Health

Is Spinal stenosis a serious condition

Spinal stenosis is a narrowing of the spinal canal due to some degenerative conditions such as bony structures, facet osteophytes, and posterior vertebral body osteophyte or it is called an uncinate spur. Other causes are like a trauma that results in the vertebrae slipping forward or its medical term is spondylolisthesis, herniated or bulging discs and synovial facet cysts.

Spinal stenosis commonly happened in patients more than 65 years old and slightly more in males with a ratio of 1.5:1. There are many locations of vertebrae that the stenosis can occur but 91% most commonly occurs at L4-5. Caucasian race and people with increased BMI hold high risk to get spinal stenosis. Other factors are congenital spine anomalies and people who have short pedicles and laminae due to failure of posterior elements to develop.

Spinal stenosis occurs when cell, water and proteoglycan content in the nucleus pulposus of the intervertebral disk decreases with age and leads to diminished disk height and protruding of the annulus fibrosus. The anterior spinal column cannot absorb more stress than usual, and caused the abnormal transfer of force to the posterior elements and increased stress through the facets. Hence, the facet joint hypertrophy, osteophyte formation, and ligamentum flavum buckling and hypertrophy occurred.

Spinal stenosis is not a serious condition until these conditions result in a compression syndrome or even worse, cauda equina syndrome because the symptoms often start slowly and only get worse over time. Central herniation affects traversing nerve root, far lateral herniations affect exiting nerve root and blood can be cut off such as segmental arteries and dorsal branches supplying blood to the dura and posterior elements.

Patients usually complain of pain in their legs that become so severe that walking even short distances is unbearable. To temporarily ease the pain, patients frequently need to sit or lean forward over a grocery cart, countertop or walker. Other symptoms that the sufferer may experience are numbness, weakness, cramping or pain in the legs, thighs or feet, abnormal bowel or bladder function, loss of sexual function or partial or complete leg paralysis if in a severe case.

You need to seek medical attention and your doctor will do some tests to confirm. They include straight leg raise and neurological examination to know there is a nerve being pinched. Investigation through imaging also can help to confirm the condition such as radiograph, MRI, and CT myelogram which is more invasive than MRI. MRI findings of spinal stenosis may usually be found accidentally in patients with no symptom.

The first-line treatments of spinal stenosis are NSAID to ease the pain, physical therapy to strengthen the peripheral muscle and weight loss. Before spinal stenosis surgery is needed, corticosteroid injection may be effective to treat symptoms. If a patient has persistent pain for 3-6 months, failed non-operative treatment, and progressive neurologic deficits, they are indicated with wide pedicle to pedicle decompression surgery.

This surgery can improve pain and function of the impaired muscles, however, this surgery holds some specific complications including wound infection, dural tear, epidural hematoma and instability. Other complications are pneumonia due to intubation during surgery, neurologic deficits if there is an injury to the nerve, urinary tract infection due to prolonged bed-bound and blood loss or anaemia requiring transfusion.

The recovery from this surgery will take 2 to 4 weeks. In this meantime, you will be on pain medication to be out of bed. Your doctor will give instructions on how to carefully sit, rise and stand. The patients are not going to be instantly better and it is important to give the body to heal. You will be probably recommended to restrict your activities and do nor do anything that moves your spine too much. Avoiding contact sports, twisting or heavy lifting while you recover also need to be practised.