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Adam Sewell MD

SPINAL STENOSIS

Spinal Stenosis is a disorder due to the narrowing of the spinal canal causing nerve and spinal cord impingement. Often this results in persistent pain in the lower back and extremities. Difficulty walking, decreased sensation in the lower extremities, and decreased physical activity may also be seen. Spinal stenosis most commonly affects people over the age of 65.  Scoliosis and hypertension are considered to be risk factors. Interestingly increasing age alone increases the risk for spinal stenosis without pre-existing pathology (Coronado 2007).

Pathology

Symptoms develop due to complications from the narrowing of the spinal canal where the spinal cord is located. This constriction produces symptoms of impingement on the spinal cord, spinal vasculature, and surrounding peripheral nerves. Disc bulging and herniation as well as arthritic changes of the vertebrae can cause narrowing of the canal. The pain and decreased mobility that is produced by this condition may cause a disability that can significantly impair a patient’s lifestyle (Boswell 2007). Another common complication of chronic pain due to spinal stenosis is Central Sensitization. Central sensitization occurs when there is an increase in the excitability of neurons within the central nervous system at the level of the spinal cord and higher. Symptoms of progressive and severe spinal stenosis include bladder or bowel incontinence, lower extremity weakness, or loss of sensation. These symptoms can be a medical emergency and require immediate evaluation.

Diagnosis

A physician most likely will order radiological imaging such as CT scan or MRI to confirm the level of stenosis.

Treatment

  • Medications such as NSAID’s, membrane stabilizing drugs and other analgesics
  • Epidural Steroid Injections involves injecting a medication into the epidural space, which includes both a long-lasting steroid.
  • Percutaneous Adhesiolysis also known as the Racz catheter uses a needle inserted into the caudal epidural space (by the tailbone). A catheter is advanced into the epidural space under fluoroscopy guidance where corticosteroid, local anesthetic, Wydase, and Hypertonic Saline are injected to aid in breaking up scar tissue.
  • Spinal Cord Stimulation (SCS) – a small electrical pulse generator is implanted under the skin. A low-voltage electrical current is administered and decreases the perception of pain by confusing the spinal cord and brain pain processing centers. This is done on a trial basis.
  • Surgical Treatments al laminectomy or foraminotomy may be necessary to take pressure off the spinal cord and surrounding nerves. Often surgical decompression is recommended in acute spinal stenosis and especially in patients who rapidly develop loss of bladder/bowel function, weakness, and decreased sensation.

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