Spinal stenosis is the narrowing of the spinal structures, either the bones or soft tissues, around the spinal cord and/or nerves. Spinal stenosis can occur in the central spine and compress the spinal cord or multiple nerves, or it can occur as nerve roots exit the spinal canal, affecting individual nerve roots.
Spinal stenosis can be classified as cervical, thoracic, or lumbar stenosis, with cervical and lumbar stenosis being the most common as these are the most mobile parts of the spine. Spinal stenosis can occur with trauma, disk herniations, degenerative changes, bony overgrowth, and anatomical variations (some people are born with it).
Progressive spinal stenosis often occurs over decades and is the result of an aging and degeneration process.
Regardless of how it occurs, spinal stenosis narrows the area around the neural elements, which can affect their function. This can result in pain, weakness, clumsiness, and sensory changes.
Spinal stenosis can present with a variety of symptoms, including pain, numbness, weakness, mobility issues, and poor balance.
Bowel and bladder incontinence, along with sexual dysfunction, can be especially worrisome. The symptoms also are concerning when they occur rapidly over hours, days, and weeks.
They can be less noticeable but still severe when they occur slowly over several years.
While nerve roots compressed as they exit the spinal canal result in more pain, weakness, and sensory changes, compression of the spinal cord centrally may not be painful and may present as clumsiness, dexterity issues, and generalized weakness.
Dr. Birinyi tells patients that compression of the spinal cord or nerve roots centrally at any level can cause symptoms at any level below that level.
It is essential to be evaluated by a neurosurgeon when symptoms occur and progress as, even with decompression of spinal stenosis, some symptoms may never resolve completely.
Spinal stenosis has many causes and can occur over hours, weeks, months, or years. The two largest/significant predictors of spinal stenosis, from a degeneration standpoint, are genetics and tobacco use.
Factors such as osteoarthritis can collapse the spinal column, resulting in bony overgrowth, bone spurs, thickened ligaments, and neural compression. Spinal injuries from fractures or disk herniations can also cause stenosis.
Wear-and-tear changes on the spine from heavy-duty work, poor posture, and overuse of the spine probably contribute to some bony overgrowth and spinal stenosis.
With any single or repetitive injury, the body tries to heal itself and protect the joints of the spine by reinforcing them with extra bone. Unfortunately, this can start to compress the nerves of the spine.
A thorough history and physical examination can lead to a spinal stenosis diagnosis, which can be confirmed with very sensitive modern imaging.
Spinal stenosis is best outlined using MR imaging, which can show how the neural elements are affected by compression by both bony and soft tissues.
If an MRI is not possible due to medical devices or free metal in the body, a CT myelogram can be helpful in the evaluation of spinal stenosis. While an MRI is a non-invasive scan, a CT myelogram requires the injection of dye into the sac containing the spinal fluid and nerve roots prior to undergoing a non-invasive CT scan.
MRI scans avoid radiation, while CT scans use radiation, the exposure to which should be minimized as much as possible. The actual scanning using both of these modalities is very quick.
If claustrophobia is an issue, which is typically more of an issue with the smaller opening of an MRI machine, sedating medications can be given prior to the imaging to make patients more comfortable.
In most cases of spinal stenosis, the condition cannot be reversed with medications, therapy, or watchful waiting. All of these may help improve symptoms if they are mild or in an attempt to improve pain leading up to a planned surgery.
Lifestyle modifications like reduced activity and avoiding bending, twisting, and heavy lifting with the spine can improve symptoms.
Injections and NSAIDs also can reduce the symptoms of spinal stenosis but do not reverse the condition itself. These treatments can be effective at delaying surgery.
If the neurosurgeon and patient decide that surgery is the best option for the definitive and long-term treatment of symptoms, non-operative symptom management strategies can give a patient time to lose weight, engage in strengthening exercises, arrange time off work, and find assistance around the house following surgery.
The treatment of spinal stenosis involves decompressing the neural elements (spinal cord and/or nerve roots). This can be at any level of the spine and might be with or without a fusion.
