What’s an Effective Treatment for Spinal Stenosis?

Spinal stenosis¹ is a condition where the spinal cord’s spaces gradually decrease, narrowing the space in the spinal canals. This narrowing of the spinal cord can be extremely painful and uncomfortable. This might also affect the nerve roots in the spinal cord, causing nerve-related issues in the body. However, with treatment for spinal stenosis, one can improve the symptoms of spinal stenosis and treat it. 

What is the Cause of Spinal Stenosis?

Our body, almost every day, undergoes loss and gain. It may be the loss and gain of our cells or simply the loss of some tissues due to major or minor injuries. With time, this loss gradually increases. Similarly, due to the gradual wear and tear of the joints in our body, we develop spinal stenosis. In other words, one develops spinal stenosis due to osteoarthritis².

Hence, due to the reason mentioned above, it is also understood that the specific age group that is being affected by the same are the older generations, who are 50 years or above in age. Our body starts deteriorating with time. Our immune system is tweaked; hence, any damage done to the body will take longer to heal than before. We lose a lot of our senses with time. We lose our ability to taste, and some lose their ability of sight, hearing, and even our motor movements are reduced with age.

In this natural process of loss, wear and tear, and damage, we are more likely to develop spinal stenosis. Research has also found that the development of spinal stenosis is more common in women than that in men due to reasons that will be explored later in this article.

Other Causes of Spinal Stenosis

1. Thickening of the Ligament

Every joint or bone has specific muscles, ligaments, or tissues to keep them in place and shape. Similarly, ligaments are present in our spine to keep those bones in place. However, in some cases, this ligament may thicken, which might bulge or extend into the spinal cord spaces, narrowing the spinal cord spaces.

2. Congenital spinal stenosis

Congenital refers to being present at birth. Some individuals may be born with small spinal spaces that automatically make them vulnerable to developing spinal stenosis. However, it is a sporadic neurological disease. Treatment for spinal stenosis must be started earlier in such cases to improve the symptoms.

3. Injuries or Surgeries

Injuries can affect the spinal nerves, nerve roots, and bones in the spine. This might easily predispose an individual to spinal stenosis. In some cases, after surgeries, one may face swelling in some tissues in the spinal cord that may alleviate pain and reduce the spinal canal space.

4. Growth of Bone Spurs

When the body senses that there is damage in the bone or at the joints, the body produces some bony structures to compensate for the damage. These bony projections may take up the spinal cord’s space, narrowing the spinal canal space.

5. Rheumatoid Arthritis

An inflammatory condition where the joints in the body are defected or damaged. This may cause stiffness and numbness that is painful and uncomfortable. This happens as the immune system damages the healthy cells or tissues in its own body, causing harm.

6. Bone Diseases

Having certain types of bone diseases may also predispose an individual to develop spinal stenosis. One must take extra care, and if any early symptoms are found, one must start the treatment for spinal stenosis to improve the symptoms.

Types of Spinal Stenosis

Depending on the location of the narrowing of the spinal cord, there are, in general, two types of spinal stenosis. Namely, cervical spinal stenosis and lumbar spinal stenosis.

1. Cervical Spinal Stenosis

The condition is called cervical stenosis when the spinal cord near your neck has reduced canal space. Here, the nerve roots near the neck can get damaged, causing specific neurological deficits called myelopathy³. This is caused by wear and tear, injuries, or other causes, as mentioned above.

Symptoms of Cervical Spinal Stenosis

a) Neck Ache

b) Imbalance in the body

c) Burning pain in the neck

d) Shock-like pain in the neck

e) Numbness of the arm, hand, or even the legs.

2. Lumbar Spinal Stenosis

This is the most common form of spinal stenosis. It is a condition where the spinal cord or canal is narrowed in the body’s lower back. Innumerable nerves pass through our vertebrates. These nerve roots get damaged due to the narrowing of the spinal cord. There is no cure for this. However, there are some options of treatment for spinal stenosis that might improve the symptoms.

