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Lumbar Spinal Stenosis






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Lumbar Spinal Stenosis Lumbar Spinal Stenosis Document Transcript

  • A Patient’s Guide toLumbar Spinal Stenosis Spine University 228 West Main, Suite C Missoula, MT 59802 Phone: info@spineuniversity.com Compliments of: Spine University
  • DISCLAIMER: The information in this booklet is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions,A Patients Guide to Lumbar SpinalinStenosis with your health care provider, nor should you disregard ailments or treatments. The information should NOT be used place of a visit the advice of your health care provider because of any information you read in this booklet. Spine University Spine University 228 West Main, Suite C Missoula, MT 59802 Phone: info@spineuniversity.com http://www.spineuniversity.comAll materials within these pages are the sole property of Medical Multimedia Group, LLC and are used herein by permission. eOrthopod is a registered trademark of Medical Multimedia Group, LLC. 2 Compliments of: Spine University
  • A Patients Guide to Lumbar Spinal Stenosis The back portion of the Introduction spinal column Stenosis means closing in. Spinal stenosis forms a bony describes a condition in which the nerves ring. When the in the spinal canal are closed in, or vertebrae are compressed. The spinal canal is the hollow stacked on top tube formed by the bones of the spinal of each other, column. Anything that causes this bony these bony rings tube to shrink can squeeze the nerves Bony ring create a hollow inside. As a result of many years of wear tube. This bony and tear on the parts of the spine, the tissues tube, called the spinal canal, surrounds the nearest the spinal canal sometimes press spinal cord as it passes through the spine. Just against the nerves. This helps explain why as the skull protects the brain, the bones of the lumbar spinal stenosis (stenosis of the low spinal column protect the spinal cord. back) is a common cause of back problems in adults over 55 years old. This guide will help you understand • how the problem develops • how doctors diagnose the condition • what treatment options are availableAnatomyWhat part of the back is involved?The human spine is made up of 24 spinalbones, called vertebrae. Vertebrae are stackedon top of one another to create the spinalcolumn. The spinal column gives the body its The spinal cord only extends to the secondform. It is the bodys main upright support. lumbar (low back) vertebra. Below this level, the spinal canal encloses a bundle of nerves 3 Compliments of: Spine University
  • A Patients Guide to Lumbar Spinal Stenosisthat go to the lower limbs and pelvic organs.The Latin term for this bundle of nerves iscauda equina, meaning horses tail. The nucleus is held in place by the annulus, a series of strong ligament rings surrounding it. Ligaments are strong connective tissues that attach bones to other bones.An intervertebral disc fits between each verte-bral body and provides a space between thespine bones. The disc normally works like ashock absorber. It protects the spine against thedaily pull of gravity. It also protects the spineduring heavy activities that put strong forceon the spine, such as jumping, running, andlifting. Causes Why do I have this problem? In the lumbar spine, the spinal canal usually has more than enough room for the spinal nerves. The canal is normally 17 to 18 milli- meters around, slightly smaller than a penny. Spinal stenosis develops when the canalAn intervertebral disc is made up of two parts. shrinks to 12 millimeters or less. When the sizeThe center, called the nucleus, is spongy. It drops below 10 millimeters, severe symptomsprovides most of the ability to absorb shock. of lumbar spinal stenosis occur. 4 Compliments of: Spine University
  • A Patients Guide to Lumbar Spinal Stenosis Spinal StenosisThere are many reasons why symptoms of Spinal Instabilityspinal stenosis develop. Some of the more Spinal instability can cause spinal stenosis.common reasons include Spinal instability means that the bones of • congenital stenosis (being born with a small the spine move more than they should. spinal canal) Instability in the lumbar spine can develop if • spinal degeneration the supporting ligaments have been stretched • spinal instability or torn from a severe back injury. People with • disc herniation diseases that loosen their connective tissuesCongenital Stenosis may also have spinal instability. Whatever the cause, extra movement in the bones of theSome people are born with (congenital) a spine can lead to spinal stenosis.spinal canal that is narrower than normal. Theymay not feel problems early in life. However,having a narrow spinal canal puts them at riskfor stenosis. Even a minor back injury cancause pressure against the spinal cord. Peopleborn with a narrow spinal canal often haveproblems later in life, because the canal tendsto become narrower due to the effects of aging.DegenerationDegeneration is the most common cause ofspinal stenosis. Wear and tear on the spine Disc Herniationfrom aging and from repeated stresses andstrains can cause many problems in the lumbar Spinal stenosis can occur when an interverte-spine. The intervertebral disc can begin to bral disc in the low back herniates (ruptures).collapse, and the space between each vertebrae Normally, the shock-absorbing disc is able toshrinks. Bone spurs may form that stick into handle the downward pressure of gravity andthe spinal canal and reduce the space avail- the strain from daily activities. However, ifable to the spinal nerves. The ligaments that the pressure on the disc is too strong, such ashold the vertebrae together may thicken and landing from a fall in a sitting position, thealso push into the spinal canal. All of these nucleus inside the disc may rupture through theconditions cause the spinal canal to narrow. outer annulus and squeeze out of the disc. This 5 Compliments of: Spine University
