11 Things Everyone Should Know About Spinal Stenosis - Dr

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September 03, 2012 cervical, exercise, exercises, lumbar,spinal stenosis,surgery,symptoms, treatment, treatments 0 Commen

11 Things everyone should know about spinal stenosis

What is spinal stenosis?

Spinal stenosis Lumbar spinal stenosis

Stenosis is a Greek word that means narrowing or constricting space or chocking. In a medical sense, spinal stenosis is

the narrowing or constricting of the space in the spine where the spinal cord and nerve roots are located that causes them to

be pressed on and irritated, and in this sense chocked. Simply, spinal stenosis is a narrowing w ithin the spine that pinches

or otherwise irritates a part of the nerve system. This nerve pressure is usually caused by osteoarthritis in a deeper area ofthe spine, giving rise to symptoms in whatever part of the body the irritated nerves travel to, like the arms, neck, legs and low

back.

Types of spinal stenosis

There are two primary types of spinal stenosis lumbar spina l stenosis and cervical spinal stenosis. Lumbar spinal stenosis

occurs in the lower part of the spine and is the most common type of spinal stenosis. Cervical spinal stenosis occurs in the

neck region of the spine. Although the locations are different each type of spinal stenosis arises in a similar manner, affects

the spine and nerve roots in a similar way, and cause similar symptoms.

Lumbar spinal stenosis vs. Cervical spinal stenosis

When lumbar stenosis compresses the lower back nerve roots pain will occur along the pathway of the major low back nerve

network, called the sciatic nerve, resulting in sciatica. The symptoms of sciatica are pain, numbness, tingling and weakness

that can radiate down from the low back and into the buttocks and back of the legs to the toes. Sciatica proble ms are easily

triggered in l umbar spinal stenosis with a ny activity that compresses the spine prolonged standing, carrying a heavy,

weight, prolonged forward flexion.

Approximately 75% of spinal stenosis occurs i n the l umbar spine (low back), with the most of the o ther 25% occurring in the

neckor cervical spine rarely does spinal stenosis affect the upper back or thoracic spine.

When cervical stenosis compresses the spinal cord and nerve roots it is far more dangerous because the spinal cord in the

neck is much larger, and carries more important parts of the nerve network (nerve supply to and from the heart and lungs, the

vagus nerve, etc.). If the spinal cord is compressed in the neck it can have dire consequences only slightly less dramatic than

when someone is executed by hanging because being hung with a rope around the neck severely compresses on the

spinal cord of the neck and stops all heart and lung function. Since the spinal cord ends in the upper pa rt of the lumbar spine

the spinal cord is not in jeopardy by lumbar spinal stenosis.

Spinal stenosis, the development of degenerative arthritic changes within the spine that presses on nerve tissue, usually

becomes significant after 50 years of age and slowly progresses as a problem as the arthritis of the spine also progresses.
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Since lumbar spinal stenosis is a much more common problem, most of this discussion will focus on this area.

Lumbar spinal stenosis symptoms

Some symptoms of lumbar spinal stenosis symptoms are rather consistent from patient to patient. Because spinal stenosis is

the expression of arthritis pressing on nerves from within the spinal column it does not begin rapidly or after trauma, as many

other lower back pain problems do it develops slowly over a period of time, and increases frequency and severity as the

spinal osteoarthritis progresses. The pain of lumbar stenosis will come and go, depending on activity levels of the individual

and anything the person might do that is favorable or unfavorable to aggravate the spinal arthritis spinal stenosis pain is not

continuous, as a rule. Symptoms will occur typically during certain activities such as walking or prolonged standing, or any

other action that stresses the area of the lumbar spine where the osteoarthritis is located . Lastly, lumbar spinal stenosis

symptoms typically can be controlled by simply lying down or sitting. The pain will slowly disappear as the reduction of

weight bearing allows the irritated tissue to calm down and no longer press on the delicate nerve structures of the sciatic

nerve.