Symptoms of Lumbar Spinal Stenosis

a) Loss of Sensation in regions such as feet

b) Pain in the lower back

c) Burning sensation in the buttocks region

d) Burning sensation in the legs

e) Numbness or cramps

f) Feeling weak

g) Loss of sexual ability

h) Difficulty in bowel or bladder control

i) Difficulty in walking due to leg pain and burning sensations

j) Pain in back and abdominal muscles

Diagnnosis of Spinal Stenosis

After discussing symptoms and medical history with the doctor, the doctor might suggest a physical examination. In this examination, potentially damaged regions might be vaguely identified. In addition to these, other scans may be administered to locate the issue and detect its intensity. These include:

1. MRI

Magnetic resonance imaging ⁴is one of the imaging tests used to get clear, accurate images of the body and its organs. This technique uses magnets and radio waves to generate clean images of the spinal cord and other related parts.

2. X-Ray

X-rays can be used to detect the formation of any new bone spurs and also to get an image of the spinal cord. In X-rays, minimal traditions are sent into the body to generate images.

3. CT Scans

Computed tomography ⁵is another technique that can detect problems in the spinal cord. These scans do not take much time and give accurate results that help avoid misdiagnosis. 

In most cases, a combination of these scans and physical examination may be required to confirm the presence of spinal stenosis. These scans are essential for determining the patient’s spinal stenosis treatment. 

Treatment for Spinal Stenosis

The treatment for spinal stenosis depends on the type of stenosis and severity of the symptoms in the context of your health conditions. Initially, the doctors may advise some home remedies in cases of early interventions, but as the severity increases, they may suggest other treatment methods for spinal stenosis.

1. Self-help Remedies

When the symptoms are mild, the doctors suggest some easy techniques for treating spinal stenosis that can be followed at home. Some of these techniques are advised in addition to medications in moderate and severe cases.

a) Exercise

Exercise in any form will help strengthen the muscles, making it healthier for the bones. This is one of the methods in the treatment of spinal stenosis. You can take part in simple stretching exercises, yoga or walking. It is important to note that you must consult your doctor before choosing a form of exercise. Doing the right exercise is as important as doing exercise in itself. Any neglect can lead to more pain and complications.

b) Packs

Hot or cold packs can help relieve pain. Hot packs can soothe the muscles and instantly provide pain relief. You can also use cold packs (ice packs, frozen packs). They strengthen your muscles. A healthy muscle can also help increase balance and flexibility lost due to spinal stenosis.

2. Medications

One can also try nonsurgical treatment for spinal stenosis to improve the symptoms. Pain relief medications are usually administered to the patients as a part of the treatment for spinal stenosis. Medications to treat the inflammation are also given in the early stages. These medications include Tylenol®, aspirin, ibuprofen, and many other similar medications. Kindly consume them only when prescribed by your doctor.

Some medications are given with caution, as they may have other side effects. So in case of any discomfort, kindly inform your doctors at the earliest to prevent any further complications.

Medications, on the other hand, can also be addictive. A sense of dependency is created on these medications, similar to that of any other form of drug dependency. Hence, the doctor will also advise you to be aware of such addictions.

3. Steroid Injections

There are varied kinds of steroid injections that are injected into the body to provide relief from the pain. These injections are given directly into the canal spaces. The liquid flows to the affected nerves and covers them, aiding in its healing, and simultaneously reducing inflammation and swelling.

It is important to remember that there would be extreme burning sensations caused due to inflammation or due to bones rubbing with each other. These injections can reduce pain but only temporarily. Corticosteroid injections or other injections such as cervical epidural steroid injections are used to relieve pain.

These injections are given in very limited amounts, as they can, in the long term, cause harm and damage to the bones. With frequent use, they can damage the tissues, muscles, or even the bones in that region, causing more harm than healing. Hence, they are given in very minimal amounts. It is further important to note that these injections might not work for everyone. Hence, a trial may be administered in this type of treatment for spinal stenosis. 

Any medications given will always be administered after checking medical history, and they will further be administered in context to other medical health conditions (if any). Medications may be given in addition to other alternatives for treatments for spinal stenosis.

4. Surgery

This method of treatment for spinal stenosis is the last resort. The spine is a very delicate bone to conduct any surgery on. This method is used when every other possible method has eventually failed. This is also used when the person is unable to carry out their everyday duties. This treatment for spinal stenosis is used when there is extreme difficulty and an inability to tolerate the pain. When everyday activities such as walking or simply balancing yourself become difficult, one may opt for surgery.

