Spinal Stenosis is a narrowing of the spinal canal which can happen
at any level in the spine. The narrowing can be either congenital, as
seen in the condition known as Trisomy 13, or it can be acquired as part
of a degenerative process. Stenosis consists of two primary forms - central spinal stenosis and lateral recess stenosis.
spinal stenosis, as the names suggests, causes blockage of the central
spinal canal. In the cervical and thoracic spine, this blockage produces
difficulty with balance such that one’s gait becomes awkward and
spastic. In the lumbar spine, the central spinal stenosis causes rapid
exhaustion of the legs with any attempted prolonged standing or walking.
Patients will start off with normal leg strength that rapidly
diminishes until they are forced to sit and rest. This diagnosis can be
confused with vascular insufficiency, however, the difference is that
with spinal stenosis, most patients seek out a chair or bench to rest
while they recover, whereas the patient with vascular insufficiency
merely needs to stop and rest while their legs recover. Sitting is
usually not part of their typical recovery experience. Lumbar stenosis
can also be confused with peripheral neuropathy which is loss of nerve
function in the hands or feet attributed to medical conditions causing
irreversible nerve failure. The neural symptoms arising from neuropathy
are constant and not affected by walking or by activities.
recess stenosis, also known as foraminal stenosis, is the blockage of
the side tunnels through the nerves escape to reach their end goal, be
it for sensation, pain detection or for muscle stimulation. This type of
stenosis causes direct nerve root entrapment and results in
well-defined areas of neural injury, in contrast to central spinal
stenosis in which the perceived distribution of the neural insult is
more wide spread.
The treatment for both forms of spinal
stenosis depends on clearly identifying the site of neural compression.
Although anti-inflammatory medications and pain-relievers will lessen
the symptoms, epidural steroid injections have become the initial
mainstay of treatment. Ultimately, surgery may become necessary to
eliminate the neural compression. Surgical options may include a
foraminotomy, laminectomy or laminotomy. In each, the goal is the same –
to eliminate the source of neural compression and to preserve the
mechanical integrity of the spine.