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Flashcards in Spinal Stenosis Deck (23):

What Is Spinal Stenosis?

Spinal stenosis is a narrowing of spaces in the spine (backbone) that results in pressure on the spinal cord and/or nerve roots.


What 3 areas does this disorder usually involve?

(1) the canal in the center of the column of bones (vertebral or spinal column) through which the spinal cord and nerve roots run, (2) the canals at the base or roots of nerves branching out from the spinal cord, or (3) the openings between vertebrae (bones of the spine) through which nerves leave the spine and go to other parts of the body.


Who gets Spinal Stenosis?

This disorder is most common in men and women over 50 years of age. However, it may occur in younger people who are born with a narrowing of the spinal canal or who suffer an injury to the spine.


What Structures of the Spine Are Involved?

Intervertebral discs
Facet joints
Intervertebral foramen
Spinal cord / nerve roots
Vetebral arch
Cauda equina


What Causes Spinal Stenosis?

Narrowing of the canal, which occurs in spinal stenosis, may be inherited or acquired. Some people inherit a small spinal canal (see fig. 5) or have a curvature of the spine (scoliosis) that produces pressure on nerves and soft tissue and compresses or stretches ligaments. In an inherited condition called achondroplasia, defective bone formation results in abnormally short and thickened pedicles that reduce the diameter (distance across) of the spinal canal.


What would Acquired Spinal Stenosis would develop out of?

Degenerative conditions


What does Spinal Stenosis most often result from?

Spinal stenosis most often results from a gradual, degenerative aging process. Either structural changes or inflammation can begin the process. As people age, the ligaments of the spine may thicken and calcify (harden from deposits of calcium salts). Bones and joints may also enlarge: when surfaces of the bone begin to project out from the body, these projections are called osteophytes (bone spurs).


What happens when one part of the spine fails?

When the health of one part of the spine fails, it usually places increased stress on other parts of the spine. For example, a herniated (bulging) disk may place pressure on the spinal cord or nerve root (see fig. 6). When a segment of the spine becomes too mobile, the capsules (enclosing membranes) of the facet joints thicken in an effort to stabilize the segment, and bone spurs may occur. This decreases the space (neural foramen) available for nerve roots leaving the spinal cord.


What are the two form of arthritis that may affect the spine?

Osteoarthritis and Rheumatoid Arthritis


What are some other acquired conditions?

Tumors of the spine
Paget's disease
Ossification of the posterior longitudinal ligament


What is Paget's disease of bone?

Paget's disease of bone is a chronic (long-term) disorder that typically results in enlarged and abnormal bones. Excessive bone breakdown and formation cause thick and fragile bone. As a result, bone pain, arthritis, noticeable bone structure changes, and fractures can occur. The disease can affect any bone of the body, but is often found in the spine. The blood supply that feeds healthy nerve tissue may be diverted to the area of involved bone. Also, structural problems of the involved vertebrae can cause narrowing of the spinal canal, producing a variety of neurological symptoms. Other developmental conditions may also result in spinal stenosis.


What is Ossification of the posterior longitudinal ligament?

Ossification of the posterior longitudinal ligament occurs when calcium deposits form on the ligament that runs up and down behind the spine and inside the spinal canal (see fig. 7). These deposits turn the fibrous tissue of the ligament into bone. (Ossification means "forming bone.") These deposits may press on the nerves in the spinal canal.


What are symptoms of Spinal Stenosis?

The space within the spinal canal may narrow without any symptoms. However, if narrowing places pressure on the spinal cord, cauda equina, or nerve roots, there may be a slow onset and progression of symptoms. The neck or back may or may not hurt. More often, people experience numbness, weakness, cramping, or general pain in the arms or legs. If the narrowed space within the spine is pushing on a nerve root, people may feel pain radiating down the leg (sciatica). Sitting or flexing the lower back should relieve symptoms. (The flexed position "opens up" the spinal column, enlarging the spaces between vertebrae at the back of the spine.) Flexing exercises are often advised, along with stretching and strengthening exercises.


What are some more severe symptoms?

People with more severe stenosis may have problems with bowel and bladder function and foot disorders. For example, cauda equina syndrome is a severe, and very rare, form of spinal stenosis. It occurs because of compression of the cauda equina, and symptoms may include loss of control of the bowel, bladder, or sexual function and/or pain, weakness, or loss of feeling in one or both legs. Cauda equina syndrome is a serious condition requiring urgent medical attention


How is Spinal Stenosis diagnosed?

Medical history
Physical exam
X ray
Bone scan


What are some non-surgical treatments for Spinal Stenosis?

Nonsteroidal anti–inflammatory drugs (NSAIDs), such as aspirin, naproxen, ibuprofen, or indomethacin, to reduce inflammation and relieve pain.1

Analgesics, such as acetaminophen, to relieve pain.

Corticosteroid injections into the outermost of the membranes covering the spinal cord and nerve roots to reduce inflammation and treat acute pain that radiates to the hips or down a leg.

Anesthetic injections, known as nerve blocks, near the affected nerve to temporarily relieve pain.

Restricted activity (varies depending on extent of nerve involvement).

Prescribed exercises and/or physical therapy to maintain motion of the spine, strengthen abdominal and back muscles, and build endurance, all of which help stabilize the spine. Some patients may be encouraged to try slowly progressive aerobic activity such as swimming or using exercise bicycles.

A lumbar brace or corset to provide some support and help the patient regain mobility. This approach is sometimes used for patients with weak abdominal muscles or older patients with degeneration at several levels of the spine.


What are some alternative therapies for Spinal Stenosis?

Chiropractic treatment


When should surgery be considered?

In many cases, the conditions causing spinal stenosis cannot be permanently altered by nonsurgical treatment, even though these measures may relieve pain for a period of time. To determine how much nonsurgical treatment will help, a doctor may recommend such treatment first. However, surgery might be considered immediately if a patient has numbness or weakness that interferes with walking, impaired bowel or bladder function, or other neurological involvement. The effectiveness of nonsurgical treatments, the extent of the patient's pain, and the patient's preferences may all factor into whether or not to have surgery.


What is the purpose of surgery?

The purpose of surgery is to relieve pressure on the spinal cord or nerves and restore and maintain alignment and strength of the spine. This can be done by removing, trimming, or adjusting diseased parts that are causing the pressure or loss of alignment.


What is the most common surgery performed on Spinal Stenosis?

The most common surgery is called decompressive laminectomy: removal of the lamina (roof) of one or more vertebrae to create more space for the nerves. A surgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disk. Various devices may be used to enhance fusion and strengthen unstable segments of the spine following decompression surgery.


What is a common surgery for Stenosis due to trauma in a young patient?

Patients with spinal stenosis caused by spinal trauma or achondroplasia may need surgery at a young age. When surgery is required in patients with achondroplasia, laminectomy (removal of the roof) without fusion is usually sufficient.


What are the major risks with surgery?

All surgery, particularly that involving general anesthesia and older patients, carries risks. The most common complications of surgery for spinal stenosis are a tear in the membrane covering the spinal cord at the site of the operation, infection, or a blood clot that forms in the veins. These conditions can be treated but may prolong recovery. The presence of other diseases and the physical condition of the patient are also significant factors to consider when making decisions about surgery.


What is SPORT?

the Spine Patient Outcomes Research Trial (SPORT), the largest trial to date comparing surgical and non-surgical interventions for the treatment of low back and associated leg pain caused by spinal stenosis. The study found that for patients with spinal stenosis, surgical treatment was more effective than non-surgical treatment in relieving symptoms and improving function. However, the functional status of patients who received non-surgical therapies also improved somewhat during the study.