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Lumbar
spinal stenosis is a disease that is caused by a gradual
narrowing of the spinal canal. This narrowing happens
as a result of the degeneration of both the facet
joints and the intervertebral discs. In this condition,
bone spurs, called osteophytes, which develop because
of the excessive load on the intervertebral disc,
grow into the spinal canal. The facet joints also
enlarge as they become arthritic, which contributes
to a decrease in the space available for the nerve
roots. The ligaments of the spinal column, especially
the ligamentum flavum, become stiff, less flexible,
and thicker with age, which also contributes to spinal
stenosis. These processes narrow the spinal canal
and may begin to impinge and put pressure on the nerves
roots and spinal cord, creating the symptoms of spinal
stenosis.
Stenosis
may occur in the central spinal canal (central stenosis)
where the spinal cord or cauda equina are located,
in the tract where the nerve root exits the central
canal (lateral recess stenosis) or in the lateral
foramen (foraminal stenosis) where the individual
nerve roots exit out to the body.
Some
distortion of the spinal canal will occur in virtually
every person as they age, but the severity of the
symptoms will depend on the size of a person's spinal
canal and the encroachment on the neural elements.
The rate of deterioration varies greatly from person
to person, and not everyone will feel symptoms.
Spinal
stenosis may be caused by a number of processes that
decrease the amount of space in the spinal canal available
for the neural elements. Degenerative causes are the
most common, but there are a few unusual causes of
stenosis. These include calcium pyrophosphate crystal
deposition, amyloid deposition, and intradural spinal
tumors. The reason why stenosis causes weakness and
pain is the subject of a significant amount of debate
and medical research. Pain in the buttocks or leg,
which is a common symptom of lumbar spinal stenosis,
may be associated with the compression of the micro-vascular
structures carrying blood flow to the nerve roots.
At the same time, the symptoms of spinal stenosis
may be the direct result of physical compression of
the nerve roots. Each of these processes may interfere
with the normal function of the nerve roots and decrease
the effectiveness and endurance of the spinal nerves.
Symptoms:
Some people with degenerative disease of the lumbosacral
spine may be totally asymptomatic, some may complain
of mild discomfort in the low back, and others may
not even be able to walk. In patients who have significant
spinal stenosis, they will begin to notice pain in
the buttocks, thigh or leg that develops with standing
or walking, and improves with rest. In some cases,
a patient will complain of leg pain and weakness without
having any back pain. More severe symptoms of the
disorder include numbness, paresthesia and weakness
in the lower extremities. Certain positions can alleviate
the symptoms of spinal stenosis by increasing the
amount of space available for the nerves. These positions
usually involve flexion of the lumbar spine and bending
forward. "Any positions that flex the lumbar
spine are associated with resolution of symptoms."
For instance, patients with spinal stenosis can ride
a bike and walk up an incline or flight of stairs
without any pain. They can often walk for extended
distances if they have something to lean on, like
a shopping cart. However, if they are walking down
an incline or flight of stairs, or if they have to
give up the shopping cart, their symptoms will often
reappear.
The
presentation and severity of the symptoms of spinal
stenosis depends on the several factors, including
the original width of the spinal canal, the susceptibility
of the nerves involved, and the unique functional
demands of the patient and the pain tolerance of each
individual patient.
Diagnosis:
The diagnosis of spinal stenosis begins with a complete
history and physical examination. Dr. Cady will determine
what symptoms are present, what makes them better
or worse, and how long they have been present for.
A physical examination is essential for determining
how severe the condition is, and whether or not it
is causing weakness or numbness in certain parts of
the body. Abnormalities in the strength and sensation
of particular parts of the body that are found with
a neurological examination provide the most objective
evidence of chronic nerve root compression caused
by spinal stenosis. There are no laboratory tests
that can detect the presence or absence of a stenosis,
but they may be helpful in the diagnosis of unusual
causes of nerve root and spinal cord dysfunction.
Routine radiographs of the lumbar spine are very helpful
in determining the amount of degeneration that is
present in the spine, which gives an indirect indication
of whether or not spinal stenosis is present. These
x-rays are also used to determine if certain parts
of the spine are unstable, which may be contributing
to the symptoms of stenosis.
A
CT scan (CAT scan) provides excellent visualization
of the bony anatomy of the spinal column and is an
indispensable tool for determining where the stenosis
is located. This test is often performed in conjunction
with a myelogram, which involves injecting dye into
the space occupied by the spinal cord and nerve roots,
in order to determine how well the cerebrospinal fluid
is able to travel along the nerve roots. An EMG or
electromyography test may help to determine which
nerve root in particular is not working normally in
the situation where several nerve roots may be involved.
Treatment:
Chiropractic care and physical therapy are very helpful
in most patients. Our approach is a little different
than with other conditions in that we determine what
joints have decreased motion and we work to improve
overall function of all of the restricted joints which
decreases the inflammation in the spine. This combined
with physical therapy to decrease swelling helps the
patient to be much more comfortable.
In
some cases, we need to work closely with your medical
doctor to allow the most improvement. Your medical
physician may prescribe medication to improve the
inflammation, injections to relieve the pain or in
severe cases, you may need surgery. Surgery is a last
resort in most cases, but is the best treatment in
some very severe cases. Call us today at 408-739-2273
to set up an appointment.
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