Here you come to know everything about Spinal stenosis. You may be:
- Living with symptoms of Spinal stenosis
- Diagnosed with Spinal stenosis
- Knowing someone with Spinal Stenosis
What does Spinal Stenosis actually mean?
Spinal Stenosis is a loss of space in the Spinal canal due to age related wear and tear from bulging discs, thickened spinal ligaments and enlarged joints. Spinal Stenosis actually means a block in your spine. The spine has a bony canal that contains the spinal cord and spinal nerves. As age advances and as you grow old, there are constant wear and tear changes in your spine. This causes the tissues and the bone inside the spinal canal to swell up. This is what leads to the block in your spinal canal. The medical term for this block is ‘Spinal canal stenosis’.
How does the MRI scan of the Normal healthy spine look like?
The lumbar spine forms the structure of your lower back. MRI scan is the most common investigation that is done to examine the lumbar spine. It shows the bones as well as the soft tissues. MRI scans are safe and they do not have any radiation risks like an x-ray or CT scan
The bones of the spine are stacked up like ‘Lego blocks’. Each lego block is called a ‘Vertebral Body’.
There are soft cushions called ‘discs’ in between these ‘Lego blocks’. These soft cushions (discs) contain a lot of water and are very soft to take the stress of the lumbar spine. These discs appear ‘white’ on the normal MRI scan.
Next to the vertebral body and the disc is the spinal canal. This is a bony canal that contains the spinal-cord. There is a special fluid in the spinal canal to protect the spinal-cord from injuries.
Changes that you can see in Spinal Stenosis on MRI
As age advances, wear and tear changes of the spine causes the soft cushions (discs) to lose their water content. They become hard and rubbery. We know that these discs are normally white in color on MRI scans.
But these white discs appear as ‘black discs’ on the MRI scan. This process is called ‘disc degeneration’. The disc therefore bulges into the canal and the tissues inside the spinal canal swell up. This causes narrowing of the spinal canal leading to a spinal block called Spinal Stenosis.
This traps the spinal nerves running in the canal.
Difference between a Normal MRI scan and scan showing Spinal Stenosis
What are the causes of Spinal Stenosis?
Sometimes the soft cushions (discs) rupture and bulge into the spinal canal. This narrows the space in the canal. The spinal nerves are trapped in the canal and cause a block in the canal. This is how a disc prolapse causes Spinal Stenosis.
2 – Fractures of the Spine
In fractures of the spine, a part of the bone is broken and moves into the spinal canal. This narrows the size of the canal. The spinal nerves are then trapped in the canal causing a spinal block. This causes Spinal Stenosis.
3 – Tumors of the Spine:
Tumours of the spine grow in and around the bones of the spine. As they grow, they move into the spinal canal. This reduces the space inside the canal. Therefore, the spinal nerves are trapped in the canal leading to a block and Spinal Stenosis.
What are the symptoms of Spinal Stenosis?
This is the most common symptom in Spinal Stenosis. The pain is present most of the time. It comes on when you start walking. Usually there is relief when you find a chair and sit down. Normal day to day activity worsens the pain.
Pain radiating from the back to the leg is called ‘Sciatica’. In Spinal Stenosis there is trapping of the spinal nerves and one or both legs may be painful. This pain comes along when you try to walk. When you rest by sitting for sometime the leg pain (sciatica) goes away. Initially the pain is not so severe and comes on occasionally while walking.
Most of us who suffer from spinal stenosis never realise that we have a problem until we develop numbness in our legs.
Back pain with loss of feeling (numbness) in the legs:
As days roll by, along with the pain in one or both the legs, you will notice that there is loss of feeling in your legs. This is worse after a walk. It will make you look for a place to sit and rest your legs in lumbar stenosis. There will be a good relief from the pain and the loss of feeling (numbness). The sensation in your legs gradually returns to normal too.
