SPINAL STENOSIS:A NEUROLOGIC DEFICIT
Along the lines of evolution, human beings have developed the most advanced nervous system, comprising of the brain and the spinal cord. The spinal cord extends down from the brain in the form a tubular structure, carrying bundles of nervous tissue. Its length in men is around 45cm while in women somewhere near 43cm. surrounding the cord is the skeletal covering of the vertebral column. Any changes, normal or pathological, occurring in the vertebras, have a direct impact on the integrity of the spinal cord, resulting in neurological deficits. One such example is Spinal Stenosis.
In the U.S, approximately 250,000-500,000 people were found to have symptoms of spinal stenosis in a survey.
A stenosis in medical terms means narrowing of any cavity or canal. In spinal stenosis, one or more of the foramina of the vertebra undergo excessive narrowing, compressing the spinal cord or the spinal nerves. This exhibits as a wide range of neurological symptoms.
FORMS OF SPINAL STENOSIS
The stenosis of the spinal canal most commonly affects the lumbar and cervical region, in descending order of frequency.
Cervical spinal stenosis: this occurs at the level of the neck (Cervical). This can be far more dangerous than its counterpart in the lumbar area. It mainly occurs due to wear and tear due to aging, but certain conditions such as spondylosis, hyperostosis, ruptured disc, slipped vertebrae or certain congenital conditions may also play a part. It occurs more commonly in middle aged men.
Lumbar spinal stenosis: Lumbar spinal stenosis occurs at the level of the lower back. With growing age, the discs between the vertebras lose their elasticity and get hardened, which puts pressure in the spinal canal. Also, growths of bony spurs may also be found that grow into the canal, narrowing it down.
TYPES OF SPINAL STENOSIS
On the basis of etiology, spinal stenosis is of the following types:
- Primary spinal stenosis: this type of stenosis is uncommon, found in only 9% of the patients. It may occur due to congenital malformations such as:
- Incomplete vertebral arch closure (spinal dysraphism).
- Segmentation failure.
- Secondary spinal stenosis: secondary or acquired form of the disease is a part of the degenerative changes. This can occur due to following reasons:
- Trauma- automobile accidents, slip and fall accidents or direct blunt trauma etc.
- Surgical procedures.
- Certain medications
- Systemic diseases that may be involved in secondary stenosis include Paget disease, fluorosis, acromegaly, neoplasm, and ankylosing spondylitis.
SYMPTOMS OF SPINAL STENOSIS
Both congenital and acquired form of the disease confers a risk of acute neurological injury to the patient. This may present as one or more of the following symptoms:
- Pain, of varying intensity, radiating from the back to the neck region as well as lower limbs.
- Numbness and tingling, extending to the buttocks and legs.
- Loss of motor functions.
- Lack of bladder and bowel control.
- Muscle weakness
- Disturbances in gait.
- Sensory disturbances.
- Abnormal reflexes.
TREATMENT OF SPINAL STENOSIS
Treatment options can be:
- Conservative: The modes of conservative therapy include rest, physical therapy with strengthening exercises for Paraspinal musculature, brace for support, use of optimal postural biomechanics, nonsteroidal anti-inflammatory medications, analgesics, and antispasmodics.
- Surgical: removal of the bony spurs or the compressing worn out disk, providing relief to the patient.
The degenerative process can be managed, but it cannot be prevented by diet, exercise, or lifestyle. A study estimate suggests that without surgical intervention, the symptoms remain unchanged in 70% of the patients, and in fact, got worse in 15% of them. The disabling consequences of this disease are inevitable, but their onset can be delayed by adapting a healthier life style.