Spinal Stenosis

Spinal stenosis arises when one or more bony openings (foramina) in the spine become narrower, leaving less room for the nerves. This narrowing can occur in the spinal canal, which houses the spinal cord; or in the intervertebral foramina, where spinal nerves leave the canal. Based on the severity and location of the narrowing, it may compress a spinal nerve or the spinal cord, leading to symptoms such as pain, numbness, tingling, or weakness.

Types of Spinal Stenosis

Foraminal Stenosis (Lateral Stenosis): Occurs when the foramina through which spinal nerves pass becomes narrowed, compressing the nerves. Lateral recess stenosis is when the spinal nerve gets compressed just before it enters the intervertebral foramen. On the other hand, far lateral stenosis happens when the spinal nerve is compressed after it exits the intervertebral foramen.

Central canal stenosis: This arises when the spinal cord is compressed within the central spinal canal, which is the bony passage it runs through.

Symptoms

• Radicular pain: Pain radiating from the spine into one arm or leg, or occasionally both. It may vary from a dull ache or tenderness to a sharp, electric-like pain or burning feeling.
• Radiculopathy: Neurological symptoms caused by spinal nerve root compression, including numbness, tingling, or muscle weakness that affects an arm or leg.
• Myelopathy: Neurological issues caused by spinal cord compression. Symptoms can include numbness, tingling, or weakness in both arms and legs. Myelopathy may also lead to other problems, such as bladder or bowel dysfunction.
• Cauda equina syndrome: A condition resulting from compression of the cauda equina (nerve roots running below the spinal cord). Symptoms include saddle anaesthesia and loss of bowel or bladder control. It is a medical emergency requiring prompt attention to prevent irreversible nerve damage.

Causes

Spinal stenosis occurs when the spaces within the spine narrow down, exerting pressure on the nerves. The most common causes are:

• Ageing: As people age, their spines naturally deteriorate.
• Osteoarthritis: The spinal canal may narrow because of bone spurs caused by cartilage degradation.
• Herniated discs: Bulging discs may press on the spinal nerves.
• Thickened ligaments: The stiffening and thickening of the spine’s ligaments can constrict the space.
• Injuries: Spinal trauma may result in swelling or misalignment.
• Tumors: The spinal canal may be compressed by abnormal growths.

Diagnosis

At The Joint Pain Clinic, we diagnose spinal stenosis by looking at the patient history, as well as conducting a physical exam.

Patient history: A detailed medical history review, including recent symptoms, helps identify potential causes.

Physical examination: The clinician examines the spine by observing and palpating, focusing on areas like the neck or lower back. Tests are conducted to assess leg and/or arm strength, reflexes and feeling (tingling or numbness). Also, provocative tests may be performed to determine the movements or positions that exacerbate nerve compression and pain.

Treatment

Our treatment options for spinal stenosis involve:

• Medications
• Physical therapy
• Steroid injections
• Laser spine surgery
• Dynamic spine stabilisation
• Spinal disc replacement surgery

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