Summary – Spinal Stenosis vs Spondylosis

Spinal stenosis and spondylosis are two spinal conditions that may affect the quality of lifestyle. Spinal stenosis causes the narrowing of the spaces of the spine, while spondylosis causes the loss of normal structure and function of the spine. So, this summarizes the difference between spinal stenosis and spondylosis.

Reference:

1. “Spinal Stenosis.” National Institute of Arthritis and Musculoskeletal and Skin Diseases, U.S. Department of Health and Human Services, 17 Dec. 2021.
2. “Spondylosis: Causes, Symptoms, Diagnosis and Treatment: HSS.” Hospital for Special Surgery.

Image Courtesy:

1. “LumbarSpinalStenosis case1 2 7” By Jmarchn – Own work (CC BY-SA 3.0) via Commons Wikimedia
2. “Lateral X-ray of lumbar spine spondylosis” By Nevit Dilmen, crop and annotation by Mikael Häggström, M.D. (CC BY-SA 3.0) via Commons Wikimedia

Spinal stenosis surgery in Moscow at the Dikul clinic: prices, appointment

Spinal stenosis occurs when the spinal cord or spinal nerve roots are subjected to compression. Symptoms of lumbar stenosis often include pain in the legs (sciatica) and tingling weakness or numbness in the legs. Muscle pain is a typical symptom of cervical stenosis. Cervical spinal stenosis with myelopathy often has difficulty coordinating movements. With compression of the spinal cord in the thoracic spine (which is quite rare), the development of a neurological deficit (disturbances in sensitivity and motor functions) is characteristic.

Most patients with cervical or lumbar spinal stenosis respond well to conservative treatment (physiotherapy, epidural injections, acupuncture exercise therapy, etc.). But in some cases, surgery for spinal stenosis is the only effective treatment.

Some people are born with a congenital narrow canal, but most people develop spinal stenosis as part of a degenerative cascade. Some patients feel no effects of the narrowing as the stenosis develops gradually as part of the aging process, but at some point radiating pain, weakness and/or numbness begin to appear secondary to compression of the nerve roots or spinal cord.

Although the narrowing can occur in different parts of the spine, the symptoms of nerve compression are often similar.

Accurate diagnosis of the location of stenosis requires both a neurological examination and the use of medical imaging techniques (MRI, MSCT) or neurophysiological tests (EMG, ENMG).

Indications for surgical treatment

Despite the fact that conservative treatment of stenosis is often effective, nevertheless, there are a number of specific indications for the surgical treatment of spinal stenosis:

• Resistance of symptoms to conservative treatment.
• Presence of intense pain syndrome for a long period of time.
• Presence of signs of radiculopathy with characteristic symptoms (pain, numbness or tingling in the extremities).
• Loss of sensation in arms or legs.
• Muscle weakness in limbs.
• Loss of bowel or bladder control (eg, cauda equina syndrome).

One of the main goals of surgery for spinal stenosis in the neck or lower back is to make room for the spinal cord and/or nerve roots.

This is called decompression. Stenosis surgery allows you to give more space to the spinal cord and nerve roots and thus reduce pain.

Another goal of spinal stenosis surgery is to increase muscle strength in the limbs. In addition, surgical treatment often allows you to restore and sensitivity.

Open surgery or minimally invasive spine surgery?

Modern surgical techniques attempt to minimize exposure to or damage to adjacent healthy tissue. Most surgeons try to preserve the vertebral ligaments and facet joint capsules to reduce the chance of future degeneration or stenosis at the next or adjacent level.

Laminectomy is the gold standard for spinal stenosis surgery. Modern methods may use small incisions to access the narrowed portion of the canal, but the goals are the same. The area of ​​bone that is compressing is removed and soft tissue, such as the hypertrophic ligamentum flavum, is pulled away from the spinal cord or roots. This method can be used in the lumbar or cervical region of the spine.

