Spinal Stenosis

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Spinal Stenosis

Spinal stenosis is an abnormal narrowing of the spinal canal. The spinal canal is the passageway where the spinal cord and nerve roots are encased. This narrowing can happen at any area in the spine.
There are three major types of spinal stenosis, and identifying each will help with the treatment.
Lateral stenosis: This is the most common type and occurs when a nerve root that leaves the spinal canal is compressed by either a bulging or herniated disc. This compression can result in sciatica or lumbar/ cervical radiculopathy; depending on where the compression is.

Central stenosis: This occurs when the central canal of the spinal cord is being choked. This can lead to compression of the spinal cord and the nerve roots.

Foraminal stenosis: This area is where the nerve root leaves the spinal canal, when this is compressed it can cause radiculopathy.

Symptoms:

Pain in the affected area
Pain in legs and, or arms
Weakness in legs or arms
Numbness and tingling in legs or arms

Causes:

Bulging or herniated discs
Thickening of the ligaments in the spinal canal
Bone spurs

Screening and diagnosis:

The doctor will start out with a physical examination, after, the doctor may order some imaging such as at CT, MRI, or myelogram to help with the diagnosis. If the doctor feels that there may be nerve damage he may schedule for an electromyography (EMG). The EMG measures the signals the nerves make.

Treatments:

Conservative approach:

Anti-inflammatory medication, and in some cases pain medication
Chiropractic care
Physical therapy
Epidural steroid injections to help decrease the nerve inflammation, thus decreasing symptoms.

Surgical approach:

Surgical decompression.

Peer-Reviewed Scientific Research:

Kamihara, M., et al. (2014). “Spinal cord stimulation for treatment of leg pain associated with lumbar spinal stenosis.” Neuromodulation 17(4): 340-344; discussion 345.

OBJECTIVE: Spinal cord stimulation (SCS) is expected to have analgesic effects in patients with neuropathic pain, ischemic pain, or mixed pain. The type of leg pain caused by lumbar spinal stenosis (LSS) is considered as mixed pain, which is expected to respond to SCS. However, there is no established view on the usefulness of SCS in the management of this type of pain. Therefore, we aimed at evaluating the efficacy of SCS against leg pain associated with LSS. MATERIALS AND METHODS: Data were collected retrospectively for the period from January 2003 to December 2011 from 91 patients with LSS-associated leg pain enrolled to the SCS trial. SCS implantation was performed in patients who responded to the trial and desired to receive this therapy. RESULTS: The response rate (percentage of patients showing 50% or greater alleviation of pain) in the trial was 65% (59/91 patients). SCS implantation was performed on 41 patients. The percentage of patients who showed a good response (definition is SCS continued for one year or longer after implantation) was 95% (39/41). CONCLUSION: SCS seemed to be effective against leg pain associated with LSS. Thus, SCS should be actively adopted in indicated patients as a method of treatment intermediate between conservative therapy and surgical therapy.

Costantini, A., et al. (2010). “Spinal cord stimulation for the treatment of chronic pain in patients with lumbar spinal stenosis.” Neuromodulation 13(4): 275-279; discussion 279-280.

OBJECTIVE: Chronic back and leg pain associated with lumbar spinal stenosis (LSS) is common in the elderly. Surgical decompression is usually performed when conservative treatments fail. We present an evaluation of the long-term outcome of patients suffering from symptomatic LSS treated with spinal cord stimulation (SCS). MATERIALS AND METHODS: Data were collected prospectively in three independent registries in three European centers. Pooled data were analyzed retrospectively. Changes in pain intensity, functional status, and analgesic medication were compared at baseline and at the last available follow-up. Demographic data as well as details regarding the implantation procedure and any adverse events were systematically recorded. RESULTS: Data were recorded in 69 patients with a mean follow-up period of 27 months. All patients showed clinically and statistically significant improvement in pain relief, the visual analog scale decreasing from 7.4 +/- 2.3 to 2.8 +/- 2.4 (p < 0.05). The use of analgesic medication decreased and the functional status improved. CONCLUSION: Spinal cord stimulation seems to be effective in the treatment of patients suffering from chronic pain associated with LSS. Being less invasive and reversible, SCS should be considered before surgical decompression, particularly in patients with increased risks associated with back surgery.