There are various surgeries. Here are a few:

a) Spinal Fusion

Spinal fusion is simply a welding procedure in which small spinal cords are corrected. This treatment is considered when there is extreme nerve pain. In spinal fusion, two vertebrates are permanently joined, fused, or welded together. The bones are usually held together with the help of rods or screws in the initial period until the bones start to heal by themselves. Healing of the bones takes a very long time. They can be anywhere from 6 months to one year or even more. This is a treatment for spinal stenosis, as aforementioned is considered at last due to its risks that will be discussed later in this article.

b) Laminectomy

This is a surgery performed to enlarge the spinal canal spaces. In this method of treatment for spinal stenosis, the lamina and the back part of the vertebrae are removed to create more space. The bone that is removed here is usually used in spinal fusions to connect the bones. Hence, in some cases, a laminectomy is first conducted if a spinal fusion needs to be conducted.

There are various types of laminectomy surgeries⁶ in the treatment of spinal stenosis.

i) Laminoplasty

This is a neurosurgical method, where a part of the lamina from the vertebrae is removed to create more space. This is usually performed near the neck region, so it is ideal for those with cervical spine stenosis. This treatment for spinal stenosis may not be performed in all, and it varies from person to person. 

ii) Interspinous Process Spaces

In this method, spacers are known as decompression spacers, or posterior interspinous devices are used to create space between the bones. In this method of treatment for spinal stenosis, a small spacer device is inserted between spinous processes. The spinous process is a bony structure projected from the back of the vertebrae. There are many spinous processes present in the body. 

This surgery is usually carried out in the case of lumbar spinal stenosis and is usually done to give space to the nerve roots in that region.

iii) Laminotomy

This is another alternative method in the available options in treatment for spinal stenosis. Here, a small part of the lamina is removed to relieve pressure.

Risk of Surgical Methods in Spinal Stenosis

As mentioned earlier, these surgical methods come with their own risk. Some of them include bleeding, formation of blood clots, infections, or reactions to the anesthesia that was administered. In addition to these risks, some other significant risks specific to this disorder are:

a) Failure of the Bone in Healing

Failure in the healing of the bone is caused when the body doesn’t receive enough vitamins and minerals such as calcium, vitamin C, and vitamin D. It may also occur if the bone is not receiving sufficient blood flow to heal. All of these are common problems in people of old age, as their immune system and their ability to absorb nutrients gradually decreases. And given that spinal stenosis also occurs in older people, the risk of failure in healing the bone is higher.

b) Injury

Surgery in itself, at times, might cause damage to certain nerve roots. It can also cause damage to specific tissues or membranes. Hence, nerve injuries are a possible risk too.

c) No Relief

In some conditions, one might have to get additional surgeries done to fix some issues that can be painful and risky. This might be upsetting, but to some, there is no relief in the pain at all, despite the surgery. Hence, there was no advantage of the surgery at all; in addition, the person may become predisposed to some of the risks mentioned above, which can make it even worse.

However, the person is usually kept in hospital for 1 or 2 days post-surgery. Therefore, if there are any complications, the medical team will be present to deal with them quickly. As these surgeries include the placement of rods or screws to hold bones in place, we might also have issues due to them. Any minor displacement of these tools can create unfavorable health conditions. However, most patients with spinal stenosis have been healed, too, so the chance of a successful surgery pushes doctors and patients to try them.

Finding the proper treatment for spinal stenosis may be challenging. But with time, physical examinations, and tests, the medical team will figure out the proper treatment for spinal stenosis for you. The treatment for spinal stenosis that works for you might not work for others; hence it is subjective in nature.

When early treatment for spinal stenosis is administered, one has a greater chance of healing or improving its symptoms. It is in severe conditions that surgery is advised to patients. Hence, do not avoid your symptoms. A regular health check every six months is advised to keep your health in check and to detect signs of any disorders as early as possible. Prevention is always better than cure. Therefore, one needs to be more conscious of one’s health.

 

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Last Updated on July 24, 2024 by Sathi Chakraborty, MSc Biology