If the operation is performed through a relatively large incision in the back, it is called open surgery. Another option is minimally invasive surgery, which is done through several small incisions. The surgeon may use a microscope, an endoscope, or a tiny camera and very small surgical instruments.

However, minimally invasive surgery is not suitable for all patients. If the surgeon has to work on many vertebrae, then open surgery is likely to be needed.

Types of surgery for spinal stenosis

Typically, surgeons use 2 surgical methods for spinal stenosis:

• Decompression: the surgeon removes tissue that is pressing on the nerve structure, which creates more space in the spinal canal (for the spinal cord) or in the foraminal canals (for nerve roots).
• Stabilization: the task of the surgeon is to limit movement between the vertebrae.

Decompression surgery for spinal stenosis

To remove tissue that is pressing on the nerves, the following techniques can be used in surgical treatment of stenosis:

Foraminotomy : if part of the disc or bone growth (osteophyte) compresses the root at the exit of the spine (in the foraminal canal) on the nerve, then a foraminotomy can be performed – it allows you to increase the size of the intervertebral foramen and relieve pressure on the spine.

Laminotomy . Unlike foraminotomy, the surgeon creates a hole in the vertebral plate, which puts pressure on the nerve structures, and thus the full conduction of impulses along the nerve fibers is restored.

Laminectomy : Sometimes a laminotomy is not enough. The surgeon may need to remove all or part of the plate, and this procedure is called a laminectomy. This operation can be carried out at many levels, without any harmful effects.

Indirect decompression is a variation of the decompression operation in which pressure on the nerves is relieved by spreading rather than removing the bones. This method of surgery can be carried out with the help of instrumentation (intervertebral devices or cage). Even artificial discs can perform some indirect decompression by restoring height between adjacent vertebrae.

Spinal Stenosis Stabilization Surgery

Not all patients undergoing spinal stenosis surgery will require stabilization, also known as spinal fusion. Stabilization is especially useful when one or more vertebrae slip out of their correct position, resulting in instability of the motor segments of the spine. In these cases, slipping of the vertebrae can lead to compression of the nerve structures. The need for stabilization also depends on how many vertebrae will be involved in the operation. For example, if a surgeon needs to remove a lamina (using a laminectomy) in multiple vertebrae, then the spine without these structures may become unstable. In such a case, spinal fusion surgery may be required to stabilize the spine.

Spinal stabilization surgeries have been performed for many years. This operation can be performed both separately and simultaneously with decompression surgery. By stabilizing the spine, the surgeon creates conditions under which the vertebrae will fuse over time (usually over several months or longer).

The surgeon uses a bone graft (usually using the patient’s own bone) or a biological substance (which will stimulate bone growth). The surgeon may use spinal instruments such as rods, screws, and plates to increase stability and help the bones fuse. Fusion (fusion) will stop movement between the vertebrae, providing long-term stability.

The results of surgery to correct spinal stenosis are usually good. Typically, 80% to 90% of patients are pain free after surgery.

Postoperative period

Pain syndrome

After surgery for spinal canal stenosis, pain is relieved by drugs. Since narcotic drugs are addictive, they are used for a limited period of time. Their regular use can also cause constipation, so drink plenty of water and eat high-fiber foods. . After narcotic drugs, pain is relieved by drugs such as acetaminophen (Tylenol).

Recommendations

• If the patient has undergone fusion surgery, it is recommended that non-steroidal anti-inflammatory drugs (NSAIDs) (eg, aspirin, ibuprofen, Advil, Motrin, etc.) be avoided for six months after surgery. NSAIDs can cause bleeding and interfere with bone healing.
• It is not recommended to move for 2-4 weeks after surgery or until the activity is agreed with the attending surgeon.
• Avoid sitting for long periods of time.
• Do not lift anything heavier than 4-5 kg. Do not bend and rotate the spine
• Household and yard work should also be avoided as directed by your healthcare provider.
• It is recommended to postpone sexual activity for some time, until the permission of the surgeon.
• Do not smoke. Smoking delays tissue healing, increasing the risk of complications (such as infections) and hindering the ability of bones to heal.

