Post by lavenderthistle on Jul 27, 2022 22:32:44 GMT -5
Stenosis is a definition only. It simply means a narrowing (any narrowing) of a bodily passage. In the case of spinal stenosis, our narrowing is in our spines. The causes for this are varied and may include, but are not limited to;
disc herniations
degenerative disc disease
bone spurs/osteophytes
congenital stenosis (narrow canal inherited at birth/heredity)
ligament hypertrophy
foraminal narrowing
facet hypertrophy
retrolisthesis
spondylolisthesis
etc.....
What is Spinal Stenosis?
By Vicki J Morgan on Sunday, June 14, 2015 at 7:32 PM
Spinal Stenosis is an often very painful condition afflicting millions of people. Despite the age related implications it can and does affect people of all ages, even young children. Stenosis literally simply means a narrowing of a space. In the case of spinal stenosis, the stenosis occurs anywhere in the spine from the cervical region to the lumbar region with the majority of cases affecting the lumbar region.
Diagnosis and Causes of Spinal Stenosis
Each diagnosis is as individual as the patient is. No one is certain how fast or how slowly stenosis damage can become or even if it will occur. There is no timeline for growth and potential for disability. MRI’s or CT scans are the best diagnosis method for soft tissue causes of stenosis. X-rays are usually the first line diagnostic tool; this will show the presence of osteophytes or bony causes of stenosis. If those are present a person will more than likely be referred for an MRI or CT scan to further assess the damage. X-rays, CT scans and MRI’s, though very helpful in diagnostics are by no means accurate owing to the facts that nerves do not follow an exact duplicate track in each person, nor are they done weighted depicting the actual force on the nerve roots or spinal cord.
Some of the causes of stenosis are intervertebral disc compromise (herniations or disc degeneration), ligament hypertrophy, osteophytes, a congenitally narrow or deformed spinal canal, cysts or tumors, facet joint arthritis, retrolisthesis, spondylolisthesis, and dislocations due to trauma. There are three main types of spinal stenosis, lateral, forminal and central. These types of stenosis can occur in any region of the spine and can be present simultaneously both in location and type, meaning that it is possible for a patient to have lateral, foraminal and central stenosis in the cervical, thoracic and lumbar regions all at once.
As stated, each case of stenosis is incredibly individual despite what are very similar findings. Stenosis could appear on diagnostic images as mild to moderate, but may in fact be presenting as severe. The final word on severity comes from a knowledgeable surgeon (usually a neurosurgeon but often an orthopedic surgeon) performing an in-office neurological exam to assess the patient for Hoffmann’s and/or Babinski reflexes which would indicate possible spinal cord compression and the risk of permanent damage due to myelopathy or cauda equina syndrome.
Myelopathy and Types of Spinal Stenosis
Myelopathy is a form of non-traumatic spinal cord injury resulting in physical and/or functional changes in the spinal cord usually without specific lesions. Myelopathy results in disturbances of messages up and down the spinal cord. This condition may develop if stenosis remains untreated, leading to continued compression and damage to the spinal cord. Delayed treatment will allow stenosis to progress and could result in permanent disability from either myelopathy or damage within the cauda equina. Stenosis can lead to multiple spinal cord syndromes based upon the location and type of stenosis present.
Lateral stenosis occurs when a bone spur or protruding disc material compresses a nerve after it has left the spinal canal and the foramen and affects the nerves rather than the nerve root.
Foraminal stenosis affects the facet joints most often in the cervical spine and has the most profound effects on nerve roots exiting the spine through the facet joint. This type of stenosis by itself does not affect the spinal cord or the central canal.
Central canal stenosis relates to the discs, ligaments and anterior vertebral bodies. This type of stenosis has the potential to do the most damage as it can directly affect the spinal cord in addition to the nerve roots. This type of stenosis encompasses disc height loss, disc bulges and herniations, osteophytes on the vertebral body, vertebral shifts, ligament hypertrophy, spinal canal malformation and narrow canal. The risk for injury to the spinal cord and subsequent paralysis is greater in more advanced cases due to compression on the cord itself and nerve roots in the cauda equina.
Possible Effects of and Treatments for Spinal Stenosis
Stenosis in the cervical or thoracic regions can have the most widespread effect on a person because spinal stenosis has the potential to act not only on the nerve roots directly at the level or levels of involvement but also any areas below it. For example, a person with stenosis in the cervical spine will often have effects in all four limbs.
