What are the causes of spinal stenosis. How does lumbar spondylosis differ from lumbar canal stenosis. What symptoms indicate spinal stenosis. Which treatments are effective for managing spinal stenosis. When is surgery necessary for spinal stenosis.

The Fundamentals of Spinal Stenosis: Lumbar Canal Stenosis and Lumbar Spondylosis

Spinal stenosis is a condition characterized by the narrowing of spaces within the spine, which can put pressure on the nerves traveling through it. Two common types of spinal stenosis affecting the lower back are lumbar canal stenosis and lumbar spondylosis. Understanding these conditions is crucial for proper diagnosis and treatment.

Defining Lumbar Canal Stenosis

Lumbar canal stenosis refers to the narrowing of the spinal canal in the lower back region. This narrowing can compress the spinal nerves, leading to various symptoms. The condition is often a result of age-related degenerative changes in the spine.

Understanding Lumbar Spondylosis

Lumbar spondylosis, on the other hand, describes the degenerative changes or arthritic conditions affecting the lumbar spine. These changes can include the formation of bone spurs, thickening of ligaments, and disc degeneration.

The Pathophysiology of Spinal Stenosis

To comprehend spinal stenosis fully, it’s essential to understand its underlying mechanisms. How does spinal stenosis develop? The process typically begins with disc degeneration, which alters the spine’s biomechanics and leads to compensatory changes in other spinal structures.

• Formation of bone spurs (osteophytes)
• Thickening of ligaments
• Bulging or herniated discs
• Facet joint hypertrophy

These changes collectively contribute to the narrowing of the spinal canal and nerve root compression, resulting in the symptoms associated with spinal stenosis.

Recognizing the Symptoms of Lumbar Spondylosis and Lumbar Canal Stenosis

Identifying the symptoms of spinal stenosis is crucial for early diagnosis and treatment. The symptoms can vary depending on the severity and location of the stenosis.

Common Symptoms of Lumbar Spondylosis

Lumbar spondylosis primarily manifests as back pain, often accompanied by other symptoms related to nerve compression. These may include:

• Chronic lower back pain
• Stiffness in the lower back
• Muscle spasms
• Sciatica (leg pain)
• Numbness or tingling in the legs

Distinctive Signs of Lumbar Canal Stenosis

Lumbar canal stenosis has some unique symptoms, particularly neurogenic claudication. This condition causes pain in the lower back, buttocks, and legs that worsens with walking or standing and improves with sitting or bending forward.

Other symptoms of lumbar canal stenosis may include:

• Weakness in the legs
• Difficulty walking
• Balance problems
• In severe cases, bowel or bladder dysfunction

Diagnostic Approaches for Spinal Stenosis

Accurate diagnosis of spinal stenosis involves a combination of clinical assessment and imaging studies. How do medical professionals diagnose spinal stenosis? The process typically involves the following steps:

1. Medical history review
2. Physical examination
3. Neurological assessment
4. Imaging studies

Imaging Techniques for Spinal Stenosis

Several imaging modalities can be used to visualize the spinal structures and confirm the diagnosis of spinal stenosis:

• Magnetic Resonance Imaging (MRI): This is the gold standard for diagnosing spinal stenosis, providing detailed images of soft tissues and nerves.
• Computed Tomography (CT): Useful for visualizing bone structures and can be combined with myelography for enhanced imaging.
• X-rays: While not as detailed as MRI or CT, X-rays can show bone spurs and narrowing of disc spaces.
• Dynamic X-rays: These can reveal instability in the spine when taken in flexion and extension positions.
• Bone scan with SPECT CT: This can be helpful in identifying areas of active bone remodeling or inflammation.

Conservative Management Strategies for Spinal Stenosis

For many patients with spinal stenosis, conservative treatments can provide significant relief and improve quality of life. What are the non-surgical options for managing spinal stenosis?

Pharmacological Interventions

Medications play a crucial role in managing pain and inflammation associated with spinal stenosis. Common pharmacological approaches include:

• Analgesics: Over-the-counter pain relievers like acetaminophen can help manage mild to moderate pain.
• Non-steroidal anti-inflammatory drugs (NSAIDs): These medications, such as ibuprofen or naproxen, can reduce both pain and inflammation.
• Muscle relaxants: These may be prescribed for short-term relief of muscle spasms.
• Gabapentin or pregabalin: These medications can help manage nerve pain associated with spinal stenosis.

Physical Therapy and Exercise

Physical therapy plays a vital role in managing spinal stenosis by improving flexibility, strength, and posture. A tailored exercise program may include:

• Stretching exercises to improve flexibility
• Core strengthening exercises
• Low-impact aerobic activities like swimming or cycling
• Posture improvement techniques

Lifestyle Modifications

Certain lifestyle changes can significantly impact the management of spinal stenosis:

• Weight management: Maintaining a healthy weight reduces stress on the spine.
• Ergonomic adjustments: Proper posture and ergonomics at work and home can alleviate symptoms.
• Smoking cessation: Quitting smoking can improve overall spine health and healing.

Advanced Non-Surgical Treatments for Spinal Stenosis

When conservative measures provide insufficient relief, advanced non-surgical treatments may be considered. These interventions aim to provide longer-lasting pain relief and improved function.

Epidural Steroid Injections

Epidural steroid injections can provide significant pain relief for patients with spinal stenosis. How do these injections work? The steroids are injected into the epidural space around the compressed nerves, reducing inflammation and alleviating pain. While the effects are often temporary, they can provide substantial relief for several months.

Alternative Therapies

Some patients find relief through alternative therapies, although scientific evidence for their effectiveness varies:

• Acupuncture
• Chiropractic care
• Massage therapy
• Yoga or tai chi

These therapies may help manage pain and improve overall well-being, but should be pursued under the guidance of a healthcare professional.

