Spinal Stenosis

Spinal stenosis is a term used to describe a narrowing of the spinal canal, which contains the spinal cord and emerging nerve roots. It can occur in any portion of the spine. Because of limited space, changes in the bone (vertebral bodies) or soft tissues (spinal ligaments) can result in compression of the affected spinal cord and blood vessels. This narrowing can be congenital (genetic) or acquired (arthritis, trauma, bone disease, tumor) or a combination of both. Stenosis can be classified by location: central (involving the spinal cord) or lateral (affecting the nerve roots). Cord compression can also occur in patients with advanced cancer. The February 27, 2008, issue of JAMA includes an article about treatment options for cord compression due to metastatic cancer.


CONDITIONS THAT RESULT IN SPINAL STENOSIS
Osteophytes—formation of bony spurs associated with osteoarthritis
Herniated disk—protrusion of a cartilage disk between vertebrae
Malignancy—cancer
Scarring and inflammation of supporting spinal ligaments
Abscess—localized infection
Spondylolisthesis—a shift or abnormal stacking of 2 vertebral bodies
Congenital—genetic predisposition, which results in a developmentally small spinal canal
Systemic bone diseases (such as Paget disease of bone)

SYMPTOMS OF SPINAL STENOSIS
Pseudoclaudication—difficulty in walking
Paresthesia—abnormal skin sensations such as numbness and tingling
Muscle weakness
Localized or radiating pain
Loss of bladder or bowel control

DIAGNOSIS AND TREATMENT
Spinal stenosis can be diagnosed based on the history of symptoms, a physical examination, and imaging tests. Once the diagnosis is confirmed, treatment may be conservative (rest, steroid injections, medications, and exercise) or surgical. As symptoms become debilitating, surgery may be considered a treatment option. The main goal of any surgical procedure is to remove pressure from the spinal cord or nerve roots. This means that the tube of the spinal canal must be made larger by removing excess bone, ligaments, and abnormal tissues that are compressing the nerve roots. This type of surgical procedure is termed a decompressive laminectomy (removing a portion of the vertebral body and surrounding soft tissue). If individuals have both spinal stenosis and instability of the spine, the surgical procedure should include a decompression coupled with a spinal fusion (use of instrumentation supplemented with bone graft to maintain the structural support of the spinal column).

FOR MORE INFORMATION
American Association of Neurological Surgeons (AANS) http://www.neurosurgery.org/
American Association of Orthopaedic Surgeons (AAOS) http://www.aaos.org/
North American Spine Society (NASS) http://www.spine.org/