The spinal cord is an integral part of our nervous system. Many nerves branch out from it, all along its length, transmitting signals to different body parts.
The spinal cord emerges from the base of the brain and runs down the spine inside a bony column or tunnel called the spinal canal. The spinal canal protects the spinal cord from day-to-day bumps and bruises.
“In certain conditions, there is a narrowing of the spaces within the spine, which puts pressure on the spinal cord and nerves. This condition is known as spinal stenosis,” says Dr Mohana Rao, neurosurgeon at Rao Hospital, Guntur, Andhra Pradesh. The symptoms could be debilitating, ultimately leading to disability in the affected person, thereby reducing the quality of life.
The upper neck (cervical region) and lower back (lumbar region) areas of the spine are frequently affected by stenosis. However, the upper back area (thoracic spine) can also get involved. Studies have suggested that 1 in every 100,000 may develop cervical spine stenosis and 5 in 100,000 lumbar spine stenosis.
Dr Rao adds that spinal stenosis is common with ageing. However, the condition is also seen in younger people born with a narrow spinal canal or an injury to the spine.
Depending on which region of the spine is affected and to what degree the spinal cord and nerves are compressed, the person experiences different symptoms. Dr Rao says, “Common symptoms include lower back pain, leg pain, numbness, weakness in limbs, and difficulty walking or maintaining balance.” He adds that spinal stenosis can compress nerves that control bowel and bladder function in severe cases, leading to incontinence (lack of control) in both.
“If left untreated or inadequately managed, spinal stenosis can lead to progressive nerve damage and permanent disability in the affected persons due to loss of functions in limbs,” says Dr Rao.
Causes of spinal stenosis
“Spinal stenosis is often caused by age-related degeneration of the spine, including bulging or protruding (herniating) discs, bone projections, and thickened ligaments,” says Dr Rao.
Three different sites can be affected in the bones of the spine (vertebrae):
- The spinal canal, the hollow space in the centre of each vertebra
- The canals at the base or roots of nerves branching out from the spinal cord
- The openings between vertebrae, through which nerves leave the spine.
Other factors include spinal tumours, fat deposition on the meninges (the protective covering of the spinal cord), fractures due to injuries and abnormal curvature of the spine (scoliosis) that can cause spinal stenosis.
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Early diagnosis is essential
Diagnosis begins with reviewing the person’s medical history and conducting a physical examination. The doctor checks for the symptoms and changes in neurological functions such as sensation, reflexes, motor strengths, and any difficulty in walking or balance.
Dr Rao suggests the following imaging tests for the diagnosis:
- X-rays identify fractures to the bone, protrusions or tumours compressing the spinal cord.
- Computed tomography (CT) scan is more sensitive and helps diagnose problems with the spinal canal and the surrounding tissues. It can clearly reveal the shape of the spinal canal and to what degree there is a narrowing. It can also help detect minor fractures and hardening of ligaments compressing the spinal cord or nerves.
- Magnetic resonance imaging (MRI) can capture images of soft tissues, such as the spinal cord, disks, ligaments, and nerve roots in and around the spine. It shows spinal cord abnormalities along with the degree of spinal stenosis. It also helps identify the degree of degenerative change and the size of the spinal canal.
“While spinal stenosis cannot be cured entirely, proper management and treatment can significantly improve symptoms and quality of life,” Dr Rao says. He lists a few methods:
Physical therapy involves exercises to help the mobility of the spine and strengthen the abdominal and back muscles. These exercises stabilise the spine, improve flexibility and build endurance.
Usually, over-the-counter pain relief medicines and anti-inflammatory steroidal injections reduce the symptoms and help manage them.
Nerve root blocks by steroid-based injections that help to numb the pain by blocking pain signals from affected nerves and providing temporary relief.
Surgery is usually suggested when non-surgical treatments have failed to provide relief, and the symptoms impact daily life. Surgical options include the removal of bony fragments or portions of vertebrae that are pressing the spinal cord and nerve roots to relieve the pressure.
Sometimes, when a disc in the spine is worn out, spinal fusion is done. This method fuses adjoining vertebrae after removing the disc between them and securing the two bones with metal or bony grafts.
Road to recovery
The time to recover from spinal stenosis varies and depends on the type of surgery performed and the individual person. It generally takes several weeks to months to fully recover.
Physical therapy is integral to the recovery process after surgery. It helps in improving strength, flexibility, and mobility. Lifestyle changes such as maintaining a healthy weight, regular exercise, and good posture help manage symptoms and prevent further progression.
Maintaining good posture, exercising regularly, and avoiding excessive strain on the spine can reduce the risk of developing spinal stenosis.