Cervical Spinal Stenosis Spinal stenosis

Cervical Spinal Stenosis Spinal stenosis







































































































































Central Canal Stenosis Symptoms and Causes



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Back & Neck Pain



Spinal Conditions

Central Canal Stenosis Symptoms and Causes


By Anne Asher, CPT | Reviewed by Grant Hughes, MD
Updated March 02, 2018
Depiction of disc herniation causing central canal stenosis

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    Central canal stenosis occurs when the passageway that houses the the highly sensitive spinal cord narrows. This passageway is known as the spinal canal, and is discussed below. The narrowing may be due to a number of things from arthritis to genetics. Causes of central canal stenosis are also discussed below.

    Most of the time, central canal stenosis is an age-related condition. It is a progressive condition, which means it keeps getting worse as time moves on.

    The Spinal Canal — Where it all Happens

    Simply stated, the spinal canal is a hole down the center of your vertebral column. Your spinal cord is located inside this hole. The spinal cord is a very key part of the central nervous system, which is comprised only of the “cord”, as it is often called for short, and the brain.

    “The spine is the structural element and the spinal cord is the electrical and conductive portion of the system,” says Dr. John Toerge, D.O., and rehabilitation specialist at Medstar National Rehabilitation Hospital in Bethesda, Maryland.

    In other words, Toerge continues, “the canal is made of bone and supports the body, and it supports the motion of the spine. The spinal cord, on the other hand, provides the means of transmitting the impulses from the brain and other areas of the nervous system to the rest of the body.”

    Along with the “cord,” the spinal canal houses blood vessels, fat and your spinal nerve roots.

    Toerge further clarifies the functions of each structure by saying that the two generally work independently of one another, except when the canal becomes narrowed, i.e., in cases of central canal stenosis. 

    The narrowing may impinge on the nervous elements of the cord, and it’s at that point when the diagnosis of central canal stenosis is made, he adds. 

    Narrowing in the spinal canal compresses the spinal cord and the spinal nerve roots , says Dr. Judith Glaser, a  physiatrist and acupuncturist practicing in New Hyde Park, New York.

    And according to Dr. Sergio Gonzalez-Arias, medical director of Baptist Health Neuroscience Center in Miami, Florida, a compressed cord may cause any number of symptoms including (but not limited to) pain, weakness, numbness, clumsiness, and possibly bowel and/or bladder problems. A classic symptom, he says, is neurogenic claudication . Neurogenic claudication refers to cramping that may be associated with prolonged walking or standing.

    As an aside, you also have a peripheral nervous system which is comprised of the nerves that branch off from the cord. These nerves exit the spine from an area on the side of the spinal column known as the  intervertebral foramen , and subsequently proceed to all areas of your body. Essentially, the job of the peripheral nerves is to detect and relay sensations — temperature, pain, joint and body position and more — as well as to communicate movement impulses from your central nervous to your muscles. As you can see, the peripheral and central nervous systems relate; just the same, they are considered separate entities.

    What Causes Central Canal Narrowing and Stenosis

    Arthritis of the spine is often at the root of central canal stenosis. Arthritis may develop on the spinal nerve roots in as well as in the canal, Toerge clarifies. 

    When arthritis affects the spinal nerve roots, it’s called neuroformaninal stenosis .

    But genetics may play a role, as well.  

    In other words, certain people are simply born with narrow spinal canals. “Some individuals have a small canal and a large spinal cord or a large canal and small spinal cord, with the latter being the better scenario,” Toerge continues.

    Not only that, but a wide variety of differences in the size of your spinal canal relative to the size of your spinal cord are possible. Toerge informs me that these differences greatly determine the issues people face with their central canal stenosis diagnosis. 

    Glaser adds tumor to the list of causes of central canal stenosis, stating that while there are less common, they are sometimes identified as underlying causes.

    Disc problems, including herniation and loss of disc height, may also cause spinal canal narrowing.

    A Word from VeryWell

    But living a sedentary life is the highest risk of all, Toerge concludes. This is because you need to use your muscles regularly in order to stay mobile and functional. If your sedentary way of life leads to a loss of physical function, “the outcome can have serious consequences.”