When stenosis occurs in the lumbar spine, the potential to suffer an injury resulting in cauda equina syndrome is great. In the lumbar region of the spine, the spinal cord terminates at around L1-L2 and the remaining nerve roots fan out. Pressure on these nerve roots is often brushed aside and called simply sciatic pain; it might just be chalked up to the patient having a bad back. The lumbar area takes the entire weight of your spine and upper body so the pressure on the nerve roots can be intense. As a result the most common level of spinal stenosis resulting from spinal disc herniation is at L5. There is the most room in the spinal canal in this area but sadly, most of the damage is done to the nerve roots not the end of the spinal cord.
Any time there is a loss of bowel, bladder or sexual function it becomes a medical emergency. Many doctors won’t even admit there is a connection unless the stenosis is lumbar. The loss of bowel or bladder control does not simply include uncontrollable urination and defecation. Loss of control or dysfunction in the bladder and bowels also includes extreme retention of bodily waste. This holds true for stenosis in all levels of the spine. These very important symptoms will often remain unreported when retention is the issue as most people are not aware of how many times in the day they urinate and doctors assure patients that people often go three days between bowel movements. Doctors generally blame constipation on pain medication placing the burden back on the patient. More frequent urinary tract infections are a classic sign that you might be retaining too much urine and might be the only clue.
When stenosis is diagnosed and treated early enough the risk for paralysis, (spinal cord disease due to myelopathy or cauda equina syndrome) diminishes drastically if it’s not removed outright. There are many ways to treat spinal stenosis, some of which include ACDF (anterior cervical discectomy and fusion), RFA (radiofrequency ablation) to control pain in nerve endings, laminoplasty, laminectomy, corpectomy, disc replacement, foraminotomy, micro decompression, activity modification, steroid injections, IDET (intradiscal electrothermal annuloplasty), traction, and others. The most benefit is usually gained through surgical intervention, removing the affected discs, vertebra or osteophytes.
Living with Stenosis
People, (doctors included) tend to allow stenosis to progress without realizing the possible implications for long term or permanent disability including paralysis. The reluctance or refusal by a surgeon to operate is understandable in many cases due to risk, age, location, overall health, or expected outcome. Patients are often reluctant to undergo surgery because they know someone who still has pain post surgery or they know someone who ended up with permanent damage from the surgery. All surgery carries with it some risk, patients have to educate themselves about those possible risks and then weigh out the pros and cons of the situation. Fusions will lead to greater pressure above and below the levels of fusion and often creates a domino effect of spinal failure. There are surgeons and patients who are willing to take the risk of further degradation in order to maintain function.
There are people who would avoid surgery at all costs. You should know and understand all your options and be aware of what could happen should you elect not to have surgery or find that you are not a surgical candidate for some reason.
Surgery should never be done to solely relieve pain. Pain is very often a lifetime companion as a result of stenosis, especially if there is permanent damage. Surgery ideally is only done to improve or maintain function and with the hope of long-term preservation of function. Once you have stenosis it is likely to recur, there is no cure for this disease unless the cause was very specific, an example would be if one disc ruptured and there was no bony involvement. Most people do have some stenosis as normal age related wear and tear. This is a natural process.
Exercise, physical therapy, rest, physical behavior modification, occupational therapy, and medication are usual first lines of treatment. Many people live long and fairly active lives without surgery and without disability if the case is mild. Again, early intervention is key to holding off or avoiding surgery.
The best treatment is for you, the patient, to become proactive in your management of this disease. This means learning as much as you can about your type of stenosis as quickly as possible; familiarizing yourself with the terms used in your MRI report, or by your doctors, is the best way to help yourself initially. Learn what everything means so you can be present mentally when discussing treatment options and your prognosis. You are of no use to yourself if you have no idea what your doctor is saying. Demystify your reports as early as possible. Request all copies of all scans on computer disc; also get copies of your written report to use as reference. Doctors don’t always understand or can be unsympathetic that their patient has no clue what they have just been told. Having written reports will aid you greatly when searching for the terms used to describe your particular condition. Looking at your MRI images on disc and learning what normal spine MRIs look like is another great way to visualize the problem, even if you can’t interpret the images just looking at them may help you understand what is going on inside your body. There are many great resources for stenosis across the internet, sites have links to help interpret the MRI images, define terms commonly used in MRI reports and will explain what treatment options are available. It can be helpful to connect with other stenosis sufferers, especially those with a similar diagnosis.
disc herniations
degenerative disc disease
bone spurs/osteophytes
congenital stenosis (narrow canal inherited at birth/heredity)
ligament hypertrophy
foraminal narrowing
facet hypertrophy
retrolisthesis
spondylolisthesis
etc.....