A fusion occurs when a surgery is performed to make bones grow together and stop motion. A fusion is necessary if instability causes stenosis or if decompression of the neural elements causes instability.
Often, a minimally invasive approach at the focused site of compression may be enough to relieve the symptoms of spinal stenosis.
Non-fusion surgeries include laminectomies, diskectomies, and foraminotomies. Any surgery has potential complications, including injury to the nerves and vascular structures. While surgeries are designed to improve patients’ symptoms, this, unfortunately, is not a guarantee.
In addition, sometimes, surgeries cause a need for additional surgeries. The philosophy at Performance Spine and Brain is to perform a tailored surgery focused on a patient’s individual symptoms and desired results and do this in the most minimally invasive way possible.
The recovery process following a surgical intervention varies widely depending on the surgery performed. Still, for most decompressive procedures, patients leave the hospital or surgery center on the same day as their procedure and require a few weeks to return to normal activities.
If routine activities involve heavy lifting and heavy-duty work, patients may be restricted for three months or more, depending on the surgery performed.
Often, spinal stenosis occurs through a degenerative process. We know that this is accelerated and caused motor significantly by genetics and smoking. Obviously, only 1 of these can be changed.
In addition, avoiding the “BLTs”—bending, lifting, and twisting—can potentially prevent and/or relieve symptoms associated with spinal stenosis. It is not reasonable to suggest that patients should not perform any of the BLTs. However, they should be done in a reasonable fashion, especially if a patient already has spinal issues.
These should be reserved for necessary occasions, like when they are part of a work routine or a gratifying hobby for a patient.
Weight management, proper exercise, and overall good nutrition and health may work to prevent spinal stenosis or improve symptoms.
Routine stretching, physical therapy, and chiropractic care are reasonable to try as a preventative strategy and will only improve spinal health.
While medical insurance covers many of the costs associated with the diagnosis and treatment of spinal stenosis and its associated symptoms, there are usually some costs to patients despite the best insurance coverage.
Treatment costs can be reduced potentially with a better focus on the prevention of the issues in the first place. A little money and time spent on trainers, physical therapists, and interventional pain management may prevent the higher costs of surgery, including the costs associated with being away from work and family.
Regardless of the non-surgical and surgical treatments that you may need, Performance Spine and Brain will work with you and your insurance company to cover the costs of treatment and can discuss financing options as we understand the financial burdens of neurosurgical treatments.
When medical insurance does not cover certain costs of treatment, Performance Spine and Brain has alternative treatment options that can be better financial considerations for patients.
Performance Spine and Brain is more than just a neurosurgeon. We offer complete spinal care and help patients access elements of spinal care that we do not offer through our network of trusted colleagues and affiliates.
Even if you do not need spine surgery at the moment, ongoing treatment and follow-up of your spine problems are essential.
The continuing establishment of care with a neurosurgeon and spine team allows for periodic imaging and assessments to detect any serious issues that might arise.
At Performance Spine and Brain, we pride ourselves on patient-provider communication and want to be your team when it comes to long-term spine care and symptom management.
Spinal stenosis, along with other spine problems, chronic pain, and the stress and anxiety of an upcoming surgery or time away from work and family, can take a mental toll on patients.
There is a significant psychological impact that often does not get addressed in the world of spine medicine. We believe that mental health support such as counseling, support groups, and cognitive behavioral therapy go hand-in-hand with the treatment of spine and chronic pain issues.
Anxiety and depression also must be treated appropriately to optimize recovery from any spine treatment.
At Performance Spine and Brain, we have a network of trusted providers in the mental health field who provide such psychological support.
Cognitive behavioral therapy is a treatment that works with patients to develop a coping strategy to deal with spine injuries and chronic pain. This is a highly recommended therapy that has proven successful for dedicated patients.
Schedule a time for an evaluation to discuss personalized treatment options. Specialized care from a neurosurgeon with expertise in spinal conditions is crucial to the management and treatment of this condition.
Phone: 800-238-0827
Fax: 318-219-5221
[email protected]
Mailing Address
PO Box 11758
Alexandria, LA 71315
