Spinal Stenosis

Excerpt

Spinal stenosis is a condition in which the nerve roots are compressed by a number of pathologic factors, leading to symptoms such as pain, numbness, and weakness. The upper neck (cervical) and lower back (lumbar) areas most frequently are affected, although the thoracic spine also can be compressed most frequently by a disk herniation. Three different anatomic sites within the vertebral canal can be affected by spinal stenosis. First, the central canal, which houses the spinal cord, can be narrowed in an anterior-posterior dimension, leading to compression of neural elements and reduction of blood supply to the spinal cord in the cervical area and the cauda equina in the lumbar area. Secondly, the neural foramen, which are openings through which the nerve roots exit the spinal cord, can be compressed as a result of disk herniation, hypertrophy of the facet joints and ligaments, or unstable slippage of one vertebral body relative to the level below. Lastly, the lateral recess, which is seen in the lumbar spine only and is defined as the area long the pedicle that a nerve root enters just before its exit through the neural foramen, can be compressed from a facet joint hypertrophy. Depending on the level of the spine affected, each type of compression can lead to different symptoms that warrant a particular treatment modality.

Most patients will experience some type of pain associated with the spine but luckily, even without surgery, the majority will have an uneventful recovery. Only 1-3% will have a herniated disc and less than 2% will have compression of a nerve root.

Spinal stenosis is common with aging but predicting which individual will develop symptoms is not possible. In most cases, the degenerative process can be controlled by changes in lifestyle.