Spinal Stenosis

Spinal stenosis is a narrowing of the spinal canal containing the spinal cord and its nerve branches. Spinal stenosis can be congenital (from birth), but it is more commonly is an acquired condition due to degeneration of the joints in the spine (wear and tear, arthritis and spondylosis). Stenosis can occur in the cervical, thoracic, or lumbar spine, most often affecting the lumbar area.

Spinal stenosis typically causes symptoms due to pressure (pinching) on the spinal cord or its nerves. Pain and/or numbness in the legs or arms are the most common symptoms. Progressive weakness and atrophy of muscles in the legs or arms can develop over time. Rarely, stiffness of the arm or leg muscles can occur. Urinary control problems are late-onset symptoms. Neck and back pain may or may not be noted. Symptoms are gradual and slow in onset, usually over several months or years. Progressive loss of walking and standing duration due to pain is typical.

Cervical stenosis (stenosis in the neck) can result in symptoms of weakness, numbness, tingling, and pain in the extremities, most notably the arms. Cervical stenosis may also result in symptoms of cervical myelopathy – balance issues, coordination issues, dropping of objects, and generalized clumsiness.

Lumbar stenosis (stenosis in the lower back) can result in leg pain, numbness, tingling, weakness, and occasionally bowel/bladder dysfunction. Many patients with lumbar stenosis will also have neurogenic claudication – numbness, tingling and cramping of the legs, sometimes with associated weakness. These symptoms often are exacerbated with standing and walking, and relieved with bending or sitting. Patients often state they feel better leaning over a shopping cart in the store.

A physical or neurologic examination may show normal strength and sensation, but common findings include loss of normal reflexes, muscle weakness or atrophy and numbness in the legs and/or arms.

An MRI scan of the spine may be diagnostic for the stenosis, or it may just be suggestive. Further testing with myelogram in combination with CT scan is sometimes recommended to confirm the diagnosis and develop a treatment plan.

Initial treatment for spinal stenosis is typically conservative management with various medications including mild analgesics, non-steroidal anti-inflammatory agents and sometimes use of cortisone, either orally or by injection. Physical therapy is frequently effective along with weight loss for nonoperative management of spinal stenosis. However, if the pain is not controlled or progressive weakness develops, surgery is then considered as a treatment option.

Surgical treatment options range from minimally invasive procedures to more invasive procedures. The least invasive surgery involves an interspinous spacer device called “XSTOP.” This procedure places the spacer between the spinous processes to indirectly decompress the thickened ligaments of the spine causing stenosis. It is typically done as a day surgery.

A more direct stenosis relief would be a minimally invasive decompression via a hemilaminectomy/hemilaminotomy procedure. This can be done at one or multiple levels and can be performed as a day surgery, or just a one- or two-night hospital stay.

The most comprehensive decompression for stenosis requires open laminectomy, which may or may not be performed with fusion of the spine. This typically requires a two- to five-day hospital stay.

Finally, in the cervical spine, the stenosis can be decompressed from the front by a procedure known as an anterior cervical discectomy, osteophytectomy for spinal cord decompression, combined with anterior fusion of the spine. The typical stay for the anterior cervical fusion is just one to three days. Alternatively, a patient may require a surgery from the back of the neck, known as a posterior cervical decompression, with or without fusion.

Postoperative physical therapy is often recommended to regain walking skills and independent daily living skills. External bracing may be recommended.

A 60% to 80% success rate can be expected for most cases of stenosis. If the stenosis is a recurrent problem from prior surgeries, the success rate is lowered to 50% to 60%.

Return to full activities can be as little as four to six weeks, three months or up to a year, depending on the complexity of the procedure. Driving an automobile can usually be resumed within two to four weeks after surgery. Office work can be resumed typically in four weeks.

Potential complications of the surgery include persistent pain problems, instability of the spine, adjacent level disk problems, nerve injury with new weakness or numbness, hematoma or cerebrospinal fluid leakage which may require reoperation.

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