Spinal stenosis it is a narrowing of the channels of the spine which causes compression of the spinal cord and nerve roots. It occurs most often in the lumbar or cervical area, especially in people of middle or advanced age.
It is caused mainly by the wear suffered by the spine due to certain degenerative diseases, although it can also occur due to traumatic or Congenital malformations .
Some cases pass asymptomatically because the narrowing does not produce pressure. However, almost always It manifests with pain, muscle weakness and other symptoms that can limit mobility.
Types of spinal stenosis
Spinal stenosis It is classified according to the region of the spine that is compromised by the narrowing. There is the possibility of having more than one type at the same time. The main ones are:
- Cervical stenosis: It is the one that affects the part of the column where the neck is located.
- Lumbar stenosis: It is the most frequent form of spinal stenosis. It occurs in the lower part of the back.
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Causes of spinal stenosis
The bones of the spine form a spinal canal that is responsible for protecting the spinal cord (nerves). When something decreases the amount of space of these channels, spinal stenosis occurs. Some people are born with a small spinal canal . However, the main cases of stenosis occur due to the changes produced by aging on the spine . The stenosis can also be caused by:
- Excessive bone growth : caused by conditions such as arthrosis and Paget's disease.
- Herniated disc produced by the degeneration of the intervertebral discs, which manage to move from their position, causing nerve compressions.
- Thickened ligaments: the passage of time causes the ligaments to become rigid and thick, protruding over the spinal canal.
- Tumors: They are rare, but can be formed inside the spinal cord, in the membranes that cover it or in the space between the spinal cord and the vertebrae.
- Spinal injuries: Dislocations or fractures in one or more vertebrae caused by trauma.
- Hereditary conditions: narrow spinal canal or scoliosis
Symptoms of spinal stenosis
The spinal channels can be narrowed, but they do not always press the marrow or the nerve roots. This is why, often, the stenosis has no symptoms and is detected during magnetic resonance or computed tomography analysis.
When it begins to manifest, it does so gradually, getting worse with the passage of time. Symptoms vary depending on the area and nerves affected.
Symptoms of cervical stenosis
- Sensation of numbness or tingling in the arm, hand or leg.
- Weakness in the arm and the hand.
- Difficulty walking and maintaining balance
- Rigidity and pain of the neck
- Dysfunction of the bladder or intestines (severe cases).
Symptoms of lumbar stenosis
- Sensation of numbness and weakness in one leg or foot.
- Pain or Cramps in one or both legs.
- Pain that increases when standing for prolonged periods or while walking.
- Pain in the lower back.
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The diagnosis of spinal stenosis begins with an interrogation on the signs and symptoms perceived by the patient. The doctor takes the medical history into account and performs a physical examination. To confirm the stenosis, complementary tests are also done, such as:
- Magnetic resonance image (MRI)
- Computed tomography (CT).
The doctor will determine the most appropriate treatment for each situation. East It may vary depending on the location of the stenosis and the severity of its symptoms. If a surgical intervention is not necessary, some medications, therapies and changes in lifestyle can be used that contribute to coping with the pain.
- Analgesics: ibuprofen, naproxen and paracetamol.
- Antidepressants: amitriptyline (used to calm chronic pain).
- Anticonvulsant medications: gabapentin and the pregabalin .
Must be supervised by a physiotherapist. Through stretching and exercises, this helps:
- Develop strength and endurance
- Maintain the flexibility and stability of the spine.
- Improve balance
They do not work in all cases and its repeated use is not recommended. However, the injection of a steroid medication (corticosteroid) can help reduce the inflammation and the pain in the space around the compression.
Surgery is considered when the treatments did not give results or when the symptoms worsen and produce disability. Surgical procedures include:
- Minimally invasive surgery
To cope with the symptoms of stenosis also Some alternative treatments can be considered:
- Massage therapy.
- Chiropractic treatment
As a complement to the treatment It is important that the patient tries to maintain a healthy weight to reduce the pressure on the back. Likewise, it is advisable to practice a regular routine of physical exercise to strengthen the column.
- Bradley, Walter G. editor. Clinical neurology: diagnosis and treatment. Editorial Elsevier Spain, 2005. ISBN 8481747408 , 9788481747409
- Torres Cueco, Rafael.The Cervical Column. Clinical Syndromes and Their Manipulative Treatment. Pan-American physiotherapy collection. Volume 2 of the cervical spine. Editorial Panamericana Medical, 2008. ISBN 8479037083 , 9788479037086
- Försth P, Ólafsson G, Carlsson T, et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med. 2016; 374 (15): 1413-1423. PMID: 27074066 www.ncbi.nlm.nih.gov/pubmed/27074066 .
- Kreiner DS, Shaffer WO, Baisden JL, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J. 2013; 13 (7): 734-743. PMID: 23830297 www.ncbi.nlm.nih.gov/pubmed/23830297 .