Surgical Interventions for Spinal Stenosis

In cases where conservative treatments fail to provide adequate relief, or when neurological deficits are severe or progressive, surgical intervention may be necessary. What surgical options are available for spinal stenosis?

Laminectomy

Laminectomy is the most common surgical procedure for spinal stenosis. It involves removing the lamina (a portion of the vertebral bone) to create more space for the nerves. This procedure can be performed as a standalone operation or in combination with other techniques.

Minimally Invasive Procedures

Advancements in surgical techniques have led to the development of minimally invasive procedures for spinal stenosis. These may include:

• Microendoscopic decompression
• Interspinous process devices
• Percutaneous image-guided lumbar decompression

These procedures aim to achieve similar outcomes to traditional surgery with smaller incisions, less tissue damage, and faster recovery times.

Spinal Fusion

In some cases, particularly when spinal instability is present, a spinal fusion may be performed along with decompression. This procedure involves joining two or more vertebrae to stabilize the spine and prevent further degeneration.

Recovery and Rehabilitation After Spinal Stenosis Treatment

Regardless of the treatment approach, proper recovery and rehabilitation are crucial for optimal outcomes in spinal stenosis management. What does the recovery process entail?

Post-Operative Care

For patients undergoing surgery, the immediate post-operative period involves:

• Pain management
• Wound care
• Gradual mobilization
• Prevention of complications such as deep vein thrombosis

Rehabilitation Program

A comprehensive rehabilitation program is essential for both surgical and non-surgical patients. This typically includes:

• Guided physical therapy exercises
• Core strengthening and stability training
• Gait and balance training
• Ergonomic education
• Gradual return to daily activities

The duration and intensity of rehabilitation will vary depending on the individual’s condition and treatment approach.

Long-Term Management and Prognosis of Spinal Stenosis

Spinal stenosis is often a chronic condition that requires ongoing management. What can patients expect in the long term? The prognosis for spinal stenosis varies depending on several factors, including the severity of the condition, the effectiveness of treatment, and the patient’s overall health and lifestyle.

Maintenance Strategies

Long-term management of spinal stenosis often involves:

• Regular exercise and physical activity
• Maintaining a healthy weight
• Proper posture and body mechanics
• Periodic follow-up with healthcare providers
• Ongoing pain management techniques

Potential Complications

While many patients experience significant improvement with treatment, it’s important to be aware of potential complications or recurrence of symptoms. These may include:

• Persistent pain or neurological symptoms
• Adjacent segment disease in cases of spinal fusion
• Progression of spinal degeneration

Regular monitoring and proactive management can help address these issues if they arise.

Emerging Treatments and Future Directions in Spinal Stenosis Management

The field of spinal stenosis treatment continues to evolve, with ongoing research into new therapies and techniques. What innovative approaches are on the horizon for spinal stenosis management?

Regenerative Medicine

Regenerative medicine approaches, such as stem cell therapy and platelet-rich plasma (PRP) injections, are being investigated for their potential in treating spinal stenosis. These therapies aim to promote tissue repair and regeneration, potentially slowing or reversing the degenerative process.

Advanced Imaging and Diagnostic Techniques

Improvements in imaging technology, including high-resolution MRI and advanced CT techniques, are enhancing our ability to diagnose and characterize spinal stenosis more accurately. This may lead to more personalized treatment approaches in the future.

Robotic-Assisted Surgery

The use of robotic systems in spine surgery is an emerging field that may improve the precision and outcomes of surgical interventions for spinal stenosis. These systems can potentially offer enhanced visualization and more accurate placement of surgical instruments.

As research in these areas progresses, patients with spinal stenosis may have access to an even wider range of effective treatment options in the coming years. Continued advancements in understanding the pathophysiology of spinal stenosis and developing targeted therapies hold promise for improved outcomes and quality of life for those affected by this condition.

Spinal Stenosis | Lumbar Canal Stenosis and Lumbar Spondylosis

​
​Introduction

Lumbar spinal degeneration, or wearing out of the lumbar spine over time, can lead to what is called lumbar spondylosis and spinal stenosis.  Lumbar spondylosis describes degenerative changes (arthritic changes) within the lumbar spine.  Lumbar canal stenosis means narrowing or compression of the spinal nerves in the lower back due to spinal degeneration (wear and tear).  

What is Spinal Stenosis

​Disc degeneration at the affected level is thought to be the precipitating factor in spondylosis, with altered biomechanics resulting in abnormal loading and compensatory degenerative changes in other spinal structures(2).   See our disc degeneration page for more information about intervertebral disc degeneration. 
 
Lumbar canal stenosis and spondylosis are very common in the general population.  It is rare to see in younger adults although it can occur.  It more commonly occurs in the older population groups. ​

​Symptoms of Lumbar Spondylosis and Lumbar Canal Stenosis
 
Lumbar spondylosis is a major cause of back pain, which commonly occurs due to concurrent degenerative disc disease or facet joint arthritis.    In addition back pain can come from abnormal or stressed:

• Periosteum/bone
• Ligaments
• Paraspinal musculature and fascia
• Nerve roots
• Psychological causes   

 
In addition to back pain, lumbar spondylosis is associated with symptoms of nerve compression which include:

• Leg pain (sciatica)
• Neurorgenic claudication (pain in backs of calves and legs with walking)
• Loss of feeling in the legs (numbness or parasthesias)
• Leg or foot weakness (for example foot drop)
• Problems with walking  (gait disturbance)
• Troubles with bladder and bowel function.  

 
Degeneration of the lumbar spine can lead to spinal nerve foramen narrowing (foraminal stenosis) causing nerve root compression and subsequent sciatica and radiculopathy.  Radiculopathy is pain, numbness and weakness in the area that the nerve supplies. 
 
