2. Spinal Stenosis of the Back – Causes & Treatments Spinal stenosis of the back, which is a narrowing of the spinal canal in the thoracic or lumbar regions of the spine, can have many different causes. Congenital defects and the presence of spinal tumors can be to blame, though the primary cause of this spinal condition is usually nothing more than the natural aging process. The spine is responsible for supporting the weight and movement of the body and can eventually begin to deteriorate from the continued stress that it endures. This deterioration can lead to a number of degenerative spinal conditions that make the spinal canal susceptible to narrowing.
3. Degenerative Spinal Conditions & Spinal Stenosis of the Back Various elements of the spinal anatomy are likely to deteriorate over time, including the vertebrae (bone structures that house and support the spinal cord), the intervertebral discs (the spongy shock absorbers that are seated between adjacent vertebrae), and the facet joints (the articulating areas of the vertebrae that are responsible for connecting a vertebra to the ones above and below it). If one or more of these components of the spine shifts out of place or invades the spinal canal, spinal stenosis of the back may follow.
4. Degenerative Spinal Conditions & Spinal Stenosis of the Back This is primarily caused by the following degenerative spinal conditions: Facet disease – A type of arthritis, facet disease occurs when the facet joints become inflamed and lose their cartilaginous lining. This can result in bone-on-bone contact, which the body may try to combat by creating bone spurs. Also called osteophytes, bone spurs are smooth extensions of the body’s natural bone structure that are created in an effort to provide added stability. If a bone spur extends into the spinal canal, the patient is said to have spinal stenosis. Degenerative disc disease – The intervertebral discs are comprised of two portions: the annulus fibrosus and the nucleus pulposus. The annulus fibrosus is the tough outer shell of the disc while the nucleus pulposus is the disc’s jellylike interior. Over time, the discs may begin to lose protein and water content, making them weak and more likely to bulge or herniate. A herniated disc occurs when the nucleus pulposus seeps through a tear in the outer wall while a bulging disc occurs when the disc becomes misshapen but its interior contents remain encapsulated. Both herniated and bulging discs can lead to spinal stenosis. Spondylolisthesis – This condition refers to a type of spinal misalignment in which one vertebra slips out of place and shifts over one of its adjacent vertebrae. Spondylolisthesis typically occurs as a result of a weakened intervertebral disc that is no longer able to support the vertebra and keep it in place. Aside from the natural aging process, this spinal condition is also commonly associated with high-impact sports such as football, gymnastics, and hockey.
5. Symptoms of Spinal Stenosis in the Back Regardless of what has caused an individual’s spinal stenosis, he or she will only experience symptoms if the spinal canal has narrowed to the point that a nerve root or the spinal cord has become compressed. The symptoms of nerve compression caused by spinal stenosis can include pain, numbness, tingling, and muscle weakness. The exact location of these symptoms will vary depending on whether the thoracic or lumbar region of the spine is affected. A compressed nerve in the thoracic spine may lead to discomfort in the middle back, ribs, torso, and/or internal organs. Nerve compression in the lumbar spine can cause symptoms to appear in the lower back, hips, buttocks, and/or legs. Since the thoracic region is much less flexible than the lumbar spine, degenerative spinal conditions and spinal stenosis in the back are more likely to occur in the lumbar region.
6. Noninvasive Treatments for Spinal Stenosis in the Back Most doctors will begin treatment for spinal stenosis with conservative, noninvasive treatments. This typically includes one or more of the following: Medication – The use of over-the-counter, non-steroidal anti-inflammatory drugs (NSAIDs) is typically the first course of action for patients with degenerative spinal conditions. NSAIDs work by blocking the body’s production of certain enzymes that are responsible for producing pain and inflammation. If a patient has a medical condition or takes another medication that precludes them from utilizing NSAIDs, a doctor or spine specialist may prescribe muscle relaxants or pain relievers. Physical therapy – A physical therapist can work with a patient to strengthen the muscles in the back. This can help to provide the spine with additional support and may help to relieve some of the pressure that is being placed on a spinal nerve. Physical therapy may also entail other types of treatment, such as posture modification techniques, hot/cold therapy, transcutaneous electrical nerve stimulation (TENS), and deep tissue massage, among others. Lifestyle changes – If a patient abuses alcohol, uses tobacco products, or is significantly overweight, correcting these issues may prove beneficial. Alcohol and tobacco contain harmful chemicals that can prohibit the body’s ability to heal and absorb nutrients. Obesity forces the spine to work extra hard to support even simple, everyday movements like sitting, standing, and walking, and may exacerbate the deterioration of the spinal elements. Shedding excess pounds and quitting unhealthy habits like smoking and excessive drinking can help to improve a patient’s spinal health. In addition to the conservative treatments a doctor prescribes, some patients may choose to pursue alternative therapies. These complementary treatments take a holistic approach to spinal stenosis treatment and attempt to improve a patient’s overall level of health. Some of the popular alternative therapies for spinal stenosis of the back are acupuncture, acupressure, chiropractic manipulation, the use of herbal supplements, and restorative yoga, among others.
7. Surgical Treatment for Spinal Stenosis If several weeks or months of noninvasive treatment fail to provide a patient with the pain relief they require, a doctor or spine specialist may recommend surgery for spinal stenosis of the back. As a general rule, patients will have the opportunity to choose between two different types of surgical procedures: open spine surgery and a minimally invasive procedure. Open spine surgery requires a large incision and may involve the dissection of the muscles in the back. This can lead to a lengthy and arduous rehabilitation and typically entails a considerable stay at the hospital. Patients face many risks, including infection, internal bleeding, and failed back surgery syndrome (FBSS), which is the worsening or continuation of symptoms following surgery. Minimally invasive procedures are performed on an outpatient basis and utilize an endoscope to gain access to the affected area of the spine. This allows many patients to heal more quickly than they would from open spine surgery and limits their risk for infection and FBSS.
8. Conclusion Both types of procedures come with their own risks and benefits. Patients who are considering surgical treatment for spinal stenosis of the back should discuss the pros and cons with a doctor or spine specialist. Patients may also want to see the opinion of an additional doctor or specialist to ensure all noninvasive treatments have been attempted.