Activity

• The patient may need help with daily activities (eg dressing, bathing) for the first few weeks.
• Gradually, you need to return to your normal activities. Walking is recommended; start with a small distance and gradually increase to 1 – 2 km per day. You can recommend a program of physical therapy (exercise therapy).
• Wearing a brace is recommended, especially during the first time after surgery. The corset can be removed at night.

Bathing / Wound Care

• As a general rule, you can shower 4 days after surgery, unless otherwise advised by your doctor.
• Staples or sutures are usually removed before being discharged home
• If the patient’s temperature at home exceeds 37.5-38 degrees or discharge appears in the incision or signs of infection appear, such as redness, swelling, pain, then it is imperative to contact your doctor.

Prognosis

• Decompressive laminectomy successfully reduces leg pain in 70% of patients, resulting in a significant improvement in function (ability to perform normal activities of daily living) and a marked reduction in pain and discomfort. However, back pain does not always improve, and 17% of older people need a second operation. Symptoms may recur after a few years.
• Decompression laminotomy successfully reduces back pain (72%) and leg pain (86%) and improves walking ability (88%). An endoscopic laminotomy results in less blood loss, a shorter hospital stay, and less need for pain medication in the postoperative period than an open laminotomy.
• The results of the operation are highly dependent on the patient. It is important to maintain a positive attitude and diligently perform physical exercises (exercise therapy) that the exercise therapy doctor should select. Maintaining weight can greatly reduce pain. Don’t expect your back to be like a healthy person

Risks of surgery for spinal stenosis

No surgical intervention is without the risk of complications. Common complications of any surgery include: bleeding, infections, thrombosis, and reactions to anesthesia. If vertebral fusion is performed at the same time as a laminectomy, there is a greater risk of complications.

The following risks should be considered:

• The vertebrae may not fuse. Among the many reasons why the vertebrae do not fuse, the most common are osteoporosis, obesity and malnutrition. Smoking is by far the biggest factor that can interfere with fusion.
• Deep vein thrombosis (DVT) is a potentially serious condition associated with the formation of blood clots inside the veins of the lower extremities. If the clots break off and enter the lungs with the bloodstream, then a deadly condition occurs – thromboembolism. Therefore, prevention of thrombosis with the help of compression stockings and the use of anticoagulants is necessary.
• Hardware fracture. The metal screws, rods and plates used to stabilize the spine are called “hardware”. The device may move or break before the vertebrae are fully fused. If this happens, a second operation may be required to fix or replace the hardware.
• Bone graft migration. In rare cases (1 to 2%), the bone graft may quickly move from its correct position between the vertebrae shortly after surgery. This is more likely if no hardware (plates and screws) was used to secure the bone graft. This complication is also more likely if fusion of the vertebrae at several levels has been performed.
• Transient syndrome (adjacent segment disease). This syndrome occurs when the vertebrae above or below the fusion receive additional stress. Additional stress can eventually lead to degeneration of adjacent vertebrae and cause pain.
• Nerve damage or persistent pain. Any spinal surgery carries the risk of damaging the nerves or the spinal cord. Damage can cause numbness or even paralysis. However, the most common cause of persistent pain is nerve damage from the disc herniation itself. Some herniated discs can cause permanent nerve damage, in which case decompression surgery may not be effective. However, even with this outcome, spinal cord stimulation or other treatments are recommended.

What is spinal stenosis – symptoms and pain relief

Spinal stenosis is when the spinal column narrows, resulting in less space for the spinal cord and spinal nerves.

What is spinal stenosis?

There are many signs and symptoms of spinal stenosis, such as pain, tingling, and weakness in the neck, arms, legs, or feet. The stenosis can be in the upper part of the spine, called the cervical region, or in the lower part of the lumbar spine. Spinal stenosis is also associated with sciatica pain that originates in the sciatic nerve.