Back pain with weakness of the legs:
All these symptoms of lumbar stenosis gradually progresses to weakness in your legs. You will find it difficult to walk long distances as your legs get tired very quickly. Going outdoors for some fresh air will become a problem. Life is confined indoors with loss of your independence.
Back pain with Incontinence:
When the spinal block (Spinal Stenosis) gets worse, the first symptom is loss of control of your bladder. You get ‘accidents’ during your daily routines. There is a loss of feeling in your bum and your private areas in addition to your legs. When you wet yourself, you do not realise the episode.
Claudication in Spinal Stenosis – what does this mean?
This is a medical term to describe the pain in your legs after walking. In Spinal stenosis, to start with, there is only back pain while you walk. After sometime, the leg pain develops along with your back pain. Over time the leg pain comes on even for shorter distances and makes you stop. This is a symptom that shows your spinal stenosis is getting worse.
What is Claudication Distance – Why is it so important?
When you are out on a walk, the distance it takes to bring on the leg pain is called ‘Claudication Distance’. In Spinal stenosis, over time the leg pain comes on even for shorter distances and makes you stop. The ‘Claudication Distance’ is getting shorter. Your doctor will want to know this as it indicates that the stenosis is worsening. You will need an MRI scan to find out the extent of spinal stenosis.
Spinal Stenosis – Why is MRI scan the best test?
MRI (Magnetic Resonance Imaging) scan is the best test. It looks at the water content of the soft tissues. Therefore, it is very sensitive in finding out any change in the soft tissues in your spine. As we now know that spinal stenosis is a soft tissue condition where the soft tissue swells up inside the canal and blocks the spinal canal. Xrays and Blood tests are not useful in Spinal Stenosis. Xrays show the bony problems in detail and are used to find out if you had a fracture (break)in your spine after a fall. Blood tests are normal in Spinal Stenosis.
MRI scan images below show the difference in the size of the spinal canal
Managing Spinal Stenosis without surgery – Is it possible?
Yes, it is possible to manage spinal stenosis in the early stages without surgery. The symptoms are mild in early stenosis and there are a few options:
- Rest and Stretches
- Spine Injections
Rest and Stretches
When we rest, the soft tissues inside and outside the spinal canal that are swollen relaxes. This can reduce the spinal block and the trapped nerves are free in the spinal canal. Stretching of the spine moves all the joints of the spine and the tissues around the spine. This will help with the low back pain. Stretching will improve the blood flow and nutrition to the soft tissues. This heals the soft tissue inflammation that is seen in early stenosis.
Paracetamol and Ibuprofen are the most popular over the counter medications. Paracetamol relieves pain but does not control inflammation. Ibuprofen acts on both pain and inflammation. Both act by reducing the chemicals released due to inflammation and injury to the soft tissues.
Antidepressants: The popular medication is Amitriptyline. It acts on the chemicals in the brain and nerves that are responsible for pain. Amitriptyline is taken at night and this helps with the mental relaxation and sleep.
Opioid Medications: Morphine, codeine and oxycodone are the common opioid medications used in the management of pain in Spinal Stenosis. They act on the spinal nerves and block the release of the chemicals that cause pain. Opioids are addictive.
Anti-seizure Medications: Gabapentin and Pregabalin are the two commonly used medications to control back and leg pain in spinal stenosis. These medications control pain by blocking the pain messages coming to the brain from the spine.
Your Spine surgeon initially recommends physiotherapy sessions to loosen the stenosis in your spine. These sessions helps to stretch the muscles and nerves around the Lumbar stenosis. It gives the “Core Stability” for your lower back. Your spine gets strengthened and most activities and your posture will become pain-free.
Please check my blog on “Physiotherapy for Low Back Pain“
In some instances, physiotherapy and altering your posture may not be successful in managing your back and leg pain caused by Spinal Stenosis. The nerves that are trapped in your back may cause you pain. This will stop you from going through all the physiotherapy exercises. A mixture of a local anaesthetic and steroid will be required to reduce the pain and inflammation caused by the trapped nerves. These injections are called Caudal Epidural Injections and are very successful in the management of pain in Spinal Stenosis.
