Scoliosis Research Society (SRS)
Scoliosis Research Society (SRS)
An International Organization Dedicated to the Education, Research and Treatment of Spinal Deformity
Our Mission is to Foster Optimal Care for All Patients with Spinal Deformities
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The Aging Spine

Osteoarthritis and Other Degenerative Conditions of the Spine

Spinal Stenosis

As the arthritis/disk degeneration worsens, the spinal canal (the space which contains the spinal cord and nerve roots) can narrow, and one of the large ligaments (ligamentum flavum) that crosses the space between two vertebrae can shorten and become relatively more thick. These structures then press on the nerves in the spinal canal.

Symptoms and Diagnosis
This constriction, or stenosis, can lead to leg pain while walking and standing and is usually relieved by sitting or lying down. These symptoms are known as neurogenic claudication, which must be differentiated from the same kind of pain radiating down the legs that is caused by circulatory problems, arthritis of the hips, or diabetic nerve problems.

Spinal stenosis is diagnosed specifically by CT or MRI scans. Sometimes, EMG and nerve conduction tests are used to differentiate this condition from diabetic nerve involvement.

Treatment
Nonsurgical treatment consists of anti-inflammatory medicines, exercise, and physical therapy. Occasionally, local anesthesia or steroids are injected into the soft tissues, such as the muscles and ligaments, or into the spinal canal (epidural) near specific nerve roots. If these procedures do not relieve the symptoms, then surgical decompression of the involved vertebrae may be necessary. This surgery is quite effective and allows patients to walk farther and stand longer without pain. Surgery involves decompressing the nerve roots by removing the roof of the spinal canal (laminectomy) and enlarging the spaces where the nerve roots exit the canal (foraminotomy). A fusion of the affected vertebrae may also be necessary if instability is present. It is important to remember that a spinal fusion is a procedure which causes the spinal segments to heal/join together using bone, either from the pelvis ( iliac crest) or from the bone bank. In the majority of cases, a metal implant consisting of screws and rods is used to help maintain stability at these segments while the fusion heals.

The hospital stay is generally shorter if fusion is not done and a bit longer if it is. In either case, particularly if a patient had some debilitation preoperatively, a short stay in a rehab facility to regain strength and mobility may be needed. The actual details of post-discharge care, resumption of normal physical and athletic activities, driving, and the possible use of a brace will be provided by the patient's surgeon based on each patient's specific case.

Open Canal Closed Canal
Cross sectional MRI view of spine on left shows open spinal canal while the similar view on right shows a severely narrowed or stenotic spinal canal..
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