Spinal stenosis is an abnormal narrowing of the spinal canal (central stenosis) or the area where the nerve exits the spinal canal (lateral stenosis) that may occur in any of the regions of the spine. It may result in radiating symptoms down the arm, leg or around the chest and these symptoms may be experienced as pain, numbness, tingling or weakness.
Spinal stenosis can be caused by abnormal bone growth, soft tissue such as the ligamentum flavum buckling or extruded disc material or combinations thereof. Depending on location, it is divided into vertebral canal stenosis (central stenosis) and lateral stenosis, where the nerve root exits. Spinal stenosis can occur with age related changes in the spine, postural changes, and scoliosis or after playing “collision” sports such as football where you can find “Spear tacklers spine”. It can also be present at birth, congenital spinal stenosis.
The history and physical exam should suggest the possibility that spinal stenosis is causing the back and/or leg pain. Plain films (xrays) analysis of the spine is an efficient and inexpensive means of the initial evaluation of spinal stenosis. In a patient with degenerative spinal stenosis xrays are not specific enought to allow treatment decisions. A myelogram in conjunction with CT scan (computed tomography) are used to obtain images in different positions. An MRI (magnetic resonance imaging) provides images in all planes and of the entire lumbar and lower thoracic areas. An MRI also provides information about soft tissue structures and bone marrow changes. Clinical correlation is very important in the diagnosis of spinal stenosis.
Most patients with lumbar spinal stenosis can be treated non-surgically. The patients must be educated to understand the goal of therapy and have realistic expectations. Treatment begins with the simplest mode of therapy, such as temporary limitations of physical activities and non steroidal anti-inflammatory drugs (nsaids). If no improvement occurs over a 3-6 week period, a change in the type of Nsaid or a trial of epidural steroid injections may be considered. These patients rarely respond to braces. However, when degenerative spondylolisthesis or degenerative scoliosis exists, this may be a worthwhile treatment alternative. Physical therapy has variable affects. Patients who do not respond to conservative treatments are candidates for surgery. Surgery needs to be planned carefully to treat all aspects of the spinal stenosis. All surgery includes a decompression (laminectomy), lateral recess decompression (undercutting the facet joints) and foraminotomy. Foraminal stenosis is often overlooked can be the cause of failed back syndrome.Follow up studies show that over time, many patients will again become symptomatic even after an initial successful surgery. This finding suggests that the degenerative process continues and the continuation should be explained to the patient before surgery.
Tampa Spinal Stenosis usually occurs as a result of prior injury or trauma, or as a progression of aging and a degenerative spine and can also be congenital – where a patient is born with this. It can be well managed with physical therapy, education or medication and epidural shots. Results following surgery are also very successful. It can return as the patient continues to age or following new trauma.
Spinal Stenosis can result in significant morbidity. Severe disability and death may result from the association of cervical stenosis with trauma resulting in a central cord syndrome. Cervical, thoracic and lumbar spinal stenosis may result in motor weakness and chronic pain. Severe lumbar stenosis can be associated with a cauda equina syndrome, which results in possible paralysis of lower extremities, bladder and bowel incontinence and chronic pain.
Good common sense is the best medicine to help prevent spinal stenosis. Regular exercising including walking, riding a bicycle and swimming may reduce your chance of developing tampa spinal stenosis. Good posture reduces the stress placed on the spinal cord by the vertebrae and maintaining a healthy weight so you don’t put excessive stress on your back and abdominal muscles or on the joints between the vertebrae.
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