Spinal Stenosis: An Overview
What Is Spinal Stenosis?
Spinal stenosis is the narrowing of the spinal canal (spaces within the spine) that may exert pressure on the nerves along the spine. Spinal stenosis occurs most often in the lower back and the neck.
What Causes Spinal Stenosis?
The main cause of spinal stenosis is bone degeneration due to ageing. As we grow older, the vertebrae and intervertebral discs are prone to collapse due to degeneration. The collapsed vertebrae may compress and cause the rupture and inflammation of the intervertebral disc. Chronic inflammation of the small joints also causes the bones to grow spurs that oppress the spinal cord and spinal nerve roots, which leads to spinal stenosis.
Other causes of spinal stenosis include:
- Bone fragments due to fractures
- Scoliosis due to old-age degeneration
- Thickening of the ligaments in of the spine
Some patients with spinal stenosis may not have any symptoms, while other patients may have multiple symptoms. In the case of spinal stenosis, symptoms may worsen over time. Symptoms may vary depending on the location of the stenosis and which nerves are affected.
- Leg pain
- Leg paralysis
- Numbness in the leg
- Weakness in the leg
- Inability to walk
To diagnose spinal stenosis, your doctor may ask you about signs and symptoms, discuss your medical history, and conduct a physical examination.
Your doctor may order several imaging tests to help pinpoint the cause of your signs and symptoms. Some of the tests include:
- MRI scan
- X-ray scan
Who Are At Risk?
There are certain risk factors that may lead to spinal stenosis. Some of the risk factors include:
- Elderly people
- Workers who have long been burdened with heavy work due to work needs
- Those who have long-term bad sitting postures
- Those with family members suffering from spinal stenosis
The treatment of spinal stenosis consists of conservative treatment and surgical treatment. Conservative treatment is more suitable for patients with mild symptoms. Patients with severe symptoms affecting quality of life should consider surgery to solve the root cause of their condition.
- Conservative treatment:
- Medication and physical therapy – taking analgesic, anti-inflammatory or swell-reducing medication combined with physical therapy can reduce the swelling of the spinal nerve roots, thus reducing pain.
- Steroid injection / infiltration – Steroids can reduce inflammation and swelling that cause the spinal nerve roots to be oppressed. However, the steroid injection only reduces pain temporarily and does not solve the root cause of spinal stenosis.
- Radiofrequency modulation – A needle-sized medical device is inserted into the lumbar spine to eliminate the pain at the nerve. This method is more effective than steroid injection / infiltration and provides longer relief.
- Decompression – This surgery aims to remove the roots of the spinal nerve roots. If the spinal stenosis is caused by bone spurs, spur resection will be done; If it is caused by thickening of the ligamentum flavum, the ligamentum flavum will be removed. The benefit of decompression surgery is that this is a low-risk procedure and the flexibility of the lumbar spine is maintained after surgery. Decompression surgery can be performed via mini-open technique, video-assisted tubular system, or endoscopic technique.
Endoscopic spine surgery (ESS) is an advanced form of minimally invasive spine surgery designed to provide the patient a quicker recovery time and less recurring pain than traditional spine surgery methods. ESS also can help preserve normal range of spine mobility post-operatively.
In the experienced hands of a spine surgeon who regularly performs endoscopic spine surgery using the endoscope—the surgery is performed in a different way offering patients many potential benefits, including:
iv. Fast recovery and healing
• Spinal fusion – This surgery aims to fixate the two vertebral bodies by implanting screws or cages across the spinal joints, removing the original intervertebral discs and fusing the joints. Recent advances have made percutaneous screw fixation possible as part of the minimally invasive surgery (MIS).
- Gleneagles Hospital Penang