Lumbar spondylosis can also lead to lumbar canal stenosis, or narrowing of the entire spinal canal at the affected level.   Lumbar canal stenosis is narrowing or constriction of the central canal leading to compression of multiple nerves in the lumbar spine. Lumbar canal stenosis causes a syndrome known as neurogenic claudication, which is pain in the backs of the calves and legs, that is often worse with walking and standing and relieved by sitting down. 
 
The symptoms of lumbar spondylosis are usually progressive and get worse with time.  However, aith appropriate management the degree of progression can be slowed or even halted. 
 
Investigations for Lumbar Spondylosis
 
Following the initial clinical assessment it is usual for some type of radiological investigation to be organised to look in more detail for the cause of the pain and discomfort and the degree of compression. 

• MRI (Note if you are able to have an MRI, this is the best test to assess lumbar spondylosis and canal stenosis)
• CT
• X-ray
• Dynamic x-ray
• Bone scan including SPECT CT

Treatment of Lumbar Spondylosis and Lumbar Canal Stenosis
 
Unless you have severe pain or significant neurological deficits, such as lower limb weakness, or bowel or bladder dysfunction, the initial treatments for lumbar spondylosis and lumbar canal stenosis are conservative non-operative therapies (3-5).   These treatments include:

• Analgesics (pain medication)
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Physiotherapy
• Steroidal injection therapies
• Behaviour modification – e.g. avoiding heavy lifting
• Bracing
• Pilates
• Hydrotherapy
• Swimming
• Weight loss is also important as extra weight places more stress on the spine contributing to back pain.  
• Exercises to strengthen core and paraspinal muscles will help provide extra stability to the spine reducing pain.
• Pain management

 
Following exhaustion of non-operative measures or when the degree of nerve compression is severe, surgery is often indicated for lumbar spondylosis.  Where symptoms of nerve compression predominate, namely, radiculopathy or neurogenic claudication, the goal of intervention is to decompress the nerves, relieving the pressure on them.  Relieving the pressure on the nerves reliably improves the symptoms of pain in the legs. 
 
Classically a laminectomy with de-roofing of the neural canal is performed.  In selected patients minimally invasive techniques will be appropriate and include, MIS laminectomy or more targeted lumbar decompression.  If significant back pain exists, there is evidence of instability or spondylolisthesis, or the amount of decompression required is likely to cause instability, more complex fusion procedures are indicated.  
 
80% of patients operated for lumbar spinal stenosis have good-to-excellent outcomes (6-8).  Over 80% of patients are satisfied and report improvement in quality of life (8, 9).  Decompressive surgery has been demonstrated to be superior to aggressive non-operative treatment in relieving symptoms and improving function(9, 10).  For me information about surgery for lumbar spondylosis see our page on laminectomy, spine fusion and other spine surgery procedures.  
 
 
 References
 
1.         Greenberg MS. Handbook of Neurosurgery. Sixth Edition ed: Thieme; 2006.
2.         Latham JM. Mechanical consequences of annular tears and subsequent intervertebral disc degeneration. Clinical Biomechanics. 1994;9(July):211-9.
3.         Kuijpers T, van Middelkoop M, Rubinstein SM, Ostelo R, Verhagen A, Koes BW, et al. A systematic review on the effectiveness of pharmacological interventions for chronic non-specific low-back pain. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2011;20(1):40-50.
4.         van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, et al. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2011;20(1):19-39.
5.         White AP, Arnold PM, Norvell DC, Ecker E, Fehlings MG. Pharmacologic management of chronic low back pain: synthesis of the evidence. Spine. 2011;36(21 Suppl):S131-43.
6.         Turner JA, Ersek M, Herron L, Deyo R. Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine. 1992;17(1):1-8.
7.         Airaksinen O, Herno A, Turunen V, Saari T, Suomlainen O. Surgical outcome of 438 patients treated surgically for lumbar spinal stenosis. Spine. 1997;22(19):2278-82.
8.         Iguchi T, Kurihara A, Nakayama J, Sato K, Kurosaka M, Yamasaki K. Minimum 10-year outcome of decompressive laminectomy for degenerative lumbar spinal stenosis. Spine. 2000;25(14):1754-9.
9.         Atlas SJ, Deyo RA, Keller RB, Chapin AM, Patrick DL, Long JM, et al. The Maine Lumbar Spine Study, Part III. 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine. 1996;21(15):1787-94; discussion 94-5.
10.      Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. The New England journal of medicine. 2008;358(8):794-810.
​

Lumbar Stenosis and Degenerative Spondylolisthesis

Lumbar stenosis is the gradual narrowing of the spinal canal caused by age-related changes of the discs and facet joints in the lower back. This degenerative process is called spondylosis (spinal arthritis). As the stenosis (narrowing) progresses, it can lead to compression (pinching) of the nerves running through the spinal canal. Pressure on the spinal nerves can result in radiating leg pain, numbness or weakness, a condition known as radiculopathy or “sciatica”. In some cases, spondylosis can result in spinal instability, allowing one bone to slip forward on top of the one below, a condition called degenerative spondylolisthesis.