A variety of treatment options are available for people with spinal stenosis to reduce symptoms, including exercise, physical therapy, massage, medication, and steroid injections. In other cases, people may have spinal surgery to relieve pressure on the spinal cord or nerves.

Spinal Stenosis Definition

Spinal stenosis is caused by a narrow spinal canal that reduces space in the spinal canal. The spinal canal, also known as the spinal canal or spinal column, is made up of 33 vertebrae stacked on top of each other. The vertebrae can move thanks to the facet joints between each vertebra. Facet joints are synovial joints covered with cartilage that helps them slide over each other. Between each vertebrae are intervertebral discs that act as shock absorbers for the spine.

There are seven cervical vertebrae, twelve thoracic vertebrae, and five lumbar vertebrae, followed by the sacrum and coccyx. One of the main tasks of the spinal canal is to protect the spinal cord. The spinal cord is an extension of the central nervous system that begins at the base of the brainstem and runs through the spinal canal. The spinal cord transmits messages from the brain to the body and back to the brain.

Thirty-one pairs of spinal nerves emerge from the spinal canal either above or below each vertebra. Each spinal nerve root exits the spinal cord and spinal canal through the intervertebral spaces. In spinal stenosis, narrowing of the spinal canal reduces space for the spinal cord and spinal nerves. The spinal cord/spinal nerves may be irritated, compressed, or pinched.

Some people with spinal stenosis may have no symptoms, while others may have a significant impact on daily life. In people with cervical spinal stenosis, most of the symptoms are in the upper body, neck, arms, and hands. People with lumbar spinal stenosis experience symptoms in the buttocks, legs, and feet.

Causes of spinal stenosis

Spinal stenosis can be congenital, that is, present at birth. Congenital stenosis is when a person is born with a narrowed or small spinal canal. Spinal stenosis can be acquired due to other diseases or age-related changes in the spine. In most cases, spinal stenosis is acquired and most often occurs in people over the age of fifty. Some risk factors for developing spinal stenosis include scoliosis, a previous back injury, and excess calcium in the body. Spinal stenosis can also be caused by a condition called Paget’s disease, which is a rare bone disease.

One of the most common causes of spinal stenosis is osteoarthritis, a degenerative disease. In osteoarthritis, the cartilage, the protective lining of the joints, wears out and the bones begin to rub against each other. This can cause inflammation and pain. Sometimes the body reacts to this degeneration by growing bone spurs, which narrow the space in the spinal column and can cause pinched nerves in the spine.

Spinal stenosis can also be caused by spondylosis. Spondylosis is a degeneration of the spine in which the intervertebral discs and joints degenerate. Spondylolisthesis can also cause spinal stenosis. Spondylolisthesis is when a vertebra slips forward and becomes out of place. A herniated disc can cause spinal stenosis because a bulging disc can press on the spinal cord or roots. Other causes include thickened ligaments, spinal fractures, trauma, spinal cord cysts, or tumors.

Symptoms of spinal stenosis

Common symptoms of spinal stenosis include pain, numbness, tingling, and weakness in the neck, back, arms, legs, hands, or feet. Cervical spinal stenosis often causes neck pain, numbness, or tingling in the arm, hand, leg/foot. In more severe cases of cervical stenosis, there may be balance problems, loss of function and muscle weakness in the arms, and loss of bladder or bowel control.

Lumbar stenosis most commonly causes pain in the buttocks, thighs, or calves when walking, running, and standing. This pain is usually relieved by bending the back or sitting. Rarely, lumbar spinal stenosis can cause weakness in the legs or loss of sensation in the perineum, anus, bladder, and intestines. The symptoms of spinal stenosis often progress and worsen over time without treatment or intervention.

Lumbar stenosis is also associated with sciatica. Acquired lumbar spinal stenosis (LSS) is a common cause of sciatica in middle-aged and older patients. Sciatica causes pain/paresthesia in the sciatic nerve, which originates in the lumbar spine and runs below the knee.

