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"Understanding Spinal Stenosis"

Spinal stenosis is described by any condition that results in the narrowing of the spinal canal or foramina. The occurrence of spinal stenosis is more common in women over the age of 50.

The pain associated with central spinal stenosis is the result of a compression on the spinal cord as it traverses through the spinal canal. This occurs when there is an abnormal build up of bone inside the canal which then closes in on the delicate structures of the spinal cord, including the peripheral nerves that feed the legs.

SPINAL STENOSIS presents with symptoms of lower back pain and/or radiating pain into the leg(s), often referred to by physicians as lumbar radiculopathy. Usually, with spinal stenosis the referring pain going into the legs is located on both sides. Symptoms of pain usually begin at the hips and go all the way into the lower legs.

Spinal stenosis is primarily caused by degenerative changes and attributed to one or more factors; a narrowing of the spinal canal, a prolapsed intervetebral disc, hypertrophy of the ligamentum flavum, or facet joint hypertrophy. Any one of these factors may compromise an exiting nerve root(s). The degree of spinal stenosis can be detected using an MRI.

Functionally, spinal stenosis will have the most impact on activities that place the lower spine into some extension (the position of arching your lower back or otherwise known as an inward bend). These are activities that include standing, walking, and climbing stairs, to name a few. The longer the individual participates in these activities, the greater the painful symptoms become. Relief is sought by going into some spinal flexion for a period of time, such as sitting. In a flexed posture, the spaces within the spinal canal are greater and thereby reduce symptoms.

Treatment for Spinal Stenosis

A physician may prescribe non steroidal anti-inflammatory medication or an external support such as a soft lumbar corset. Epidural steroid injections have also been known to have some benefit for people with spinal stenosis. The physician may also prescribe physical therapy with therapeutic exercises for your spinal stenosis.

Therapeutic exercises can be of some benefit, and should focus on flexion patterns. Education should be to avoid repeated extension patterns. Shearing forces of the lower back should also be avoided and would include activities that place the spine into positions of rotation. Aerobic conditioning can be performed with emphasis on spinal flexion, like that of a recumbent stationary bike.

Lifestyle modifications are important in order to avoid activities which will exacerbate the condition.

Spinal Stenosis Surgery

If the quality of life continues to diminish, surgery may be a viable option. An orthopedic surgeon or neurosurgeon may perform what is called a laminectomy. This involves removing a piece of the lamina from the vertebrae to provide posterior exposure of the spinal cord and nerve roots to relieve pressure and create more space. 

Obviously, an approach that is non surgical in nature is not as aggressive, and it will not alter the structural changes taking place in the spinal canal. It will only work to manage spinal stenosis until a more permanent solution is sought.

 

Tommy Hoffman, P.T. By Tommy Hoffman, Licensed Physical Therapist

 


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