Stenosis – narrowing of the spinal canal , mainly caused by a combination of aging processes and degenerative-dystrophic changes in the spine. Wear and tear of various parts of the spinal column leads to bulging of the intervertebral discs, thickening of the ligaments and expansion of the intervertebral joints. All this leads to a narrowing of the spinal canal and puts pressure on the spinal cord and nerve roots. Spinal stenosis usually develops in people over 60 years of age. In younger age groups, it is less common and is traditionally caused by a narrow spinal canal from birth. Stenosis most commonly causes pain in the lower back and leg, causing lameness.
The reasons
The primary cause of spinal stenosis in the lumbar spine is osteoarthritis. Some development of an intervertebral hernia is also possible. In elderly patients, a bony growth may appear on the intervertebral disc, which protrudes into the spinal canal. In the advanced stages of arthritis, the joints that help hold the vertebrae together lose this ability. They do not prevent the vertebrae from moving relative to each other. This condition is called spondylolisthesis and can later lead to spinal stenosis. In the cervical spine, the appearance of stenosis of the spinal canal depends on the state of the intervertebral disc and adjacent vertebral bodies. It is in this place that spurs are found when the degeneration of the intervertebral disc occurs. They gradually penetrate the spinal canal or the opening in it through which the nerves exit the spinal canal. Similarly, spondylolisthesis develops, which can cause or worsen spinal stenosis. Sometimes hardening of the ligaments that form the back of the spinal canal can cause stenosis.
Ossification of the posterior longitudinal ligament does not often cause stenosis in the cervical spine. The ligaments that connect the vertebral bodies harden and calcify, thus forming a bony layer within the spinal canal.
Symptoms
The main symptoms of spinal stenosis are heaviness in the legs, weakness and pain when walking, or simply standing for a long time. Also characteristic are symptoms caused by compression of the nerve structures: local pain in the spine, lower extremities. Often these symptoms disappear after a short rest.
Diagnosis
Diagnosis of all diseases of the spine begins with the collection of complaints and anamnesis, filling in the history of the disease and examination. Next, the doctor will prescribe a set of diagnostic procedures, which will most likely include the following: X-ray of the lumbar spine, MRI. In some cases, CT may be ordered in addition to or instead of MRI. Also diagnostically important: myelo(tomy)graphy, epidurography, venospondylography, discography.
Treatment
For many patients with spinal stenosis, conservative treatment can be successful. But if the pain is causing you to be unable to work or significantly interfere with your ability to walk, your doctor may recommend spinal surgery. Acute loss of bowel or bladder function has traditionally been considered a condition requiring immediate medical and urgent surgical intervention.