Symptoms

• Lower back pain with radiation into hips and buttocks
• Radiculopathy – radiating leg pain or numbness caused by compression of the spinal nerves

Natural History – What happens when the condition is not treated

• Not all patients with stenosis have symptoms
• Symptoms may be short-lived and infrequent
• Patients may develop more persistent and debilitating pain as the stenosis or instability progresses

Three Phases of Treatment:

• Phase I – Non-Invasive Treatments
• Phase II – Spinal Injections
• Phase III – Surgery
• Goals of Each Phase:
  • Relieve Pain
  • Improve Function

Treatment Options: Phase I – Non-Invasive Treatments

• Physical Therapy and Regular Home Exercise
• Core and Back Strengthening
• Flexibility and Stretching
• Oral Medications
• Steroids
• Non-Steroid Anti-Inflammatories (NSAIDs)
• Pain relievers
• Muscle Relaxants
• Ice and Heat

Treatment Options: Phase II – Epidural Steroid Injections

• Outpatient procedure
• Done with x-ray guidance
• May relieve symptoms, but will not repair the disc
• 1-3 injections may be needed

Treatment Options: Phase III – Surgery

Surgical Options for Lumbar Stenosis and Degenerative Spondylolisthesis

• Learn more about Laminectomy
• Learn more about Minimally Invasive Lumbar Microdecompression (MILM)
• Learn more about Endoscopic Discectomy and Foraminotomy

Lumbar Fusion

• When spinal instability (degenerative spondylolisthesis) is significant, fusion may be necessary to fully relieve symptoms by restoring the proper spinal alignment and preventing further slippage
• Learn more about Laminectomy and Posterior Fusion
• Learn more about Anterior Lumbar Interbody Fusion (ALIF)
• Learn more about Minimally-Invasive Lumbar Fusion (MIS TLIF)

Spinal stenosis – treatment, symptoms, causes, diagnosis

Spinal stenosis – narrowing of the free space in the spinal canal, which leads to pressure on the roots of the spinal cord or spinal cord. This disorder usually involves narrowing of one or more areas of the spinal column: the canal through the central openings in the vertebrae (spinal canal) through which the spinal cord and roots pass, and the intervertebral foramen through which the roots exit the spine and innervate parts of the body. The narrowing can involve a small part of the spine, or it can be over a large area. Pressure on the lower spinal cord or nerve roots can lead to pain and sensory disturbances in the lower extremities. With pressure on the higher parts of the spinal cord (in the neck), the symptoms can be both in the lower extremities and in the upper ones.
Most often spinal stenosis occurs over the age of 50, equally common in men and women. However, stenosis can also develop at a younger age in the presence of congenital narrowness of the spinal canal or the presence of spinal injuries.

Structures involved in the formation of stenosis.

The spine consists of 26 bones and extends from the skull to the pelvis. ” 24 of these are called vertebrae. 7 vertebrae in the cervical region, 12 in the thoracic region, 5 lumbar vertebrae, the sacrum consists of five fused vertebrae and the lowest part of the coccyx consists of 3-5 underdeveloped vertebrae. The spine is a column of 26 bones that extend in a line from the base of the skull to the pelvis. Between the vertebrae are intervertebral discs, which perform both a binding and cushioning function. The spine is the main support for the upper body, allowing a person to stand, turn, bend down, in addition, the spine reliably protects the spinal cord from damage. The most commonly affected structures in stenosis are:

• Intervertebral discs – cartilaginous tissue containing a gel-like substance, located between the vertebrae and performing shock-absorbing functions.
• Facet joints – connect the vertebral arches to each other (the arches are located at the end of the vertebral body). These joints help to better fix the vertebrae among themselves and allow the body to deviate back.
• Intervertebral foramen – the space between the vertebrae through which the nerve roots exit and innervate certain parts of the body.
• Vertebral arch – part of the vertebra in the back of the vertebra, which is involved in the formation of the posterior wall of the spinal canal.
• Ligaments – elastic connective tissue formations that fix the vertebrae and prevent the vertebrae from slipping. Quite often, a large yellow ligament, which stretches along the entire spine, is involved in the formation of stenosis.
• Pedicels – part of a vertebra that forms the walls of the spinal canal.
• The spinal cord and roots are an extension of the central nervous system that extends from the brain down to the lumbar region along the spinal canal, which protects it like a sheath. The spinal cord consists of nerve cells, their clusters. The spinal cord is connected to all parts of the body by 31 pairs of roots that emerge from the spinal cord and exit the spine.
• Synovial membranes are thin membranes that produce fluid (synovial) needed to lubricate the inside of the joint.
• The vertebral arch is a circle of bony tissue that forms the canal through which the spinal cord passes. The circle of bone around the canal through which the spinal cord passes.
• Horse tail (Cauda equina) – a bundle of roots that originates in the lumbar spine, where the spinal cord ends, and these roots provide innervation to the lower body.

Causes of stenosis

A normal spinal canal provides sufficient space for the spinal cord and cauda equina. The narrowing of the canal that occurs with spinal stenosis can be congenital or acquired. Some people are born with a narrow spinal canal or have a curvature of the spine that puts pressure on nerves, soft tissues, or ligaments. In the presence of such a disease as achondroplasia, abnormal formation of the bone tissues of the vertebrae occurs, thickening and shortening of the pedicles of the vertebrae occur, which leads to a narrowing of the spinal canal.

Acquired causes include the following.

Degenerative diseases

Spinal stenosis most often occurs due to degenerative changes that occur as a result of aging. But degenerative changes can be due to morphological changes or an inflammatory process. As the body ages, there is a thickening of the ligaments and their calcification (the formation of a depot of calcium salts inside the ligaments). There is also growth in the area of ​​the vertebrae and joints – these growths are called osteophytes. When one part of the spine is affected, there is an increase in the load on the intact part of the spine. For example, with a herniated disc, compression of the root or spinal cord occurs. When hypermobility of a segment of the spine occurs, the capsules of the facet joints thicken due to efforts to stabilize the segment, which can also lead to the formation of osteophytes. These osteophytes reduce the space of the intervertebral foramen and exert compression on the nerve roots.

Spondylolisthesis is a condition where one vertebra slips in relation to another. Spondylolisthesis occurs due to degenerative changes or trauma, or is extremely rarely congenital. The disturbed biomechanics of the spine due to listhesis can lead to pressure from the slipped vertebra and with it the disc, to pressure on the spinal cord or roots.