  • A Patients Guide to Lumbar Spinal Stenosisis called a disc herniation. If an intervertebral walking require the spine to straighten or evendisc herniates straight backward, it can press extend (bend back slightly). This position ofagainst the nerves in the spinal canal, causing the low back makes the spinal canal smallersymptoms of spinal stenosis. and often worsens symptoms. Diagnosis How do doctors diagnose the problem? Diagnosis begins with a complete history and physical examination. Your doctor will ask questions about your symptoms and how your problem is affecting your daily activities. This will include questions about your pain or if you have feelings of numbness or weakness in your legs. Your doctor will also want to know whether your symptoms are worse when youre up standing or walking and if they go away when you sit down.Symptoms The doctor does a physical examination toWhat does the spinal stenosis feel like? see which back movements cause pain orSpinal stenosis usually develops slowly over a other symptoms. Your skin sensation, musclelong period of time. This is because the main strength, and reflexes are also tested.cause of spinal stenosis is spinal degenera- X-rays can show if the problems are fromtion in later life. Symptoms rarely develop changes in the bones of the spine. The imagesquickly when degeneration is the source of the can show if degeneration has caused the spaceproblem. A severe injury or a herniated disc between the vertebrae to collapse. X-rays maymay cause symptoms to develop immediately. also show any bone spurs sticking into thePatients with stenosis dont always feel back spinal canal.pain. Primarily, they have pain and weakness When more information is needed, yourin their legs, usually in both legs at the same doctor may order a magnetic resonancetime. Some people say they feel that their legs imaging (MRI) scan. The MRI machine usesare going to give out on them. magnetic waves rather than X-rays to showSymptoms mainly affect sensation in the lowerlimbs. Nerve pressure from stenosis can causea feeling of pins and needles in the skin wherethe spinal nerves travel. Reflexes becomeslowed. Some patients report charley horses intheir leg muscles. Others report strange sensa-tions like water trickling down their legs.Symptoms change with the position of thelow back. Flexion (bending forward) widens Fthe spinal canal and usually eases symptoms.Thats why people with stenosis tend to getrelief when they sit down or curl up to sleep.Activities such as reaching up, standing, and Magnetic resonanace imaging 6 Compliments of: Spine University
  • A Patients Guide to Lumbar Spinal Stenosisthe soft tissues of the body. This test gives a coming from other conditions, such as arthritisclear picture of the spinal canal and whether or infection.the nerves inside are being squeezed. This Treatmentmachine creates pictures that look like slices ofthe area your doctor is interested in. The test What treatment options are available?does not require dye or a needle. Nonsurgical TreatmentComputed tomography (a CT scan) may be Unless your condition is causing significantordered. The CT scan is a detailed X-ray that problems or is rapidly getting worse, mostlets your doctor see slices of bone tissue. The doctors will begin with nonsurgical treatments.image can show any bone spurs that may besticking into the spinal column and taking up At first, doctors may prescribe ways to immo-space around the spinal nerves. bilize the spine. Keeping the back still for a short time can calm inflammation and pain.When the diagnosis is still not clear, doctors This might include one to two days of bed rest.may recommend electrical tests of the nerves Patients may find that curling up to sleep orthat go to the legs and feet. An electromyo- lying back with their knees bent and supportedgram (EMG) checks whether the motor gives the greatest relief. These positions flexpathway of a nerve is working correctly. Motor the spine forward, which widens the spinalimpulses travel down the nerve and work to canal and can ease symptoms.energize muscles. A lumbar support belt or corset may be prescribed, though their benefits are contro- versial. The support can limit pressure in the discs and prevent extra movement in the spine. But it can also cause the back and abdominal muscles to weaken. Some doctors have their patients wear a rigid brace that holds the spine in a slightly flexed position, widening the spinal canal. Health care providers normally only have patients wear a corset for one to two weeks.Doctors may also order a somatosensoryevoked potential (SSEP) test to locate moreprecisely where the spinal nerves are beingsqueezed. The SSEP is used to measure nervesensations. These sensory impulses travel upthe nerve, informing the body about sensa-tions such as pain, temperature, and touch. Thefunction of a nerve is recorded by an electrodeplaced over the skin in the area where thenerve travels.Not all causes of spinal stenosis are fromdegenerative conditions. Doctors use bloodtests to determine whether symptoms are 7 Compliments of: Spine University