What is Spinal Stenosis?
By Vicki J Morgan on Sunday, June 14, 2015 at 7:32 PM
Spinal Stenosis is an often very painful condition afflicting millions of people. Despite the age related implications it can and does affect people of all ages, even young children. Stenosis literally simply means a narrowing of a space. In the case of spinal stenosis, the stenosis occurs anywhere in the spine from the cervical region to the lumbar region with the majority of cases affecting the lumbar region.
Diagnosis and Causes of Spinal Stenosis
Each diagnosis is as individual as the patient is. No one is certain how fast or how slowly stenosis damage can become or even if it will occur. There is no timeline for growth and potential for disability. MRI’s or CT scans are the best diagnosis method for soft tissue causes of stenosis. X-rays are usually the first line diagnostic tool; this will show the presence of osteophytes or bony causes of stenosis. If those are present a person will more than likely be referred for an MRI or CT scan to further assess the damage. X-rays, CT scans and MRI’s, though very helpful in diagnostics are by no means accurate owing to the facts that nerves do not follow an exact duplicate track in each person, nor are they done weighted depicting the actual force on the nerve roots or spinal cord.
Some of the causes of stenosis are intervertebral disc compromise (herniations or disc degeneration), ligament hypertrophy, osteophytes, a congenitally narrow or deformed spinal canal, cysts or tumors, facet joint arthritis, retrolisthesis, spondylolisthesis, and dislocations due to trauma. There are three main types of spinal stenosis, lateral, forminal and central. These types of stenosis can occur in any region of the spine and can be present simultaneously both in location and type, meaning that it is possible for a patient to have lateral, foraminal and central stenosis in the cervical, thoracic and lumbar regions all at once.
As stated, each case of stenosis is incredibly individual despite what are very similar findings. Stenosis could appear on diagnostic images as mild to moderate, but may in fact be presenting as severe. The final word on severity comes from a knowledgeable surgeon (usually a neurosurgeon but often an orthopedic surgeon) performing an in-office neurological exam to assess the patient for Hoffmann’s and/or Babinski reflexes which would indicate possible spinal cord compression and the risk of permanent damage due to myelopathy or cauda equina syndrome.
Myelopathy and Types of Spinal Stenosis
Myelopathy is a form of non-traumatic spinal cord injury resulting in physical and/or functional changes in the spinal cord usually without specific lesions. Myelopathy results in disturbances of messages up and down the spinal cord. This condition may develop if stenosis remains untreated, leading to continued compression and damage to the spinal cord. Delayed treatment will allow stenosis to progress and could result in permanent disability from either myelopathy or damage within the cauda equina. Stenosis can lead to multiple spinal cord syndromes based upon the location and type of stenosis present.
Lateral stenosis occurs when a bone spur or protruding disc material compresses a nerve after it has left the spinal canal and the foramen and affects the nerves rather than the nerve root.
Foraminal stenosis affects the facet joints most often in the cervical spine and has the most profound effects on nerve roots exiting the spine through the facet joint. This type of stenosis by itself does not affect the spinal cord or the central canal.
Central canal stenosis relates to the discs, ligaments and anterior vertebral bodies. This type of stenosis has the potential to do the most damage as it can directly affect the spinal cord in addition to the nerve roots. This type of stenosis encompasses disc height loss, disc bulges and herniations, osteophytes on the vertebral body, vertebral shifts, ligament hypertrophy, spinal canal malformation and narrow canal. The risk for injury to the spinal cord and subsequent paralysis is greater in more advanced cases due to compression on the cord itself and nerve roots in the cauda equina.
Possible Effects of and Treatments for Spinal Stenosis
Stenosis in the cervical or thoracic regions can have the most widespread effect on a person because spinal stenosis has the potential to act not only on the nerve roots directly at the level or levels of involvement but also any areas below it. For example, a person with stenosis in the cervical spine will often have effects in all four limbs.