Age-related degenerative changes in the spine are the most common causes of spinal stenosis. Often the cause of stenosis is two forms of arthritis (osteoarthritis and rheumatoid arthritis).

Osteoarthritis is the most common form of arthritis and typically occurs in middle-aged and older adults. It is a chronic, degenerative process that can involve many joints in the body. With this disease, wear and thinning of the surface layer of the cartilaginous tissue of the joints occurs, and often there is excessive bone growth of osteophytes and a decrease in the functionality of the joints. When the facet joints and discs are involved in the process, a condition occurs that is called spondylosis. Spondylosis can be accompanied by degeneration of the disc with bone growths, which can lead to both narrowing of the spinal canal and intervertebral foramens.

Rheumatoid arthritis – usually affects people at an earlier age than osteoarthritis and is associated with inflammation and thickening of the soft tissues (synovium) of the joints. And although rheumatoid arthritis is not so often the cause of spinal stenosis, but damage to the ligaments of the bones of the joints can be quite serious and begins with synovitis. Segments with excessive mobility (for example, the cervical spine) are affected primarily in rheumatoid arthritis.
Other conditions not associated with degenerative changes in the body are the following conditions:
Tumors of the spine – an overgrowth of tissues that can put direct pressure on the spinal cord or narrow the spinal canal. In addition, tumor tissue growth can lead to bone resorption or bone fragmentation.

Injuries, fractures of the vertebrae can cause both a narrowing of the canal, in addition, with complicated fractures, there may be an impact of bone fragments on the spinal cord or roots.

Paget’s disease is a chronic bone disease characterized by abnormal bone growth that becomes thick and brittle (which increases the risk of fractures). As a result, arthritis occurs in the joints. The disease can develop in any part of the body, but most often in the spine. Structural changes in the bone tissue of the spine can lead to narrowing of the spinal canal and cause severe neurological symptoms.

Fluorosis is an excessive level of fluoride in the body. May be caused by inhalation of industrial gases and dusts, ingestion of foods high in fluoride, or occasional ingestion of foods high in fluoride insecticides. An excess of fluoride can lead to hardening of the ligaments and/or softening of the bones and degenerative changes leading to spinal stenosis.

Ossification of the posterior longitudinal ligament occurs when calcifications accumulate in the ligament that runs along the entire spine. These calcium deposits actually turn ligamentous tissue into bone. And these calcium deposits can put pressure on the nerves in the spinal canal.

Symptoms

The space inside the spinal canal may be narrowed and may be asymptomatic. However, if the constriction puts pressure on the spinal cord, the cauda equina, or the nerve roots, symptoms develop and progress slowly. The neck or lower back may or may not hurt. More commonly, patients experience numbness, weakness, cramps, or generalized pain in the arms or legs. If the narrowed area puts pressure on the nerve root, then patients may experience pain radiating to the leg (sciatica). Squatting or flexing the spine can reduce pain (when flexed, there is an increase between the vertebrae in the spine. Therefore, spinal flexion exercises are recommended, along with weight exercises.

Patients with more severe stenosis may experience bowel, bladder, or lower limb function problems. For example, cauda equina syndrome is a rare but very serious form of spinal stenosis. Cauda equina syndrome occurs due to compression on the structures of the cauda equina, and symptoms may include loss of bowel control, bladder control, erectile dysfunction or pain, weakness, and loss of sensation in the lower extremities. Cauda equina syndrome is a medical emergency.

Diagnosis

The doctor can use different approaches to diagnose spinal stenosis and exclude other diseases:
Medical history – the patient describes in detail the symptoms, history of injuries, existing diseases that may be the cause of spinal stenosis.
Physical examination – the doctor examines the patient, determines the presence of limitation of movement in the limbs, checks for pain during hyperextension of the spine, neurological parameters such as sensitivity, muscle strength in the limbs, reflex activity.

Radiography x-rays allow you to get a two-dimensional image of the spine. X-rays may be given as the first examination, especially when helping to diagnose injuries or tumors. Radiography allows you to visualize the structure of the vertebrae, the configuration of the articular surfaces, to detect calcifications.

The MRI uses a powerful magnetic field that, passing through the body, hits the scanner and undergoes computer processing. MRI allows you to scan tissue sections, which are then converted into a two or three-dimensional image. MRI is especially relevant for obtaining information about the condition of soft tissues, such as intervertebral discs or ligaments. In addition, the spinal cord, nerve roots and surrounding tissues are visualized, thus allowing the diagnosis of tissue enlargement, degeneration or tumors.

Computed tomography (CT ) – X-ray passes through tissues at various angles, hits the scanner and is analyzed by a computer. As well as MRI allows you to get a two-three-dimensional image of tissues in layers. CT better visualizes bone structures, but also allows you to see soft tissues. CT allows visualization of the spinal canal and structures surrounding it.

Myelography is a type of X-ray, but only with myelography, a contrast agent is injected into the spinal canal. This allows you to visualize the presence of tumor stenosis, osteophytes or signs of pressure on the spinal cord of herniated discs.

Radioisotope scanning (scintigraphy) The radioisotope introduced into the blood is distributed selectively in tissues with increased metabolism. This method allows you to diagnose fractures, tumors, infections. Radioisotope scanning is carried out to confirm the diagnosis, but in its pure form does not allow differentiating diseases.

Treatment of stenosis

Conservative treatments

Medical treatment

NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, naproxen, ibuprofen, indomethacin help reduce inflammation and reduce swelling and pain.

Injections of corticosteroid into the membranes that cover the spinal cord can reduce inflammation and pain in the legs.
Injections with anesthetics, called blockades, relieve pain for a while.