    Acupuncture may provide one way to improve your physical functioning impairments due to central canal stenosis. A 2018 study published in BMC Complementary Alternative Medicine found that acupuncture was more effective than exercise for improved physical functioning and more effective than medication for patient satisfaction. The researchers suggest that doctors and patients factor their results in when making treatment decisions for lumbar spinal stenosis.

     

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    Article Sources





    • Sources:
    • Email Interview. Glaser, J. DO, LAC, Restorative Medicine in New Hyde Park, NY January 2014.
    • Email Interview. Gonzalez-Arias, Sergio M.D., Medical Director, Baptist Health Neuroscience Center, Miami, FL. January 2014.
    • Oka, H., et. al. A comparative study of three conservative treatments in patients with lumbar spinal stenosis: lumbar spinal stenosis with acupuncture and physical therapy (LAP study). BMC Complement Altern Med. Jan. 2018.
    • Email Interview. Toerge, J. DO, MedStar National Rehabilitation Hospital, Bethesda, MD. January 2014.

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    Lumbar Spinal Stenosis

    Lumbar Spinal Stenosis

    Lumbar Spinal Stenosis | American Association of Neurological Surgeons

    The lumbar spine (lower back) consists of five vertebrae in the lower part of the spine, between the ribs and the pelvis. Lumbar spinal stenosis is a narrowing of the spinal canal, compressing the nerves traveling through the lower back into the legs. While it may affect younger patients, due to developmental causes, it is more often a degenerative condition that affects people who are typically age 60 and older.

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    Narrowing of the spinal canal usually occurs slowly, over many years or decades. The disks become less spongy with aging, resulting in loss of disk height, and may cause bulging of the hardened disk into the spinal canal. Bone spurs may also occur and ligaments may thicken. All of these can contribute to narrowing of the central canal and may or may not produce symptoms. Symptoms may be due to inflammation, compression of the nerve(s) or both.

    Such symptoms may include:

    • Pain, weakness or numbness in the legs, calves or buttocks
    • Cramping in the calves with walking, requiring frequent short rests to walk a distance
    • Pain radiating into one or both thighs and legs, similar to the lay term “sciatica”
    • In rare cases, loss of motor functioning of the legs, loss of normal bowel or bladder function
    • Pain may improve with bending forward, sitting or lying down

    Degenerative spondylolisthesis and degenerative scoliosis (curvature of the spine) are two conditions that may be associated with lumbar spinal stenosis. Degenerative spondylolisthesis (slippage of one vertebra over another) is caused by osteoarthritis of the facet joints. Most commonly, it involves the L4 slipping over the L5 vertebra . It is usually treated with the same non-surgical (“conservative”) and surgical methods as lumbar spinal stenosis.

    Degenerative scoliosis occurs most frequently in the lower back and more commonly affects people aged 65 and older. Back pain associated with degenerative scoliosis usually begins gradually and is linked with activity. The curvature of the spine in this form of scoliosis is often relatively minor. Surgery may be indicated when nonsurgical measures fail to improve pain associated with the condition.

    Diagnosis

    Diagnosis is made by a neurosurgeon based on history, symptoms, physical examination and test results.

    Imaging studies used may include the following:

    • X-ray : Focuses radiation through the body to create an image and can show the structure of the bones, alignment of the spine and outline the joints.
    • CT scan or CAT scan : Creates images by combining multiple X-rays together and can show the shape and size of the spinal canal, its contents and the structures around it with details of the bony anatomy.
    • MRI : Creates images by using powerful magnets and computer technology and can show the spinal cord, nerve roots and surrounding areas, as well as enlargement, degeneration and tumors.
    • Myelogram : Injects contrast dye into the spinal fluid space (cerebrospinal fluid) to outline the nerves and spinal cord, and show evidence of any pressure affecting these areas; seen on X-ray, sometimes done with a CT scan.

    Nonsurgical Treatment

    A combination of time, medications, posture management, stretching and exercise can be helpful to many patients for pain flare-ups. Weight management, nicotine cessation and bone-strengthening endeavors may also be indicated.