Please check my blog on: “Injections for Spinal Stenosis“
Surgery for Spinal Stenosis – Posterior Decompression of Lumbar Spine
This is a common procedure done for Spinal stenosis. This is a very safe procedure. It is usually recommended when all the above conservative non-surgical options do not work. If your symptoms progress, surgery for spinal stenosis is a good option. You will have a general anaesthetic and your are fully asleep during the entire procedure. The results of surgery today are reliable.
What happens before the lumbar spine decompression procedure for Spinal Stenosis?
You’ll be required to come to the hospital the night before so that they can perform simple blood tests, check your temperature and blood pressure. This ensures that you are safe and healthy for the spine decompression procedure. An experienced anaesthetist will arrange your anaesthesia during the procedure. He will also review your medication and advice on the time of fasting for the procedure.
Your spine surgeon and his team will make sure that you have all the necessary information on Spinal Stenosis before the procedure.
Most probably you will be advised to:
- Bring are your medications including the prescription
- Stop all tablets that causes your blood to become thin
- Have a blood test to check your fitness for the procedure
How is the lumbar spine decompression procedure performed for Spinal Stenosis?
You will be transferred to the anaesthetic room and anaesthetist and his team will relax you into sleep. You will not feel any pain during the procedure. You will lie flat on your tummy and the Spine surgeon will make a small incision in the middle of your back. With the help of an operating microscope, he opens the spinal canal and removes the block. He will make sure that he frees up all the spinal nerves in the spinal canal caused by the spinal stenosis. The incision is closed with absorbable sutures and covered with a dressing.
The benefits of the microscopic lumbar decompression include unlimited muscle dissection, good clarity and detail of the anatomy that ensures safety of the procedure. The pain and the risk of complication is much reduced and there is very little discomfort during recovery.
What happens after Lumbar Spine decompression procedure for Spinal Stenosis?
After the procedure your Consultant anaesthetist will arrange transfer from the operating theatre into the recovery room. After you are fully awake, you will be then transferred to your room. Later in the day, the physiotherapist and the spinal specialist nurse will help you to get up and move about. Next day, we will assess your progress. Once the Consultant spinal surgeon and his team are satisfied with your progress, you will be discharged with a clear set of instructions to follow. You will be expected to stay for a period of 1 to 2 days after surgery for Spinal Stenosis.
After discharge from the hospital
After discharge from the hospital you will be given a discharge summary and a booklet. This will contain all the details of the Lumbar decompression procedure. The summary will contain the list of medications that you might need to take to control your pain after surgery. It will also help you move around. The physiotherapist will help you with the exercises for spinal stenosis surgery. This will improve your muscle tone and aids faster return to normal activity. There will be a wound check at one week and a further appointment to remove any stitches. You will be advised on the level of activity permitted.
What should I do at home?
The spine surgeon and his team will expect you to have had a good rest so that the soft tissues around your lower back has enough time to heal. This will reduce complications like infection and bleeding. You can gradually increase your daily activities with support during the first few days. Please follow the physiotherapist advice for lumbar spinal stenosis surgery on how to sit, stand and get on and off the bed. You’ll be required to take your medications for the first few weeks so that you’ll be able to mobilise without any pain.
What do I need to be careful about after Spine Decompression Surgery?
Lumbar Spine Stenosis surgery is complex surgery. Your skin is sutured with many layers of stitches. Please make sure that your surgical wound does not get wet or soiled when you wash and clean yourself in the first 14 days. Do not bend or lift anything as this will cause the wound to open up and get infected. Physiotherapist will guide you with gentle physiotherapy exercises to increase the tone and strength of your back muscles for faster recovery back to normal. Get in touch if there are any concerns.
Follow up appointment after Spine Decompression Surgery
The secretary will arrange a follow-up appointment in about two weeks’ time for a review with the spine surgeon after spinal stenosis surgery. You may need to continue physiotherapy rehabilitation for a period of up to 6 weeks.