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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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