Spinal Stenosis

Spinal stenosis is a condition characterised by the narrowing of spaces within the spine, which can exert pressure on the nerves travelling through the spinal column. This condition predominantly occurs in the lower back and the neck. The narrowing can occur in different parts of the spine and affects the gap in the bones of the spine through which nerves pass.

Spinal stenosis can be categorised into two main types, depending on the region of the spine affected:

Cervical Stenosis

This type occurs in the neck area (cervical spine). It involves the narrowing of the spinal canal in the cervical region, which can compress the spinal cord and nerve roots.

Lumbar Stenosis

The more common form, lumbar stenosis, occurs in the lower back (lumbar spine). This condition is characterised by the narrowing of the spinal canal in the lumbar region, potentially compressing the nerve roots.

The development of spinal stenosis is often attributed to changes in the spine that occur as a natural part of ageing. However, several factors can contribute to or accelerate the narrowing of the spinal canal:

• Degenerative Changes
  Age-related wear and tear is the most common cause of spinal stenosis. Degenerative processes like ligament thickening, disc herniation, and bone spur formation can narrow the spinal canal, encroaching on its space.
• Osteoarthritis
  This condition, often associated with ageing, can lead to the development of bone spurs that can narrow the space within the spine.
• Herniated Discs
  The soft cushions (discs) between the vertebrae can sometimes bulge out or rupture, encroaching upon the spinal canal.
• Ligament Thickening
  Over time, the spinal ligaments can thicken and stiffen, protruding into the spinal canal.
• Spinal Injuries
  Trauma to the spine, such as from accidents or falls, can cause dislocations or fractures that may damage the spinal canal.
• Spinal Tumours
  Abnormal growths can form inside the spinal cord, within the membranes covering the spinal cord, or in the space between the spinal cord and vertebrae, leading to a narrowing of the canal.
• Certain Conditions
  Diseases like Paget’s disease of bone, achondroplasia, and scoliosis can also contribute to spinal stenosis.

For many individuals with spinal stenosis, non-surgical treatments can effectively manage symptoms. These options include:

Medications:

• • Pain Relievers: Over-the-counter pain medications, such as ibuprofen or acetaminophen, can help ease mild to moderate pain.
  • Antidepressants: Certain antidepressants may be prescribed to help alleviate chronic pain.
  • Anti-seizure Drugs: These medications might be used to reduce pain caused by damaged nerves.

Physical Therapy: A tailored physical therapy program can help improve strength, flexibility, and balance, potentially reducing the symptoms of spinal stenosis.

Steroid Injections: Corticosteroid injections can reduce inflammation and relieve pain temporarily. However, their effectiveness diminishes with frequent use, and they can have side effects.

Activity Modification: Learning how to modify activities and adopting ergonomic practices can help manage symptoms and prevent the worsening of the condition.

Assistive Devices: For some patients, using devices like braces, corsets, or walking aids can provide additional support and reduce pain.

Surgery may be considered for spinal stenosis patients when non-surgical treatments have not provided adequate relief, or if there is severe impairment of function or quality of life. Surgical options include:

• Laminectomy
  Laminectomy is the most common surgery for lumbar spinal stenosis. Often referred to as decompression surgery, this procedure involves removing the back part of the affected vertebra (lamina) to create more space within the spinal canal and relieve pressure on the nerves.
• Laminotomy
  Similar to laminectomy, but involves removing only a portion of the lamina, targeting the specific areas that are causing nerve compression.
• Laminoplasty
  Performed only on the cervical spine, this procedure involves creating more space for the spinal cord and nerves by reshaping the vertebrae.
• Foraminotomy
  This surgery enlarges the openings where nerve roots exit the spinal canal, easing pressure on nerves.
• Spinal Fusion
  In some cases, particularly where spinal stenosis is associated with spinal instability, orthopaedic surgeons may perform spinal fusion. This procedure involves joining two or more vertebrae together to provide stability to the spine.

While it may not be possible to prevent spinal stenosis, especially due to its association with age-related degeneration, there are strategies to reduce risk and slow its progression:

• Regular Exercise: Engaging in activities that strengthen the back and abdominal muscles can help support the spine. Low-impact exercises such as walking, swimming, or cycling are beneficial.
• Maintain a Healthy Weight: Excess body weight can put additional stress on the back, contributing to spinal problems. Managing weight through diet and exercise can alleviate this stress.
• Good Posture: Practising good posture can reduce the pressure on the spine and the likelihood of developing stenosis symptoms.
• Ergonomic Workspace: Setting up a workstation to promote good posture can help minimise stress on the spine, especially for individuals who sit for long periods.
• Avoid Smoking: Smoking can accelerate the degeneration of spinal tissues and should be avoided.
• Regular Check-ups: Regular medical check-ups can help detect spinal issues early and allow for timely intervention.