Spinal Stenosis, or its abbreviated term “stenosis”, typically refers to the lumbar spine (low back), but can also be attributed to the cervical spine (neck). This is a condition that typically occurs in people 60 years old and older, but can show up in younger folks who have experienced trauma to their spines. It is considered a medical condition, and can cause pain in the low back or neck, but often it doesn’t cause pain, but a seemingly unexplainable weakness particularly in the legs. Most of the patients I see have a poor understanding as to what it actually means. In fact, when I ask my patients, who have previously been diagnosed with stenosis, what is causing their stenosis, I typically encounter a rather puzzled look from them. It’s my intention here to help you have a much greater understanding of spinal stenosis, and what to do about it.
Definition of Spinal Stenosis
Spinal Stenosis is an abnormal narrowing of the spinal canal. The spinal canal is what houses and protects our spinal cord. There is also something called neuro-foraminal stenosis, which is a narrowing of the opening between the vertebrae where our spinal nerves exit from the spinal cord to travel into out arms, legs, and organs.
Understanding Anatomy / Spinal Stenosis
There are many potential causes of stenosis, it used to be thought of as only a degenerative condition of the spine, but as the definition states — it’s a narrowing of the spinal canal. So in order to understand what can narrow the spinal canal, or the neuro foramen, it’s important to look at the anatomy of the spine.
The anterior part of the spine (front) is made up of the vertebral body and the disc, it is the largest part of the spine as it’s also the weight bearing portion of the spine. The vertebral bodies are joined to the back of the spine by a structure called the pedicle—which can be fractured or weakened from birth and create something called a spondylolysis, and a spondylolisthesis.
The pedicle attaches to the Facet joint and then the lamina and spinous process at the back of the spine. So the borders of the spinal canal are essentially made up of the vertebral body, the intervertebral disc, the facet joint and lamina, and a ligament called the ligamentum flavum, which connects from the lamina of one vertebra to the lamina of the one above and below. There is also a capsular ligament around the facet joint.
Causes of Spinal Stenosis
So, what could possible go wrong to cause stenosis? Essentially, anything that affects any of the structures bordering the canal can potentially cause stenosis. Let’s look at them. Degenerative Disc Disease (DDD) is a condition where the nucleus of the disc loses its water, and the annulus of the disc weakens and dries out causing the entire disc structure to being to collapse. This can lead to disc bulges of disc herniations, and often bone spurs on the edge of the vertebral body, if the bone spurs get big enough, they can cause a bony narrowing of the canal leading to spinal stenosis. While we see a fair amount of degenerative disc disease and bone spurs off the lip of the vertebra, we rarely see it as the only cause of stenosis. It does happen, but it is fairly infrequent. What often happens is the disc begins to dry out or become a desiccated disc, it alters the way your disc can distribute weight and the forces it is subjected to on a daily basis. As the disc weakens it can bulge out, something we call a bulging disc (or disc bulge). As the disc bulges outward it pushes into the spinal canal, or it can push into the neuro-foramen causing, you guessed it, spinal stenosis or neuro-foraminal stenosis. In the same way, as the disc weakens, and you move in such a way that the disc suffers a catastrophic failure you can cause a disc herniation, which might be a disc protrusion, a disc extrusion, or a disc sequestration — a breakdown of those definitions can be found on another page here. When a disc herniates posteriorly (backwards), it can and will most definitely cause stenosis of the spinal canal or the neuro-foramen. Interestingly enough, disc bulges tend to be broader even though there is less damage to the disc and contribute to spinal stenosis more frequently and disc herniation’s tend to be more focal and lead to neuro-foraminal stenosis.
When the disc breaks down as in degenerative disc disease, or when the disc bulges from the disc herniation this alters the distribution of forces that the disc is designed for and puts stress on other structures of the spine that aren’t designed to be weight bearing.
Your Treatment Options
An extremely effective means of treating a spinal stenosis is non-surgical spinal decompression. Non-surgical spinal decompression allows us to reduce the compressive force on the disc, allowing us to reduce the disc herniation size and restore normal function to the disc. This can then remove the pressure on pinched nerves caused by all the conditions of a disc that can cause stenosis, reducing and eliminating the pain caused by them. In addition, we do many other therapies designed to improve strength and mobility to your spine hips and neck to reduce the likelihood of re-injury. Non-invasive, non-surgical decompression should always be tried before surgery after a proper neurological examination has been performed to determine if you are a good candidate for this procedure. There will likely be many other specialized services performed and or taught to you to help you recover your lost function as a result of spinal stenosis.
Ready to find out if you’re a candidate for our alternative treatments for spinal stenosis?