  • A Patients Guide to Lumbar Spinal StenosisDoctors sometimes prescribe medication for Patients often work with a physical therapist.patients with spinal stenosis. Patients may By evaluating your condition, your therapistbe prescribed anti-inflammatory medication can assign positions and exercises to easesuch as nonsteroidal anti-inflammatory drugs your symptoms. Your therapist may suggest(NSAIDs) or aspirin. These medications can using traction. Traction is a common treat-cause side effects in the kidneys and gastro- ment for stenosis. It gently stretches the lowintestinal tract. Also, because most stenosis back, taking pressure off the spinal nerves.patients are elderly, doctors closely monitor Your therapist may also suggest strengtheningpatients who are using these medications to and aerobic exercises. Strengthening exercisesavoid complications. focus on improving the strength and controlNarcotic drugs, such as codeine or morphine, of the back and abdominal muscles. Aerobicare generally not prescribed for stenosis exercises are used to improve heart and lungpatients. They are addictive when used too health and increase endurance in the spinalmuch or improperly. Muscle relaxants are muscles. Stationary biking offers a goodoccasionally used to calm muscles in spasm. aerobic treatment and keeps the spine bent slightly forward, a position affording relief toSymptoms of stenosis can lead to mood many patients with lumbar stenosis.changes. As a result, doctors sometimesprescribe anti-depressant medication, called Surgerytricyclics. Tricyclics help steady peoples If the symptoms you feel are mild and theremoods, and some tricyclics even improve is no danger theyll get worse, surgery is notsleep by helping the body make an important usually recommended. When there are signshormone called serotonin. These medications that pressure is building on the spinal nerves,also seem to calm back pain by affecting the surgery may be required, sometimes rightmembranes around pain nerves. away. The signs doctors watch for whenSome patients are given an epidural steroid reaching this decision include weakening ininjection (ESI). The spinal cord is covered the leg muscles, pain that wont ease up, andby a material called dura. The space between problems with the bowels or bladder.the dura and the spinal column is called the Pressure on the spinal nerves can cause a lossepidural space. It is thought that injecting of control in the bowels or bladder. This is ansteroid medication into this space fights emergency. If the pressure isnt relieved, it caninflammation around the nerves, the discs, and lead to permanent paralysis of the bowels andthe facet joints. This can reduce swelling and bladder. Surgery is recommended to removegive the nerves more room inside the spinal pressure from the nerves.canal. The main surgical procedure used to treat spinal stenosis is lumbar laminectomy. Some patients also require fusion surgery immedi- ately after the laminectomy procedure if spinal instability is present. Lumbar Laminectomy The lamina is the covering layer of the bony ring of the spinal column. It forms a roof-like structure over the back of the spinal canal. When the nerves in the spinal canal are being 8 Compliments of: Spine University
  • A Patients Guide to Lumbar Spinal Stenosissqueezed by a herniated disc or bone spurs,a lumbar laminectomy removes the entirelamina to release pressure on the spinal nerves.This is the primary type of surgery used forlumbar spinal stenosis. Metal plates and screws moving. This protects the graft so it can heal better and faster. Rehabilitation What should I expect as I recover? Nonsurgical RehabilitationPosterior Lumbar Fusion Even if you dont need surgery, your doctorA posterior lumbar fusion may be needed after may recommend that you work with a physicala surgeon performs a lumbar laminectomy. or occupational therapist. Patients are normallyThe fusion procedure is recommended when a seen a few times each week for one to twospinal segment has become loose or unstable. months. In severe cases, patients may need a few additional weeks of care. Your therapist creates a program to help you regain back movement, strength, endur- ance, and function. Treatments for lumbar spinal stenosis often include lumbar traction, described earlier. Hands-on treatments such as massage and specialized forms of soft-tissue mobilization may be used initially. They are used to help you begin moving with less pain and greater ease. Therapists also guide patients in a program of exercise designed to widen the spinal canal and take pressure off the spinal Lumbar fusion nerves. It is important to improve the strength andA fusion surgery joins two or more bones into coordination in the abdominal and low backone solid bone. This keeps the bones and joints muscles. Your therapist can also evaluatefrom moving. In this procedure, the surgeon your workstation or the way you use yourlays small grafts of bone over the back of the body when you do your activities and suggestspine. Most surgeons also apply metal plates changes to avoid further problems.and screws to prevent the two vertebrae from 9 Compliments of: Spine University
  • A Patients Guide to Lumbar Spinal StenosisAfter Surgery As the rehabilitation program evolves, patients do more challenging exercises. The goal is toAfter surgery, surgeons may have their patients safely advance strength and function. As thework with a physical or occupational therapist. therapy sessions come to an end, therapistsPatients whove had fusion surgery normally help patients get back to the activities theyneed to wait two to three months before enjoy. Ideally, patients are able to resumebeginning a rehabilitation program. They will normal activities. Patients may need guidanceprobably need to attend therapy sessions for six on which activities are safe or how to changeto eight weeks and should expect full recovery the way they go about certain activities.to take up to six months. When treatment is well under way, regularDuring therapy after surgery, the therapist may visits to the therapists office will end. Theuse treatments such as heat or ice, electrical therapist will continue to be a resource. Butstimulation, and massage to help calm pain and patients are in charge of doing their exercisesmuscle spasm. Then patients begin learning as part of an ongoing home program.how to move safely with the least strain ontheir healing back. 10 Compliments of: Spine University
  • A Patients Guide to Lumbar Spinal Stenosis Notes 11Compliments of: Spine University