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Spinal Stenosis Diseases & Conditions
Spine
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What Is Spinal Stenosis?

Spinal stenosis is a narrowing of spaces in the spine (backbone) that results in pressure on the spinal cord and/or nerve roots. This disorder usually involves the narrowing of one or more of three areas of the spine: (1) the canal in the center of the column of bones (vertebral or spinal column) through which the spinal cord and nerve roots run, (2) the canals at the base or roots of nerves branching out from the spinal cord, or (3) the openings between vertebrae (bones of the spine) through which nerves leave the spine and go to other parts of the body. The narrowing may involve a small or large area of the spine. Pressure on the lower part of the spinal cord or on nerve roots branching out from that area may give rise to pain or numbness in the legs. Pressure on the upper part of the spinal cord (that is, the neck area) may produce similar symptoms in the shoulders, or even the legs.

Who Gets Spinal Stenosis?

This disorder is most common in people over 50 years of age. However, it may occur in younger people who are born with a narrowing of the spinal canal or who suffer an injury to the spine.


What Structures of the Spine Are Involved?

The spine is a column of 26 bones that extend in a line from the base of the skull to the pelvis. Twenty-four of the bones are called vertebrae. The bones of the spine include 7 cervical vertebrae in the neck; 12 thoracic vertebrae at the back wall of the chest; 5 lumbar vertebrae at the inward curve (small) of the lower back; the sacrum, composed of 5 fused vertebrae between the hip bones; and the coccyx, composed of 3 to 5 fused bones at the lower tip of the vertebral column. The vertebrae link to each other and are cushioned by shock-absorbing disks that lie between them.

The vertebral column provides the main support for the upper body, allowing humans to stand upright or bend and twist, and it protects the spinal cord from injury. Following are structures of the spine most involved in spinal stenosis.

What Causes Spinal Stenosis?

The normal vertebral canal provides adequate room for the spinal cord. Narrowing of the canal, which occurs in spinal stenosis, may be inherited or acquired. Some people inherit a small spinal canal or have a curvature of the spine (scoliosis) that produces pressure on nerves and soft tissue and compresses or stretches ligaments. In an inherited condition called achondroplasia, defective bone formation results in abnormally short and thickened pedicles that reduce the diameter of (distance across) the spinal canal.

What Are the Symptoms of Spinal Stenosis?

Spaces within the spine can narrow without producing any symptoms. However, if narrowing places pressure on the spinal cord or nerve roots, there may be a slow onset and progression of symptoms. The back itself may or may not hurt. More often, people experience numbness, weakness, cramping, or general pain in the legs that occurs during flexing the lower back while sitting. (The flex position "opens up" the spinal column, enlarging the spaces between vertebrae at the back of the spine.) If a disk between vertebrae is compressed, people may feel pain radiating down the leg (sciatica).

People with more severe stenosis may experience abnormal bowel and bladder function and foot disorders. For example, cauda equina syndrome is a partial or complete loss of control of the bowel or bladder and sometimes sexual function; it is due to compression of the collection of spinal roots that descend from the lower part of the spinal cord and occupy the vertebral canal below the cord. In very rare instances, compression above the area where the lumbar vertebrae and sacrum meet results in partial or complete paralysis of the legs.

Who Treats Spinal Stenosis?

Nonsurgical treatment of spinal stenosis may be provided by internists or general practitioners. The disorder is also treated by specialists such as rheumatologists, who treat arthritis and related disorders; and neurologists, who treat nerve diseases. Orthopaedic surgeons and neurosurgeons also provide nonsurgical treatment and perform spinal surgery if it is required. Allied health professionals such as physical therapists may also help treat patients.

To read the rest of this excellent article from The National Institute of Arthritis and Musculoskeletal and Skin Diseases, including how spinal stenosis is diagnosed and treated, please click here: http://www.niams.nih.gov/hi/topics/spinalstenosis/spinal_sten.htm


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March 2008