Spinal Stenosis: Description and Diagnosis
What Is It?
The term "spinal stenosis" is heard quite frequently today because
of the concentration of elderly in our populace. "Spinal stenosis" is primarily
an aging process. Many years ago it was called creeping paralysis. It was accepted
that if one got old enough, one could acquire it and have to "live and bear
it".
The two words are separated primarily for clarification; "spinal" giving the location and "stenosis" meaning the condition. Stenosis is derived from the Greek word meaning "narrowing of a normally larger opening". The term stenosis is widely used in medicine to describe a narrowing of various parts of the body.
The primary area discussed here is stenosis of the spine, which can occur in the cervical, thoracic or lumbar region. We will address the lumbar area in this article because of the greater percentile that we see. Factors that predispose a person to acquiring spinal stenosis can start in the womb as a result of genetics or congenital problems acquired from the mother. In addition, there are many perfectly normal backs after childhood development that are mechanically ruined due to self-destructive modes, but not all self-controlled.
Lumbar Spinal Stenosis
Eventually the narrowing of spaces in the spine (backbone) results in pressure on the spinal cord and/or nerve roots. When the neuroforamina are reduced in size due to surrounding debris, the nerves react to the pressure by swelling. As the window closes on the nerve the associated pain may become excruciating and debilitating.
Diagnosis
Pain may be felt in the buttocks, thighs, and/or calves when walking and/or
standing. Spinal stenosis may also cause numbness, weakness, burning sensations,
tingling, and pins and needles in the involved extremity, such as the arm or
leg.
Some patients with spinal stenosis may find the pain eases when bending forward or sitting. This may happen because bending forward creates more vertebral space, which may temporarily relieve nerve compression. The doctor may use a variety of approaches to diagnose spinal stenosis and rule out other conditions.
Medical History - the patient tells the doctor details about symptoms and about any injury, condition or general health problem that might be causing the symptoms.
Physical Examination - the doctor (1) examines the patient to determine the extent of limitation of movement; (2) checks for pain or symptoms when the patient hyperextends the spine (bends backwards); and (3) looks for the loss of extremity reflexes, which may be related to numbness or weakness in the arm or legs.
X-Ray - an x-ray beam is passed through the back to produce a two-dimensional picture. An x-ray may be done before other tests to look for signs of an injury, tumor, or inherited abnormality. This test can show the structure of the vertebrae and the outlines of joints, and can detect calcification.
MRI (Magnetic Resonance Imaging) -- energy from a powerful magnet (rather than x-rays) produces signals that are detected by a scanner and analyzed by a computer. This produces a series of cross-sectional images ("slices") and/or a three-dimensional view of parts of the back. A MRI is particularly sensitive for detecting damage or disease of soft tissues, such as the discs between vertebrae or ligaments. It shows the spinal cord, nerve roots, and surrounding spaces, as well as enlargement, degeneration or tumors.
Computerized Axial Tomography (CAT) - x-rays are passed through the back at different angles, detected by a scanner, and analyzed by a computer. This produces a series of cross-sectional images and/or three-dimensional views of the parts of the back. The scan shows the shape and size of the spinal canal, its contents, and structures surrounding it.
Myelogram - a liquid dye that x-rays cannot penetrate is injected into the spinal column. The dye circulates around the spinal cord and spinal nerves, which appear as white objects against bone on an x-ray film. A myelogram can show pressure on the spinal cord or nerves from herniated discs, bone spurs, or tumors. Bone Scan - an injected radioactive material attaches itself to bone, especially in areas where bone is actively breaking down or being formed. The test can detect fractures, tumors, infections, and arthritis, but may not tell one disorder from another. Therefore, a bone scan is usually performed along with other tests.