Diagnosis of spinal stenosis

Diagnosis of spinal stenosis is usually based on a clinical evaluation by a physician following a physical examination and history taking. The diagnosis of spinal stenosis can also be made on the basis of imaging studies such as MRI (magnetic resonance imaging) or CT. An X-ray scan can also help detect spurs.

Treatment for spinal stenosis

Although there is no cure for spinal stenosis, there are treatments available to relieve the symptoms of spinal stenosis, including physical therapy, surgery, and medication. Physical exercise, including aerobic exercise, flexibility training, and strength training, may help relieve some of the symptoms of spinal stenosis. Some people with spinal stenosis may also see a physical therapist to treat their spinal stenosis. The physical therapist may work with their client on gait training to help open the spinal canal and exercises to strengthen muscles to support the spine and improve flexibility and balance. Other conservative treatments include the application of heat, which can increase blood flow, relax muscles, and provide short-term pain relief. Applying cold can help reduce swelling, tenderness, and inflammation. Massage and acupuncture can also help relieve pain caused by spinal stenosis.

Sometimes a person may need surgery, such as spinal decompression surgery. During this decompression surgery, bone spurs or growths and inflamed tissue are removed to expose the spinal cord and nerve roots. There are options for a minimally invasive surgical approach that can reduce tissue damage and reduce risks. This approach involves a smaller incision and a reduced risk of infection. In some cases, surgeons may perform spinal fusion surgery if there is a misalignment in the spine that is causing pressure on the nerve roots. These surgeries may come with potential risks, such as blood clots. The doctor will help evaluate whether spinal surgery is the best option for each patient.

Other non-surgical treatments to help relieve pain include pain medications. There are prescription drugs, such as anti-inflammatories or analgesics, to help manage pain and symptoms. Steroid or corticosteroid injections can also help reduce swelling and pain caused by spinal stenosis.

Final Thoughts on Spinal Stenosis

Spinal stenosis is a condition that can occur at birth. However, it is most commonly caused by age-related changes in the spinal canal seen in situations such as osteoarthritis or other conditions such as a herniated disc. Narrowing of the spinal canal puts pressure on the spinal cord and spinal nerves. This can cause symptoms that range from very mild to more severe.

Various treatments can help relieve symptoms and control pain. In some more severe cases of spinal stenosis, surgery may be used. Spinal decompression surgeries help open the spinal canal and relieve pressure or any irritation to the spinal cord or spinal nerves. In less severe cases, non-surgical treatments may be preferred. These therapies include physical therapy, massage, medications such as muscle relaxers, or alternative therapies such as acupuncture.

Spinal Stenosis: Frequently Asked Questions

Can spinal stenosis worsen?

• Many methods help to manage spinal stenosis, including regular exercise to strengthen the back and spine, as well as correct posture and body mechanics.
• Physical therapy, massage and acupuncture can also help manage spinal stenosis.

Is there anything to avoid in spinal stenosis?

• In spinal stenosis, it is recommended to avoid high-impact sports or activities, hyperextending the back or carrying heavy loads.

Can spinal stenosis be cured?

• There is no cure for spinal stenosis, but treatment can help reduce the symptoms of spinal stenosis and relieve the pain associated with spinal stenosis.
• Spinal stenosis diagnosed at an early stage is even more treatable.
• Spine surgery can help open space in the spinal column by removing bone spurs and excess tissue to relieve pressure on the spinal cord and nerve roots, which also helps relieve symptoms.
• Neurological or orthopedic surgeons can perform spinal stenosis surgery.

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Resources fabrics – Merck Manuals Professional Edition

Spinal Stenosis – Symptoms and Causes – Mayo Clinic

Spinal Stenosis: What it is, Symptoms, Causes, Treatment and Surgery

Lumbar Stenosis: Pathophysiology and Treatment Principle: A Narrative Review – PMC

Sciatica – StatPearls – NCBI Bookshelf

Adult Lumbar Spondylolisthesis – OrthoInfo – AAOS

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