When stenosis occurs in the lumbar spine, the potential to suffer an injury resulting in cauda equina syndrome is great. In the lumbar region of the spine, the spinal cord terminates at around L1-L2 and the remaining nerve roots fan out. Pressure on these nerve roots is often brushed aside and called simply sciatic pain; it might just be chalked up to the patient having a bad back. The lumbar area takes the entire weight of your spine and upper body so the pressure on the nerve roots can be intense. As a result the most common level of spinal stenosis resulting from spinal disc herniation is at L5. There is the most room in the spinal canal in this area but sadly, most of the damage is done to the nerve roots not the end of the spinal cord.
Any time there is a loss of bowel, bladder or sexual function it becomes a medical emergency. Many doctors won’t even admit there is a connection unless the stenosis is lumbar. The loss of bowel or bladder control does not simply include uncontrollable urination and defecation. Loss of control or dysfunction in the bladder and bowels also includes extreme retention of bodily waste. This holds true for stenosis in all levels of the spine. These very important symptoms will often remain unreported when retention is the issue as most people are not aware of how many times in the day they urinate and doctors assure patients that people often go three days between bowel movements. Doctors generally blame constipation on pain medication placing the burden back on the patient. More frequent urinary tract infections are a classic sign that you might be retaining too much urine and might be the only clue.
When stenosis is diagnosed and treated early enough the risk for paralysis, (spinal cord disease due to myelopathy or cauda equina syndrome) diminishes drastically if it’s not removed outright. There are many ways to treat spinal stenosis, some of which include ACDF (anterior cervical discectomy and fusion), RFA (radiofrequency ablation) to control pain in nerve endings, laminoplasty, laminectomy, corpectomy, disc replacement, foraminotomy, micro decompression, activity modification, steroid injections, IDET (intradiscal electrothermal annuloplasty), traction, and others. The most benefit is usually gained through surgical intervention, removing the affected discs, vertebra or osteophytes.
Living with Stenosis
People, (doctors included) tend to allow stenosis to progress without realizing the possible implications for long term or permanent disability including paralysis. The reluctance or refusal by a surgeon to operate is understandable in many cases due to risk, age, location, overall health, or expected outcome. Patients are often reluctant to undergo surgery because they know someone who still has pain post surgery or they know someone who ended up with permanent damage from the surgery. All surgery carries with it some risk, patients have to educate themselves about those possible risks and then weigh out the pros and cons of the situation. Fusions will lead to greater pressure above and below the levels of fusion and often creates a domino effect of spinal failure. There are surgeons and patients who are willing to take the risk of further degradation in order to maintain function.
There are people who would avoid surgery at all costs. You should know and understand all your options and be aware of what could happen should you elect not to have surgery or find that you are not a surgical candidate for some reason.
Surgery should never be done to solely relieve pain. Pain is very often a lifetime companion as a result of stenosis, especially if there is permanent damage. Surgery ideally is only done to improve or maintain function and with the hope of long-term preservation of function. Once you have stenosis it is likely to recur, there is no cure for this disease unless the cause was very specific, an example would be if one disc ruptured and there was no bony involvement. Most people do have some stenosis as normal age related wear and tear. This is a natural process.
Exercise, physical therapy, rest, physical behavior modification, occupational therapy, and medication are usual first lines of treatment. Many people live long and fairly active lives without surgery and without disability if the case is mild. Again, early intervention is key to holding off or avoiding surgery.
The best treatment is for you, the patient, to become proactive in your management of this disease. This means learning as much as you can about your type of stenosis as quickly as possible; familiarizing yourself with the terms used in your MRI report, or by your doctors, is the best way to help yourself initially. Learn what everything means so you can be present mentally when discussing treatment options and your prognosis. You are of no use to yourself if you have no idea what your doctor is saying. Demystify your reports as early as possible. Request all copies of all scans on computer disc; also get copies of your written report to use as reference. Doctors don’t always understand or can be unsympathetic that their patient has no clue what they have just been told. Having written reports will aid you greatly when searching for the terms used to describe your particular condition. Looking at your MRI images on disc and learning what normal spine MRIs look like is another great way to visualize the problem, even if you can’t interpret the images just looking at them may help you understand what is going on inside your body. There are many great resources for stenosis across the internet, sites have links to help interpret the MRI images, define terms commonly used in MRI reports and will explain what treatment options are available. It can be helpful to connect with other stenosis sufferers, especially those with a similar diagnosis.