Restriction of motor activity depending on the nerves involved.

LFK . Physical exercises selected by the exercise therapy doctor help to increase the range of motion in the spine, strengthen the abdominal and back muscles, which allows you to stabilize the spine. In some cases, aerobic exercise (such as swimming or cycling) may be recommended, but with a gradual increase in exercise.

Corsets . Perhaps the use of a corset for a short period of time to fix the spine and reduce pain. As a rule, corsets are relevant in elderly patients with weak abdominal muscles and with degenerative changes in several parts of the spine.

Chiropractic This treatment is based on the principle that a decrease in the range of motion in the segments of the spine results in impaired function and causes pain. The task of manipulations by a chiropractor is to restore the range of motion in the spine, remove muscle blocks. Manual therapy also uses traction techniques (traction of the spine) to reduce compression on the nerve structures of the spinal cord. The study showed that manual therapy is as effective as other conservative treatments for spinal stenosis.

Acupuncture — This treatment is the stimulation of certain areas of the body by various methods, most often by inserting fine needles through the skin. Studies have shown that acupuncture can achieve good results, especially for lower back pain.

Surgical treatment . In many cases, the conditions that led to the stenosis cannot be eliminated by conservative methods of treatment, although it is possible to relieve pain with the help of conservative methods of treatment for a while. Therefore, first of all, conservative treatment is always prescribed. But if there are symptoms such as weakness in the legs with a violation of the process of walking, dysfunction of the bladder and intestines, then there is a need for emergency surgical intervention. In addition, for the choice in favor of surgical treatment, the absence of the effect of conservative treatment is important. The task of surgical treatment is to eliminate compression on the spinal cord and roots, and to remove excess tissues that cause compression of the nerve structures. The most common operation is decompression laminectomy, which is performed both with fixation and without fixation of the vertebrae.

Risk and prognosis of surgical treatment

Any surgical intervention is associated with risks during general anesthesia and the risk is high in elderly patients. The risk of the most surgical intervention in spinal stenosis is possible damage to the dural membranes, infectious complications, and thrombosis. The presence of concomitant somatic pathology is a factor affecting the possibility of surgical treatment. As a rule, the result of surgical treatment is a rapid regression of symptoms, due to the fact that the causes of pressure on the nervous structures are eliminated. But in some cases, symptoms may persist for a long time after surgery. This usually happens in cases where there was prolonged compression on the nerves or spinal cord in the preoperative period and damage to the very structure of the nerves occurred. Long-term results of surgical treatment depend on the degree of degenerative changes in the spine and the usefulness of rehabilitation.

causes, symptoms and treatment of cervical stenosis

Contents

• 1 Cervical spondylosis and cervical stenosis: symptoms, treatment and prevention
  • 1.1 Cervical spondylosis: what is it?
  • 1.2 Causes of cervical spondylosis
  • 1.3 How does cervical spondylosis present?
  • 1.4 Diagnosis of cervical spondylosis
    • 1.4.1 Basic diagnostic methods:
  • 1.5 How to prevent cervical spondylosis?
  • 1.6 Basic treatments for cervical spondylosis
  • 1.7 Drug treatment for cervical spondylosis
    • 1.7.1 Non-steroidal anti-inflammatory drugs
    • 1.7.2 Muscle relaxants
    • 1.7.3 Narcotic analgesics
    • 1.7.4 Preparations for the relief of neuropathic pain
    • 1.7.5 Vitamins and supplements
  • 1.8 Exercise for cervical spondylosis
  • 1. 9 Massage for cervical spondylosis
  • 1.10 Physiotherapy for cervical spondylosis
    • 1.10.1 Physiotherapy for cervical spondylosis
    • 1.10.2 Manual therapy for cervical spondylosis
  • 1.11 Surgical treatment of cervical spondylosis
    • 1.11.1 Indications for surgery
    • 1.11.2 Types of surgery
    • 1.11.3 Postoperative period
    • 1.11.4 Rehabilitation period
  • 1.12 Related videos:
  • 1.13 Q&A:
    • • 1.13.0.1 What are the causes of necks leg spondylosis?
      • 1.13.0.2 How to determine the presence of cervical spondylosis?
      • 1.13.0.3 How to treat cervical spondylosis?
      • 1.13.0.4 Which exercises are recommended for cervical spondylosis?
      • 1.13.0.5 Can cervical spondylosis be avoided?
      • 1.13.0.6 What are the consequences of untreated cervical spondylosis?

Cervical spondylosis acquired stenosis of the cervical spine – causes, symptoms and treatment. Find out how to deal with cervical spondylosis and avoid its development in the article on our website.

Cervical spondylosis is a disease of the spine that occurs as a result of degenerative changes in the cervical spine. One of the most dangerous and common manifestations of cervical spondylosis is stenosis of the cervical spine.

Cervical spinal stenosis is a narrowing of the spinal canal in the cervical region caused by a number of factors such as poor circulation, changes in the shape of the vertebrae, bony ridges and other degenerative changes. When the spinal canal narrows, it leads to severe pain and disruption of the normal functioning of the nervous system.

Symptoms of cervical stenosis may include pain in the neck, shoulders, arms and head, numbness or tingling in these areas, loss of sensation in the hands and fingers, limitation of movement, and dizziness and other cognitive impairment.

Before starting the treatment of cervical stenosis, it is necessary to make an accurate diagnosis and identify the causes of the disease. In the future, an appropriate complex of medical and physical treatment is selected, which includes anti-pain and anti-inflammatory drugs, physiotherapy, massage and rehabilitation exercises.

Cervical spondylosis: what is it?

Cervical spondylosis is a disease characterized by changes in the spine in the cervical region. It can occur in both young and old people. The process of development of cervical spondylosis can lead to stenosis of the cervical spine.

