Spinal Stenosis Treatment

Spinal stenosis is a medical condition characterized by the narrowing of one or more spaces within the spinal canal, the tunnel that runs through each of the vertebrates and contains the spinal cord and the nerve roots. This narrowing can exert pressure on the spinal cord and the nerves roots causing them to become irritated, compressed or pinched.

Treatment for this spinal condition in Cuba is based on the severity of symptoms but usually includes conservative treatments such as medication, physical therapy and steroid injections or for people whose condition has not responded to non-surgical treatment or whose symptoms are severe, surgical intervention may be recommended.

Potential consequences if spinal stenosis is left untreated include:

• Chronic pain in the back, neck, arms or legs that becomes harder to manage
• More frequent and severe numbness or tingling
• Severe numbness and weakness in extremities
• Loss of coordination and balance, higher risk of falls
• Bladder and Bowel Dysfunction
• Incontinence or difficulty with urination and bowel movements
• Significant impact on independence and quality of life
• Permanent nerve damage
• Irreversible damage from prolonged nerve compression
• Difficulty with daily activities

Types of Spinal Stenosis

Spinal stenosis can be classified in few ways:

• Cervical Stenos: Occurs in the neck (cervical spine).
• Lumbar Stenosis: Occurs in the lower back (lumbar spine).
• Thoracic Stenosis: Occurs in the mid-back (thoracic spine), although it is less common.
• Lateral Stenosis: Affects the nerve roots exiting the spinal canal.
• Central Stenosis: Narrowing of the central spinal canal.
• Foraminal Stenosis: Narrowing of the openings (foramina) where nerve roots exit the spine.

Causes of Spinal Stenosis

Spinal stenosis has several causes that can be divided into two main groups, congenital (from birth) and acquired (after birth) most commonly after the age of 50 usually from an injury or changes in the spine that occur due to aging (degenerative changes).

Causes of congenital spinal stenosis:

• Congenital spinal stenosis arises due to genetic factors that influence the development of the spine whereby it is naturally narrow leading to potential compression of the spinal cord and nerves.

Causes of acquired spinal stenosis:

• Bone Spurs: Wear-and-tear damage from arthritis can lead to the growth of extra bone (bone spurs) that encroach upon the spinal canal.
• Herniated Disks: The disks between the vertebrae, which act as shock absorbers, can develop tears. When the soft inner material of a disk leaks out, it can press against the spinal cord or nearby nerves, leading to stenosis.
• Thickened Ligaments: Over time, the ligaments that stabilize the spine can become stiff and thickened. These thickened ligaments can protrude into the spinal canal, contributing to narrowing and nerve compression.
• Tumours: In rare cases, tumours can develop within the spinal canal, exerting pressure on the spinal cord and nerves.
• Spinal Injuries: Trauma or injuries to the spine can cause swelling or dislocation of bones, leading to stenosis.

Symptoms of Spinal Stenosis

• Pain and cramping in the lower back or neck area.
• Numbness and tingling.
• Muscle weakness.
• Difficulty walking.
• Bladder or bowel dysfunction.
• Sexual dysfunction

Diagnosis of Spinal Stenosis

Diagnosis of spinal stenosis beings with medical history to review symptoms, medical history, and risk factors and physical examination to assess pain, mobility, and neurological function.

• Imaging Tests
  • X-rays: Identify bone changes, such as bone spurs and disc degeneration
• Magnetic Resonance Imaging (MRI): Detailed images of soft tissues, including discs, ligaments, and the spinal cord, to detect narrowing and nerve compression
• Computed Tomography (CT) Scan: Used more for complex cases where precise anatomical details are necessary.
• Bone Scan (if necessary): Detects areas of increased bone activity, which can indicate fractures, tumours, or infections
• Nerve Function Tests
  • Electromyography (EMG): Measures the electrical activity of muscles to evaluate nerve and muscle function and detect nerve damage or irritation.
• Nerve Conduction Study (NCS): Assesses the speed and strength of electrical signals traveling through nerves to identify areas of nerve damage.
• Laboratory Tests:
  • Ruling Out Other Conditions: Lab tests may be used to rule out other conditions that could cause similar symptoms, such as infections, inflammatory diseases, or metabolic disorders.
• Assessing Overall Health: In preparation for potential surgical treatment, lab tests might be conducted to assess the patient’s overall health and readiness for surgery.
• Identifying Underlying Causes: If there is suspicion of an underlying condition contributing to spinal stenosis, such as a tumour or systemic disease, specific lab tests might be ordered to gather additional information.

Treatment Options for Spinal Stenosis

Treatment for spinal stenosis is dependent on the several factors including:

• Severity of symptoms
• Location of stenosis
• Overall health and medical history
• Presence of other medical conditions (e.g., diabetes, heart disease)
• Previous spine surgeries or treatments
• Cause of stenosis
• Patient’s age
• Patient’s activity level
• Response to previous treatments

Non-surgical treatment:

Initially treatment for spinal stenosis is with non-surgical methods including medication to relieve pain, as well as:

• Physical Therapy: Individualized physical therapy plays is an important role enhancing overall spinal health and functionality:
• Core, leg and upper body strengthening: Focus on abdominal and back muscles to support the spine, exercises to strengthen leg muscles and improve overall mobility and exercises to support posture and reduce strain on the spine.
• Flexibility and Stretching: To relieve tension in the lower back, to improve hip mobility and reduce lower back strain and to maintain flexibility.
• Low-impact activities: Such as walking, swimming, or cycling to improve cardiovascular health without stressing the spine.
• Water therapy: Exercises performed in water to reduce impact on the spine.
• Posture training: Techniques to maintain good posture during daily activities.
• Body mechanics: Strategies to avoid positions and movements that exacerbate symptoms
• Balance and coordination: Exercises to improve balance, enhance coordination, stability to prevent falls
• Gait training: Techniques to improve walking patterns and efficiency
• Manual therapy: Hands-on techniques to manipulate and mobilize the spine
• Steroid Injections: Corticosteroid injections directly into the epidural space to reduce inflammation and provide temporary pain relief.

Surgical Options

Indication for surgical intervention include:

• Severe and Persistent Pain
• Progressive neurological deficits
• Bladder and bowel dysfunction
• Structural instability
• Failure of conservative treatments
• Quality of life impact

Surgical options include:

• Laminectomy: This is the most common type of spinal stenosis surgery and involves the removal of the lamina (part of the vertebra) to create more space for the spinal cord and nerves.
• Foraminotomy: Foraminotomy is used to widen the foramen, the parts of the spine where the nerves exit by removing bone or tissue in the area.
• Spinal fusion: Spinal fusion is generally performed in more severe cases, particularly when multiple spinal levels are affected. The procedure uses bone grafts or metal implants to join (fuse) the affected vertebrae together