Spinal stenosis treatment

Surgery is usually not necessary to treat a spinal stenosis problem. This is good because spinal stenosis surgery can be

complex and dangerous since it involves going w ithin the spinal structure very close to the spinal cord. Depending o n thelocation and degree of spinal osteoarthritis and the severity of symptoms that results, spinal stenosis can usually be managed

well using non-invasive, non-drug methods with three common methods.

Three common non-surgical spinal stenosis treatments include:

Ice/Heat applications

Apply straight i ce to the area of the lower back at the level of greatest pain and where the sciatica seems to start (where the

spinal stenosis is located), following the instructions for applying cold/heat.

Activity modificationThis treatment for stenosis usually turns out to be an exercise in becoming aware of what aggravates the spinal stenosis and

what makes it feel better. Thus you should avoid whatever aggravates the back pain and do what feels better to the back.

The primary observation that people with spinal stenosis make is that they feel less pain and their back is more relaxed while

holding the low back, or neck, flexed forward.

Examples of activity modification as treatment of spinal stenosis: first thing in the morning lean on the bathroom sink before

washing to get ready for the day by stretching the lower back and relaxing it sleep on your left or right side while bringing one

or both knees up toward our chest like your body is rolled up into the shape of a ball leaning forward at the hips on a walker

or shopping cart instead of walking upright leaning forward and bent over on the handlebars of a stationary bike or other

exercise equipment instead of walking for exercise sit in a recliner that is flattened out a bit instead of on a straight-back

chair when sitting on a couch periodically bring your feet off the floor as you bring your knees up toward your chest and

snuggly wrap your arms around your knees.

With this treatment for stenosis, patients are usually counseled to avoid activities that cause adverse spinal stenosis

symptoms. Patients are typically more comfortable while flexed forward. Examples of activity modification for treatment of

spinal stenosis might include: walking while bent over and leaning on a walker or shopping cart instead of walking upright

stationary biking (leaning forward on the handlebars) instead of walking for exercise sitting in a recliner instead of on a

straight-back chair.

Spinal stenosis exercise


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Spinal stenosis exercises (strengthening) Spinal stenosis exercises are very helpful, but they cannot do more than

control and mini mize the problem not cure it. These exercises are a critical part of treatment because of the importance of

remaining as active as the condition will allow.

Treating sciatica from spinal stenosis requi res use of forward flexion or bending exercises. This posture increases the size o

the compressed nerve passageways, allowing the irritation or impingement to subside. For this reason people w ith spinal

stenosis will flex at the hips to feel sciatic pain relief as well as lower back pain relief.

In many ways spinal stenosis causes the nerves to become pressed upon, or compressed, resulting in what some people

would call a pinched nerve, whether in the low back or the neck. There are a series of simple and effective things a person

with a pinched nerve can do that can be very helpful in many cases. Review some of these ideas for pinched nerve

treatmentto learn how to help yourself and reduce or eliminate the need for more aggressive medical treatment.

Discuss these exercises with your doctor, chiropractor or therapist:

Lumbar spinal stenosis exercise

1. Strengthening the muscles that bring the spine into flexion (forward bending).Using two of the same exercises that

were used for strengthening the low b ack, it is possible to stretch the lower back muscles and other soft tissue thatholdthe spine in a b ackward bending position. These stretches are usually held in a gentle and easy posture that does

not provoke any back or leg pain, for 30 seconds .

Back flexion. Comfortably lie on a padded surface face up, on the back, gently

pulling both knees toward the chest until a comfortable stretch is felt. After 30

seconds, slowly return to the starting position. Do about 3-6 repetitions. As an

alternate, try pulling just one knee toward the opposite shoulder until a

comfortable stretch is felt. After 30 seconds, slowly return to starting position.

Do about 3-6 repetitions.

Back flexion. Using a padded surface, get down on the hands and knees. Roc

back so you are sitting back down on your heels, allowing your chest to come

down clo se to the floor and your arms outstretched in front of you. Do not

bounce on heels. After 30 seconds, slowly return to the starting position. Do

about 3-6 repetitions.

