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Spinal Stenosis and Back Pain




A narrowing of the spinal canal where the spinal cord and spinal nerves pass through is known as Spinal Stenosis. The narrowing space is caused by material build-up which compresses the space normally reserved for the spinal cord or spinal nerves.

Degenerative changes in the spine can cause material build up within the spinal canal, limiting the space available for the spinal cord and spinal nerves. Nerves are highly sensitive receptors that need sufficient space to maintain proper functions. When stenosis occurs, nerves lose the ability to function correctly, causing pain in the affected areas.

Causes of Spinal Stenosis

Spinal stenosis is one of the conditions brought about by ageing. It is sometimes mistakenly attributed to back pain suffered by millions of patients. Stenosis is a process in itself which is normally devoid of pain, but is often caused by other painful conditions like:

1.) Degenerative disc disease – a shrinking and dehydration of the spinal discs results in loss of disc height. Because of this, the discs start to bulge out into the spinal canal, reducing the space required for the spinal cord and spinal nerves to function properly.

2.) Herniated discs – this also causes an outward protrusion into the spinal canal. If herniation occurs at the centre of the disc, this can result in a “mass effect” on the spinal canal and usher in the development of stenosis.

3.) Spinal arthritis – the ageing process affects the bones in the spine, sometimes causing the formation of bone spurs which crowd into the spinal canal. This disorder is hard to treat and may require surgery.

4.) Spondylolisthesis – a reallocated vertebra may move into the spinal canal, causing symptoms of stenosis. In this instance, stenosis is merely a side-effect of spondylolisthesis and not the true cause of the disorder itself.

Symptoms of Spinal Stenosis

Spinal stenosis is a common condition associated with ageing and is mostly an asymptomatic disorder. Most people experience very little or no symptoms at all. Even if symptoms may turn out to be chronic, they occur intermittently and may be disregarded. Spinal stenosis can be difficult to diagnose since most of its symptoms are similar to back pain caused by nerve compression. Some of the symptoms include:

• Localized or radiating pain
• Numbness in the arms
• Tingling in the arms and hands, or legs and feet
• Muscle weakness in the arms or legs

Treatment of Spinal Stenosis

Treatment of spinal stenosis can either be mild and conservative, or tough and drastic, depending on the degree of severity of the condition and its symptoms. It is advisable to thoroughly understand the various treatment options, including their risks and benefits, before making an informed choice of therapy.

Conservative treatments will not totally cure the stenosis but will help make the condition more bearable. Conservative treatments for spinal stenosis include:

• Medicine to relieve pain symptoms
• Epidural injections for longer lasting pain relief
• Physical therapy to encourage blood flow into the affected area. Although more suited for pain due to oxygen deprivation, physical therapy can apparently promote relief from stenosis symptoms.


Surgery for Spinal Stenosis

Surgery can be considered as a last resort remedy if conservative treatments fail to relieve pain symptoms. In critical emergency cases like Cauda
Equina Syndrome, surgery may be the only option available.
Spinal stenosis can be corrected through a laminectomy procedure to widen the size of the spinal canal. However, surgery results may not be conclusive in remedying the problem and some patients end up in a worse situation than before surgery. It is therefore advisable to turn to surgery only if there are no other options for conservative treatment.

Minimally Invasive Spine Surgery

It is heartening to note that modern medicine has developed the use of minimally invasive surgical procedures to correct many medical problems. Instead of cutting a patient wide open and exposing many layers of otherwise healthy muscle and tissue to get to the problem area, smaller incisions are now being made to allow the surgeon access into the body. Through the use of catheters, small precise instruments inserted into the catheters, fluoroscopy (live X-rays), and fibre optics, a surgeon may view and treat the area needing correction. This type of surgical procedure is safer, faster and allows for a speedier recovery period.

Minimally Invasive Back Surgery

As with minimally invasive spinal surgery, there are many types of back surgery that involve various surgical methods. Most of these procedures are so far-removed from the open surgery of the past.


Small incisions are made surrounding the surgical site and the surgeon then inserts hollow catheters into the incision, followed by small and precise surgical implements which are inserted into the hollow of the catheters. There surgical tools are used in undertaking the actual procedure.

While a wide open view of the surgical site is not available, the area is magnified using fluoroscopy (live X-ray) or fibre optic technology, which allows a first-rate high definition view of the whole procedure.


A majority of these surgical procedures are accomplished using laser, ultrasound, electricity or radio waves to correct the problem. Often the use of needles, thin wires and tiny incisions are involved in treatment.

Some of these surgeries are performed through the stomach, doing away with having to touch any the sensitive and intricate workings of muscles and nerves of the back.

Discectomy

One of the most common procedures to repair herniated discs, discectomy involves removing a portion of the herniated disc to get rid of the pain. This procedure has been performed for more than 60 years and has improved considerably in the present day.

Spinal Fusion Surgery

When two or more vertebrae are fused together, movement is impaired in their respective vertebral levels. To correct this problem, a surgical procedure called Spinal Fusion Surgery is performed. This procedure permanently attaches each vertebra to the other, resulting in one firm section of bone, as compared to a joint which allows motion.

Spinal Fusion Surgery Risks

The risks involved in spinal fusion surgery include:

• Infection
• Spinal fluid leak
• Nerve damage
• Negative surgical results, continued pain and limited range of motion
• Bone graft rejection (particularly when the graft is taken from a cadaver donor)
• Side-effects of anaesthesia


Recommendations for Spinal Fusion Surgery

Surgery should only be considered as a last resort. Spinal fusion surgery has the potential to do more harm than good. It cements the spine into a solid shape, defeating the spine’s purpose of motion. This can put pressure on the other unaffected levels of the spinal column and cause of the onset of bone degeneration. Having this procedure done at a young age will only cause more back pain and more surgery. However, in cases where there has been violent trauma to the spine, this procedure can save lives. It can also correct severe curvature of the spine.

Why Back Surgery Should Be Avoided

Undergoing spinal surgery is an overwhelming situation. While there are other alternative remedies for chronic back pain, surgery must be avoided at all costs. Some patients, who have spent years seeking a cure for chronic back pain, are often warming up to the idea of having a surgical procedure. Other patients who have been freshly diagnosed with a back problem have been advised that they are ideal candidates for surgery. Thorough research of the facts and necessity of spinal surgery must be made before even considering this option.

 




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