Spinal Stenosis – Answered by Arizona Pain

Slow, progressive narrowing of the spinal canal is called spinal stenosis, and compression of the spinal cord is called myelopathy. With spinal stenosis and myelopathy, the patient experiences a wide range of symptoms, inhibits mobility, and causes discomfort.

What symptoms are associated with spinal stenosis?

Symptoms occur when the spinal canal nerve roots and cord become compressed. This leads to cramping, pain, numbness, and/or weakness. Depending on where the narrowing occurs, the patient may feel symptoms in the low back, neck, legs, shoulders, and/or arms. The pain in the legs often affect walking and climbing stairs.

What causes spinal stenosis?

Spinal canal narrowing is usually caused by wear and tear arthritis (osteoarthritis). It is also caused by thickening of the ligaments and bulging of the intervertebral discs. The symptoms usually progress as the disease progresses. In addition, some people are born with a small spinal cord, which is referred to as congenital stenosis.

Who is at risk for spinal stenosis?

Risk factors for developing spinal stenosis include:

Gender – Females are more likely to have the condition than males.

Congenital condition – Being born with a narrow spinal canal.

Age – You are 50 years old or more.

Structural damage – This includes any previous surgery or injury of the spine.

Certain diseases – These include bone spurs, osteoarthritis, inflammatory spondyloarthritis, spinal tumors, and Paget’s disease.

How is a diagnosis for spinal stenosis made?

You would be asked questions about your symptoms, by the doctor, a physical examination would be conducted, and imaging tests would be done. These include x-rays to evaluate bones, magnetic resonance imaging (MRI) scans, which use radio waves and magnets to take detailed pictures of your spinal discs and nerves. A computed tomography (CT) scan takes 3-D images of the spine and spinal cord, and a CT myelogram involves injecting dye into the spinal cord sac to show details of the injured or damaged structures. The doctor may conduct an electromyography (EMG), which assesses nerve and muscle cell function.

How can spinal stenosis be treated?

Treatment of spinal stenosis depends on the severityof thedisease, and what therapies have failed in the past. Options include:

Physical therapy – You will work with a physical therapist to learn exercises that will strengthen the spine, improve flexibility and balance, and improve posture. These therapies will help relieve the pressure on your pinched nerves.

 

Epidural steroid injection – ESI is used to introduce a corticosteroid into the epidural cavity between the spinal cord and the epidural layer. Sometimes, the doctor adds an anesthetic agent for a numbing effect. ESI showsan 80-90% success rate in clinical studies.

 

Medications –Non-steroidal anti-inflammatory drugs, for instance, ibuprofen may be prescribed. Many medicines will help with the symptoms associated with spinal stenosis.

 

Facet joint injections (FJIs) – The doctor will insert small needles into the facet joints, which are located along the back of the spinal column. A long-acting anesthetic (with or without a corticosteroid) is injected into the joint space.

 

Facet joint denervation – If the patient responds to FJIs, the pain specialist may choose to use radiofrequency energy to disrupt the nerve root at the affected region. A recent clinical study found this procedure to have a 76% efficacy rate, with the majority of participants reporting complete symptom relief.

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