Cervical spondylosis causes degeneration of the joints, intervertebral discs and ligaments of the cervical spine. Gradually, they fail, which leads to a change in the shape of the cervical spine.

This disease is accompanied by pain in the neck, headache, restriction of movement in the neck and tinnitus. Cervical spondylosis can lead to other serious conditions such as migraines, high blood pressure, and dizziness.

Causes of cervical spondylosis

Cervical spondylosis are spinal changes that occur in the cervical region. Many people develop problems in this area over time, causing pain and limited movement. What causes can provoke the development of cervical spondylosis?

• Age. The very nature of our body causes an increase in degenerative and regenerative processes that affect the health of the spine. The risk of cervical spondylosis is higher in older people.
• Sedentary lifestyle and malnutrition. Lack of movement leads to weakening of the muscles that support the spine, which can lead to the development of cervical spondylosis. A diet rich in fat and sugar also has a negative effect on the structure of the vertebrae.
• Neck injury. Past injuries to the neck can lead to cervical spondylosis in the future. In addition, disturbances in walking and standing posture, such as scoliosis, can cause spinal muscle failure and subsequent degenerative changes.

Knowing the causes of cervical spondylosis will help you take steps to prevent it. It is important to monitor the condition of your neck, avoiding excessive stress and muscle overload. Regular exercise, proper nutrition and care for the health of the neck will help to avoid the development of this disease.

How does cervical spondylosis manifest itself?

Cervical spondylosis is a degenerative disease that affects the cervical spine. Spondylosis is characterized by the appearance of pain in the neck and / or in the area of ​​​​the shoulders and arms due to compression of the nerve roots in the spinal canal.

One of the main symptoms of cervical spondylosis is dizziness. This may be due to the fact that the disease leads to impaired blood circulation in the vessels of the neck. Also, pain, numbness and pain in the neck, as well as the shoulders and arms, can let you know about the presence of this problem.

Manifestations of cervical spondylosis can vary greatly, depending on the severity of the disease and individual characteristics of the organism. In rare cases, a fever may appear, during which a person experiences a sharp pain in the neck and instantly loses consciousness. If you have a suspicion of cervical spondylosis, be sure to consult your doctor, because. illness can have serious consequences.

Diagnosis of cervical spondylosis

Diagnosis of cervical spondylosis is an important step in the treatment of pathology. At the first signs of the disease, it is necessary to consult a neurologist who will conduct an initial examination and identify the presence of symptoms of stenosis of the cervical spine.

Various diagnostic methods are used to confirm the diagnosis, including computed tomography, magnetic resonance imaging, radiography, electroneuromyography and other diagnostic methods.

Basic diagnostic methods:

1. Computed tomography (CT) – allows you to get a three-dimensional image of the spine, detect changes in the structure of the vertebrae, discs and other elements of the spinal column.
2. Magnetic resonance imaging (MRI) is a diagnostic method that allows you to get a more detailed image of soft tissues, which allows you to identify the presence of inflammatory processes, tumors and other changes in the spine.
3. X-ray is a diagnostic method that allows you to detect changes in the structure of the bones of the spine, detect the presence of osteophytes, nodes, deformities and other changes in the bone tissue.
4. Electroneuromyography (ENMG) is a research method that allows you to assess the functional state of muscles and nerve fibers, to identify the presence of disturbances in the conduction of nerve impulses, which is a characteristic symptom of cervical spondylosis.

How to prevent cervical spondylosis?

Cervical spondylosis is a disease that can develop in people who lead a sedentary lifestyle or subject to excessive stress on the neck. However, there are several ways to prevent or slow down the progression of the disease.

• Strengthen your neck and back muscles . Regular exercise to strengthen these muscles can help reduce the risk of developing cervical spondylosis. For example, you can perform exercises that require raising and lowering the head, turning, bending, etc.
• Sit and stand correctly . Poor posture can lead to cervical spondylosis. We advise you to ensure that when sitting or standing, the spine is straight and the shoulders are even.
• Reduce neck strain . We advise you to avoid reliable head turns and long-term maintenance of a fixed posture. You should also take regular breaks to stretch your neck and shoulders.
• Watch your weight . Excess weight can cause spondylosis of various parts of the spine, including the cervical. Weight loss can reduce pressure on the neck and reduce the risk of developing the disease.

Basic treatments for cervical spondylosis

Treatment of cervical spondylosis can be medical, surgical or non-pharmacological. Each of the methods can be used depending on the degree of development of the disease and its manifestations.

Medical treatment for includes anti-inflammatory drugs, analgesics, muscle relaxants, and hormones. They help not only reduce pain, but also relieve inflammation, which helps restore normal blood circulation.

Surgery is used in very rare cases and usually when other treatments have failed. Surgery may include the removal of parts of the spine and the placement of implants to stabilize it, or a laminectomy, which removes nerve compression.

Non-drug therapies include physical rehabilitation, physiotherapy, massage and exercise. Physical rehabilitation can help strengthen the muscles around the affected spine, as well as disperse them and reduce pain. Physiotherapy is used to improve circulation to the affected spine and reduce pain. Massage and exercise can help improve microcirculation and reduce pressure on the nervous system.

All treatments must be prescribed by and under the supervision of a physician.

Cervical spondylosis drugs

Nonsteroidal anti-inflammatory drugs

NSAIDs are the most common drugs used to treat pain and inflammation in cervical spondylosis. They reduce inflammation, reduce pain and improve neck mobility. Usually they are prescribed for a long time, but the use may be accompanied by side effects such as stomach ulcers, dizziness, allergic reactions, and others.

Muscle Relaxers

Muscle Relaxers help with muscle spasms that can occur with cervical spondylosis. They are usually used in combination with NSAIDs for best results. But, as with NSAIDs, their use can be accompanied by side effects such as drowsiness, dizziness, and incoordination.

