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
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
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
• Numbness in the arms
• Tingling in the arms and hands, or legs and feet
• Muscle weakness in the arms or legs
Treatment of Spinal
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
• Medicine to relieve
• 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.
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.
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
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.
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
Spinal Fusion Surgery
The risks involved in spinal
fusion surgery include:
• 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
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.