Spinal Stenosis

As arthritis or disk degeneration and facet arthritis worsens, the spinal canal (the space which contains the spinal cord and nerve roots) can narrow—causing stenosis. During the narrowing, a large ligament (ligamentum flavum) that crosses the space between 2 vertebrae can shorten and become relatively thicker. The thicker ligament, the arthritis in the facet joint, and the narrowed disk space puts added pressure on the nerves in the spinal canal.

Symptoms

The constriction of the spinal canal, or stenosis, produces symptoms known as neurogenic claudication. The patient can have leg pain while walking and standing (and is usually relieved by sitting or lying down). The constriction around one or two nerves can cause leg pain known as radiculopathy. Worsening of pain varies with position, but may be relieved by lying down.

Imaging Evaluation & Diagnostics

Pain from spinal stenosis must be differentiated from similar pain caused by circulatory problems, arthritis of the hips, or diabetic nerve problems through one or more of the following diagnostic tools:

• Computerized tomography (CT) for initial diagnosis
• Magnetic resonance imaging (MRI) scans when further diagnostic investigation is needed
• EMG and nerve conduction tests can differentiate this condition from diabetic nerve involvement

Treatment Options

Nonoperative Treatment

• Anti-inflammatory medicines
• Exercise
• Physical therapy
• Local anesthesia or steroids injections in muscles and ligaments
• Epidural in the spinal canal (near specific nerve roots)

Operative Treatment

Surgical decompression of the involved vertebrae allows patients to walk farther and stand longer without pain.

• Decompression surgery removes the roof of the spinal canal (laminectomy) and enlarging the spaces where the nerve roots exit the canal (foraminotomy). The result is decompressed nerve roots and pain relief.
• Vertebral fusion may be necessary (often in conjunction with decompression surgery) if instability is present. The spinal fusion joins together and heal spinal segments fusing bone, either from the pelvis (iliac crest) or from the bone bank (donated bone). 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 spinal fusion is not performed and a bit longer if it is. In either case, particularly if a patient’s condition had debilitated rapidly 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.