Abdominal muscle and core strength. Lie face up on a padded surface, with

both knees bent and feet flat on floor. Tighten abdominal muscles. Slowly

raise one foot off the floor about 4-6 inches and hold that position for 5-10

seconds over time increase time that foot is held up off floor to 30 seconds.

Return to starting position. Do about 3-6 repetitions.

Back extension.Comfortably lie on a padded surface face up. Tighten the low back and buttock muscles while allowing the

low back to flatten firmly against the floor. Hold that position for 5-10 seconds over time increase time that foot is held up off

floor to 30 seconds. Return to starting position. Do about 3-6 repetitions.
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Spinal stenosis treatment withepidural injections

An i njection of cortisone into the spa ce outside the dura (the epidural space)

can temporarily relieve symptoms of spinal stenosis. While injections can seldom be considered curative, these spinal

stenosis treatments can alleviate the pain in about 50% of cases. Up to three injections over a course of several months can

be tried. Although they are not considered diagnostic in and of themselves, generally, if the pain caused by spinal stenosis is

relieved by an epidural steroid injection, then the patient can also be expected to have a good result if they later choose to

have spinal stenosis surgery.

Spinal stenosis surgery

The primary goal of spinal stenosis surgery is to remove those spinal structures that are compressing the nerves in the spinal

canal or vertebral foramen. The procedure used is commonly referred to as lumbar decompressio n surgery (foraminotomy,

laminectomy and laminotomy).

Spinal stenosis surgery is best indicated for anyone who does not improve with conservative measures (rest, exercise,

hot/cold applications, stretching, chiropractic, etc.) or if severe and rapidly progressive weakness or loss of bowel or bladder

function occurs. Depending o n the results of physical examination findings and imaging studies, various surgical procedures

can be used to treat the non-responsive lumbar spinal stenosis patient, from laminectomy to multiple fusion procedures.

Generally, stenosis surgery is more reliable for relief of sciatica leg symptoms and less reliable for relief of lower back pain

symptoms.

It is critical that as a patient you discuss these basic points with your doctorbefore you agree to spinal stenosis surgery:

1. Get a sense of the level of confidence that the surgeon has a clear and detailed understanding where your

spinal stenosis is located. The doctor must know exactly what he/she is going to do and where the problem is

located during stenosis surgery. This is especially true if yours is a complex problem with more than one location that

is being i mpinged upon, or if both sides of the spine must be opened. If your doctor cannot speak with confidence abou

the surgery then the results might not make you pleased. You might want to find a doctor to do the spinal stenosis

surgery who more clearly understands your lower back pain problem.

2. Ask about the possibility that the stenosis surgery might cause new problems or worse problems for you than

you now have. It is good to discuss the possibility of injury to nerves in the area, or if the surgery will cause instability

and weakness of the spine that you currently do not have now. Along this same line of thought you want to assure that

this stenosis surgery should not cause a situation that might require an additional surgery later. If you learn that there

are other techniques of spinal stenosis surgery that will cause fewer problems later, then you should find another

surgeon who does this kind of operation. .

3. Ask the surgeon if the method that will be used to correct or relieve y our spinal stenosis is the least invasive

technique that is available and used. Ask if the method of spinal surgery will be minimally destructive of normal

structures in the area and near important nerve structures. Ask if the technique and method of stenosis surgery wil l

leave as much as possible of the normal or slightly abnormal tissues alone. If you are told that there are other methods

that destroy less normal tissue, then you need to determine who can do that kind of surgery.

4. Ask if the surgery can be done under an epidural anesthetic instead of general anesthesia. Spinal stenosis

surgery for decompression of nerve tissue when done under general anesthesia is stressful for the patient since it is

often a many-hour procedure. Some patients cannot tolerate this kind of metabolic and physical stress. If you are learn
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that this surgeon prefers to work with a patient under general anesthesia, be sure to find out why, what would be the

reasons that you could be an exception, and this risk is justified in your case. If you are not satisfied with the answers

then it might be better to find a different surgeon who can safeguard you during your stenosis surgery.

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11 Things Everyone Should Know About Spinal Stenosis - Dr