to pain and weakness in legs.
*Numbness, tingling, cramping or feeling hot or cold in the legs or arms (in case of cervical spinal stenosis).
*Sciatica pain radiating down the leg
*The pain diminishes while lying with the knees drawn up to the chest.
*Severe stenosis may lead to bowel, bladder and sexual dysfunction.

Diagnosis
Simple bedside tests done by physicians – Reproduction of symptoms occurs when the patient bends backwards or hyper-extends the spine and some relief is brought upon by leaning forward or bending knee towards chest while lying down.  

X-rays of the spine – Can visualise the joint, detect ligament calcification or boney spurs that may be the cause of stenosis.

MRI (magnetic resonance imaging) – More sophisticated and sensitive modality for detecting damage or disease of soft tissues or visualising the shape and size of the spinal canal, its contents, and structures surrounding it.

CAT scan (computerised axial tomography) - Can also a useful tool.
Treatment
Exercise and physiotherapy help a great deal in this situation, along with the following medical options:

Mild cases – Simple analgesics, such as acetaminophen, may help to relieve pain.
If surrounding inflammation is present, NSAIDs such as aspirin, naproxen, ibuprofen or indomethacin help to reduce inflammation and relieve pain.

Moderate to severe cases – Steroid injections help to lower inflammation and pain. But repeated steroid shots can be harmful. Blocking nerves by anaesthetic injections near the affected area can also temporarily relieve pain.

Surgery – Surgery is usually recommended when other nonsurgical treatments have failed, and for patients with increasing weakness of the legs or loss of bowel or bladder function. The operation involves cutting off part of the vertebrae and/or disc to create more space for the nerves to relieve pressure on the spinal cord and restore normal spacing. Although surgery can effectively treat the leg symptoms, it is less reliable for the relief of back pain.

Tips
The following exercises or therapies have proven to be helpful in alleviating the pain:
Flexing exercises – Sitting or bowing forward relieves symptoms as the flexed position ‘opens up’ the spinal column, enlarging the spaces between vertebrae at the back of the spine. Thus, flexing exercises are often advised, along with stretching and strengthening exercises.  This includes trying to touch one's toes or drawing the knees towards the chest while standing or sitting.

Core strengthening exercises – Strengthening of the abdominal and back muscles helps to corrects posture, and provides proper support to the spinal column.

Spine stabilising exercises – Prescribed physical therapy, along with exercises to maintain motion and endurance of the spinal muscles, help maintain alignment and strengthening of the spine.

Lumbar brace or corset – To provide some support for people with weak abdominal muscles or for older patients.

Chiropractic treatment – Traction, controlled adjustments or spinal manipulations to help increase space between the vertebrae and reduce pressure on affected nerves may restore normal spinal movement and lessen the pain.

Acupuncture - has also proven to be beneficial.

The writer is a doctor of internal medicine.

Spinal Stenosis

A typical scenario of spinal stenosis is an individual, usually an elderly person, complaining of excruciating back pain while bending backwards, along with pain, tingling and numbness on the legs. They feel comfortable leaning forward while sitting, walking or climbing stairs. But walking downhill, which requires the body to incline backwards for maintaining balance, is particularly distressful. Stenosis is caused by narrowing of the spinal canal in the vertebral column in the neck and lower back area, putting pressure on the spinal cord and nerves that supply the arms and legs. Any disorder that causes loss of curvature of the spine (scoliosis) or produces pressure on nerves and soft tissue, compresses or stretches ligaments may lead to stenosis. Causes Normal aging Degeneration of vertebral joints, ligaments and discs due to everyday wear-and-tear calcifies the supporting soft tissues, leading to thickening and thus, narrowing of the spinal canal. Heredity/congenital Some people are simply born with a narrower canal. Arthritis In old people, osteoarthritis causes bone thinning and collapse of the vertebra. Sometimes, small bone spurs, called osteophytes, can also narrow the canal. Rheumatoid Arthritis In a young person, inflammation and enlargement of the joint can give rise to spinal stenosis. Tumor/growth around spine A tumor or growth around the spine may lead to compression, displacement and bone resorption, leading to disruption of the spinal space. Trauma -- Trauma or fracture of the spinal column may also cause stenosis. Symptoms *Back pain, as well as pain in the legs and buttocks. *Reduced mobility and limited flexibility of the spine. *Falling, imbalance and clumsiness during movement. *Difficulty in walking due to pain and weakness in legs. *Numbness, tingling, cramping or feeling hot or cold in the legs or arms (in case of cervical spinal stenosis). *Sciatica pain radiating down the leg *The pain diminishes while lying with the knees drawn up to the chest. *Severe stenosis may lead to bowel, bladder and sexual dysfunction. Diagnosis Simple bedside tests done by physicians Reproduction of symptoms occurs when the patient bends backwards or hyper-extends the spine and some relief is brought upon by leaning forward or bending knee towards chest while lying down. X-rays of the spine Can visualise the joint, detect ligament calcification or boney spurs that may be the cause of stenosis. MRI (magnetic resonance imaging) More sophisticated and sensitive modality for detecting damage or disease of soft tissues or visualising the shape and size of the spinal canal, its contents, and structures surrounding it. CAT scan (computerised axial tomography) - Can also a useful tool. Treatment Exercise and physiotherapy help a great deal in this situation, along with the following medical options: Mild cases Simple analgesics, such as acetaminophen, may help to relieve pain. If surrounding inflammation is present, NSAIDs such as aspirin, naproxen, ibuprofen or indomethacin help to reduce inflammation and relieve pain. Moderate to severe cases Steroid injections help to lower inflammation and pain. But repeated steroid shots can be harmful. Blocking nerves by anaesthetic injections near the affected area can also temporarily relieve pain. Surgery Surgery is usually recommended when other nonsurgical treatments have failed, and for patients with increasing weakness of the legs or loss of bowel or bladder function. The operation involves cutting off part of the vertebrae and/or disc to create more space for the nerves to relieve pressure on the spinal cord and restore normal spacing. Although surgery can effectively treat the leg symptoms, it is less reliable for the relief of back pain. Tips The following exercises or therapies have proven to be helpful in alleviating the pain: Flexing exercises Sitting or bowing forward relieves symptoms as the flexed position opens up the spinal column, enlarging the spaces between vertebrae at the back of the spine. Thus, flexing exercises are often advised, along with stretching and strengthening exercises. This includes trying to touch ones toes or drawing the knees towards the chest while standing or sitting. Core strengthening exercises Strengthening of the abdominal and back muscles helps to corrects posture, and provides proper support to the spinal column. Spine stabilising exercises Prescribed physical therapy, along with exercises to maintain motion and endurance of the spinal muscles, help maintain alignment and strengthening of the spine. Lumbar brace or corset To provide some support for people with weak abdominal muscles or for older patients. Chiropractic treatment Traction, controlled adjustments or spinal manipulations to help increase space between the vertebrae and reduce pressure on affected nerves may restore normal spinal movement and lessen the pain. Acupuncture - has also proven to be beneficial. The writer is a doctor of internal medicine.