    • Anti-inflammatory medications can be used to reduce swelling and pain, and analgesics can be used to relieve pain. Most pain can be treated with non-prescription medications, but if the pain is severe or persistent, prescription medications may be provided.
    • Epidural injections of medications may be prescribed to help reduce swelling.
    • Physical therapy and/or prescribed exercises may help to stabilize and protect the spine, build endurance and increase flexibility. Therapy may help the patient to resume a normal lifestyle and activities. Typically, four to six weeks of therapy is encouraged.

    Surgical Treatment

    A doctor may recommend surgery if non-surgical management (as described above) does not improve symptoms. There are different types of spinal surgeries available, and depending on the specific case, a neurosurgeon will help to determine what procedure might be appropriate for the patient. As with any surgery, a patient’s risks include age, overall health and other issues, which are all taken into consideration beforehand.

    A patient may be considered a candidate for surgery if:

    • Back and leg pain limits normal activity or impairs quality of life;
    • Progressive neurological deficits develop (leg weakness, foot drop, numbness in the limb);
    • Loss of normal bowel and/or bladder functions;
    • Difficulty standing or walking;
    • Medications and physical therapy are not effective;
    • The patient is in reasonably good health.

    There are several different surgical procedures that can be utilized, the choice of which is influenced by the severity of the case. In a small percentage of patients, spinal instability may require that spinal fusion be performed — this decision generally is determined prior to surgery. Spinal fusion is an operation that creates a solid union between two or more vertebrae. Spinal fusion may assist in strengthening and stabilizing the spine, and may thereby help to alleviate severe and chronic back pain.

    Types of Surgeries

    The most common surgery in the lumbar spine is called decompressive laminectomy , in which the laminae (roof) of the vertebrae are removed to create more space for the nerves. A neurosurgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disk. A spinal fusion with or without spinal instrumentation may be used to enhance fusion and support unstable areas of the spine.

    Other types of surgeries or techniques/methods to treat lumbar spinal stenosis include:

    • Laminotomy : Creates an opening in the bone (in the lamina ) to relieve pressure on the nerve roots.
    • Foraminotomy : Surgical opening or enlargement of the bony exit for the nerve root as it leaves the spinal canal; can be done alone, or along with laminotomy/laminectomy.
    • Medial Facetectomy : Removal of part of the facet (bony joint) which may be overgrown, to create more space in the spinal canal.
    • Anterior Lumbar Interbody Fusion (ALIF): Removal of the degenerative disk by going through the lower abdomen. A structural device, made of bone, metal, carbon filter or other materials, is placed to take the supportive place of the removed disk and packed with bone, so that ultimately fusion between the bone (body of the vertebrae) above and below occurs.
    • Posterior Lumbar Interbody Fusion (PLIF): Removal of the degenerative disk by going through the skin on the back, removal of the posterior bone of the spinal canal, retraction of the nerves to get to the disk space. A structural device, made of bone, metal, carbon filter or other materials, is placed to take the supportive place of the removed disk and packed with bone, so that ultimately fusion between the bone (body of the vertebrae) above and below occurs. Similar to TLIF, this is often done on both sides of the spine.
    • Transforaminal Lumbar Interbody Fusion (TLIF): Removal of the degenerative disk by going through the skin on the back, removal of the posterior bone of the spinal canal, retraction of the nerves to get to the disk space. A structural device, made of bone, metal, carbon filter or other materials, is placed to take the supportive place of the removed disk and packed with bone, so that ultimately fusion between the bone (body of the vertebrae) above and below occurs. Similar to PLIF, this is often done on only one side of the spine.
    • Posterolateral Fusion : Places bone graft on the back and side(s) of the spine to achieve a fusion.
    • Instrumented Fusion : Using “hardware” (hooks, screws, other devices) to add stability to the construction for fusion.

    The potential benefits of surgery should always be weighed carefully against the risks of surgery and anesthesia. Although a large percentage of lumbar spinal stenosis patients who ultimately undergo surgery report significant pain relief after surgery, there is no guarantee that surgery will help every individual.

    The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon online tool.

    Read the Story of a Patient Diagnosed with Lumbar Spinal Stenosis

    Harold’s Story

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