Narcotic analgesics

Narcotic analgesics may be prescribed as a temporary solution for severe pain that is not relieved by NSAIDs or muscle relaxants. However, they must be administered with great care, as there is a risk of addiction and other side effects.

Neuropathic pain medications

Neuropathic pain medications may be prescribed if the patient has chronic neuropathic pain. These drugs can help improve symptoms, but they can also come with side effects such as dizziness, nausea, and trouble sleeping.

Vitamins and supplements

Vitamins and supplements may be added as an adjunct to the main treatment. For example, vitamin D promotes healthy bones and joints, while glucosamine can help relieve pain and improve neck flexibility. However, the use of these drugs should be discussed with the doctor as they may interact with other medications the patient is already taking.

Before starting drug therapy, the patient should consult a physician to select the optimal drugs and dosages, as well as to avoid possible side effects.

Exercise for cervical spondylosis

Cervical spondylosis is a disease in which the activity of the cervical spine is disturbed. Its symptoms can manifest as pain and numbness in the neck, shoulders, and arms. To reduce pain and improve the mobility of the head and neck, special physical exercises are recommended.

Another useful exercise is tilting the head to the right and left. Place your right hand on your left ear and slowly lean to the right while pressing your head against your hand. Repeat the exercise on the left side.

The bridge exercise is also helpful. Lie on your back, bend your knees and place your hands behind your back. Tighten your abdominal muscles and lift your pelvis up. Hold this position for a few seconds, then repeat.

You can also do the cat exercise. While on all fours, slowly and smoothly straighten and bend your neck up and down, while slowing down your breathing.

It is important to remember that before starting any physical activity, it is necessary to consult a doctor and select exercises depending on the degree of the disease.

Cervical spondylosis massage

Cervical spondylosis can lead to stenosis of the cervical spine, which can cause pain and disruption of normal functioning. Massage can be one of the ways to alleviate the condition with this disease.

For massage, you need to contact a qualified massage therapist who will help you choose the appropriate techniques and massage maneuvers for each patient individually.

Care must be taken when performing massage so as not to cause additional harm to the patient and not aggravate his condition. The masseur should be attentive to possible soreness and stop the massage when acute pain occurs.

Massage can help improve blood circulation, reduce muscle tension, increase flexibility of the cervical spine. It can also help relieve pain and improve overall well-being. However, massage is not a panacea and should be used in conjunction with other treatments as prescribed by a doctor.

Physiotherapy for cervical spondylosis

Physiotherapy for cervical spondylosis

One of the main components of the complex treatment of cervical spondylosis is physiotherapy. Physiotherapy methods can significantly improve the condition of the spine, reduce pain and restore neck mobility.

Electrotherapy. This method is based on the use of various types of electrical currents for therapeutic purposes. Electrotherapy helps relieve muscle spasms, improve blood circulation and metabolism in the tissues of the spine.

Magnetotherapy. The method is based on the use of magnetic fields of varying intensity. This leads to a decrease in pain and inflammation in the tissues of the spine, and acceleration of tissue regeneration.

Ultrasound therapy. This method uses ultrasonic waves that penetrate deep tissue layers, causing relief from pain and muscle spasms, as well as improving blood circulation and lymph flow.

Manual therapy for cervical spondylosis

Manual therapy can be an effective treatment for cervical spondylosis. This method includes various techniques of manual impact on the spine, aimed at increasing the mobility of the cervical segments.

Manipulation. This method involves rapid and active movements of the spine, which are aimed at restoring its mobility.

Soft techniques. This method is based on gentle techniques used to relax muscles and reduce pain.

Traction. This is a stretching of the spine with the help of special devices. This method helps to increase the space between the vertebrae, reduce the load on the intervertebral discs and improve blood circulation in the tissues of the spine.

Surgical treatment of cervical spondylosis

Indications for surgery

Due to stenosis of the cervical spine, disruption of the brain, nervous system and other organs can occur. If conservative methods of treatment do not bring results and the symptoms continue to worsen, they resort to surgery. The operation is prescribed only when there is a real threat to the patient’s life.

Types of surgery

There are several surgical options for treating cervical stenosis. Most common:

• Decompression – removal of the superior vertebral arches and restoration of the normal size of the canal
• Laminectomy – removal of the bone that restricts the passage of the nerve in the canal
• Fixation – often prescribed after decompression or laminectomy, to stabilize the spine and prevent recurrence of the problem

Postoperative period

After cervical spine surgery, the patient should limit physical activity for a few weeks, stay in bed, and do some exercise to prevent scar tissue from forming. Antibiotics and pain medications are often prescribed to prevent infection and reduce pain. Subsequent rehabilitation may take up to several months.

Rehabilitation period

After surgery, it is necessary to monitor nutrition and physical activity. It is recommended to engage in physical therapy, which helps restore muscle tone. It is important to follow the rules of labor protection and eliminate the cause of the disease in order to prevent the problem from recurring.

Related videos:

Q&A:

What are the causes of cervical spondylosis?

The root cause of the development of cervical spondylosis is aging, when the intervertebral discs accumulate degenerative changes associated with lack of nutrition and deterioration of blood supply. Other causes of cervical spondylosis include PTSD, poor posture, arthritis, and obesity.

How to determine the presence of cervical spondylosis?

Symptoms of cervical spondylosis can be varied: headaches, cutting pains in the neck, shoulders and arms, numbness of the extremities, dizziness, difficulty falling asleep. Diagnosis of cervical spondylosis includes examination of highly specialized specialists, X-ray and MRI.

How to treat cervical spondylosis?

Cervical spondylosis can be treated conservatively or surgically.