Spinal Stenosis

Believe it or not, you can have a lot of things  happening in your body without you even realizing it. Spinal Stenosis is one of those things. By the time you feel it, something may have to be done to slow down or reverse the symptoms that have finally decided to show themselves.

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In spinal stenosis,  the space for the nerves or the spinal cord is narrowed,  potentially causing irritation of the nerve elements. It is an ongoing disease, we all have some degree of stenosis, but it has  progressed in some patients by the time they  feel the average symptoms of exertion fatigue, intolerance to walking any distance, leg pain (usually described as aching) and numbness and weakness.

In terms of anatomic,  or diagnostic evaluations,  MRI’s or CT scans can measure the diameters of the canal spaces.  A space less than 10 mm in diameter,  or 100 mm sq in area is considered to be a spinal stenosis. While the anatomic definition has been standardized,  many people may have spinal stenosis without any complaints related to the diagnosis.

Spinal stenosis can happen at any level of the spine. At the cervical and thoracic level it is especially worrisome as the openings for the nerves (foramina) and the spinal column are already narrow so any further bone buildup can cause compression on the nerves or the spinal cord. Initial symptoms can be numbness, tingling and weakness in the upper extremities. As compression on the cord increases, it could cause the same symptoms in the lower extremities. The most severe symptoms (and a good reason to go to the ER) would be paralysis, or loss of function in the bowel and bladder.

More common is  lumbar spinal stenosis. This is also due to a build up of bone around the lumbar foramina and patients generally present with low back pain and severe leg pain, numbness and tingling. The biggest clue that it is stenosis, is that the patient feels better when they lean forward, as in pushing a shopping cart. Poor circulation and neuropathy are often confused with spinal stenosis.

Because spinal stenosis complaints are usually associated with activities,  many times standard physical examinations by your general physician will not identify any specific nerve irritation findings.

Spinal stenosis is better defined by a clinical history,  rather than specific physical examination findings.  It takes a certain level of clinical suspicion to order diagnostic tests that will identify the anatomic findings discussed above. If there are concerns for spinal stenosis,  an evaluation by a spine specialist such as a Neurologist,  Physical Medicine and Rehabilitation Physician,  or Spine Surgeon can help differentiate the potential causes for the symptoms.

Treatment of spinal stenosis can include: prevention (exercise and weight training to prevent osteoporosis), Epidural Steroid Injections (to calm down temporarily inflamed nerves) and decompressive surgeries (such as laminectomies or foraminotomies). The goal is to safely remove anything pressing on the nerves or spinal cord.

So if grocery shopping is the most comfortable thing you do all week, you may want to consider talking to your physician about this.

What is spinal stenosis? Hi, I'm Dr. John Shim, and as a spinal specialist, I see lots of people who are concerned about that finding. For most folks, usually that diagnosis is found only after obtaining testing such as a cat scan or MRI of your spine. Like many things the term sounds intimidating. Let me simplify. Stenosis means narrowing. In the spine this narrowing has potential to pinch either the nerves or the spinal cord. Oftentimes a person may have some neck or back pain, and because the pain did not resolve, testing such as an MRI or cat scan is obtained. Interestingly, just because there's narrowing and pinching it does not necessarily mean there's a specific pain, numbness or tingling. Because of our experience of testing many people, and because of research that tested people without any complaints, the medical community knows as we age spinal stenosis is expected. The process of developing spinal stenosis is related to a combination of disc degeneration and arthritis. As explained in some of my prior videos, as the discs narrow the outer strong fibers, the annulus, and other associated ligaments such as the post your longitudinal ligament and the ligamentum flavum are not stretched to its normal orientation. This causes a broadening and widening of these ligaments. These ligaments typically encase the spinal components. With broadening and widening this causes narrowing on to the spinal components. Also with the disc-based narrowing the side holes where the nerves exit out the spinal canal also narrow. In addition, because the joints in the back which are called these facet joints start to rub against each other abnormally, the normal arthritis process of cartilage wear, and subsequent elongation of the bony surfaces of the joints happen. This is the so called bone spur process. When you combine these three processes, there's the development of the narrowing pinching and the spinal stenosis phenomena. The question is how does spinal stenosis affect your body? Spinal stenosis is part of the degenerative cascade. There is that arthritis component. Arthritis of your spine can cause neck and back pain. This can explain actually a lot of the discomfort you are currently having. If the nerves or the spinal cord are being pinched it can potentially cause many different sensations. A pinched nerve can be very painful with radiating symptoms down the arms and legs. Spinal stenosis can be associated with difficulty of walking for certain distances. The classic description of spinal stenosis involves the ability to walk for certain distances, then you tire. Some people can even count the steps when this happened. When they have that inability to walk, they will sit or bend for a certain period of time, then they can resume their normal walk. Another classic description of spinal stenosis is the ability to walk without difficulty when bent over a shopping cart but when standing upright you're limited to your distance of ambulation. Spinal stenosis when narrowing of the spinal cord can actually cause progressive weakness to both the arms and legs and loss of some important bodily functions including the ability to control your bladder and bowels. If you have spinal stenosis identified on testing it may not cause any pain at all. On the other hand it can cause many of the more serious complaints discussed before. Understand that spinal stenosis is part of the aging process, and is expected for everyone after a certain age. If you have a diagnosis of spinal stenosis it's important to have a discussion with your doctor to see if the findings on testing is actually related to your current complaints. Depending on your symptoms, options as simple as activities modifications to as drastic as surgery may be necessary. I'm Dr. John Shim, discussing spinal stenosis. If you find this information useful, please explore our other blogs and videos, and subscribe to our YouTube channel. Please contact us if there's a specific topic you'd also like to review. Thanks for watching.

Last modified: August 9, 2019

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