By
definition, Spinal Stenosis is a narrowing of the spinal canal, nerve
root canal or intervertebral foramina of the spine compressing and
blocking nerve roots. Wow, what does all that mean? Everyone has a
different spinal cord and canal size, therefore, the risk factor of
developing it varies. Stenosis can exist for years and may go
undetected. During this time, one may not experience any pain or
discomfort associated with the condition. Often, it is usually gradual
and gets worse as the spine ages and with various spinal movements, or
when a sudden fall or accident takes place that stenotic pain makes
itself known. The most common area of stenosis includes the L4/5 region
of the lumbosacral spine (low back).To explain, the brain sends information down to the body by way of
the spinal cord. This structure
is about the size of your little finger and extends all the way down
your spine to a little above your waist. Actually it ends at the bottom
of the thoracic spine and rib cage; the rest of the spinal column
contains individual nerves. If the opening that the spinal cord travels
through gets smaller, that is called stenosis. If the opening that the
nerves pass through in the neck or low back area gets smaller, or if the
opening that the nerves exit the spinal canal from gets narrower, that
is also called stenosis.
Imagine wrapping elastic around your
finger. The tighter the elastic is, the more irritated your finger will
be. The circulation gets cut off and your finger may swell, turn red and
become painful. The same thing happens with stenosis. As the opening
the nerves or cord pass through gets smaller, the little blood vessels
associated with the nerve structures will get irritated and symptoms
will occur.Factors leading to spinal stenosis are:
- Spinal Degenerative Arthritic Changes and Injury
- Mechanical Dysfunctions
- Ailments in the Aging Spine
- Hypertrophied Ligaments
- Growing Infection
- Abscess
- Congenital or Developmental Anomaly
- Vertebral Fractures or Dislocations
- Spinal Cord Tumour
Signs and symptoms of spinal stenosis include:
- Neurogenic claudication producing back and/or leg pain with cramping and tingling (sciatica) triggered by walking or prolonged standing, during extension (bending backwards) and usually improved by sitting in a forward flexed position
- Loss of neck, arm, shoulder and leg sensation such as numbness , tingling and temperature (hot or cold) feelings in one or both upper or lower extremities
- Limping
- Leg fatigue
- Fear of falling
- Muscle Spasms
- Muscle Weakness, and
- It may be asymptomatic for years without causing pain or discomfort, but any type of trauma, including a fall, may trigger characteristic stenosis pain.
To Diagnose Spinal Stenosis
The
diagnosis of spinal stenosis is based upon the patient's history of
symptoms, an imaging test, and a thorough physical examination. Unlike
an MRI, an electrodiagnostic study is usually viewed as a more reliable
method of gathering information on stenosis. To diagnose spinal stenosis
arising from an infection or an abscess, a blood test may be required.
On the other hand, spinal and vertebral tumours are best diagnosed with
precise imaging.
At times, it is tough to differentiate between
neurogenic claudication and vascular claudication. This is when the
blood supply to the legs is not adequate and is not sufficient to
support the muscles and tissues of the leg. For those who have
neurogenic claudication, walking uphill is a better option because it
results in bending of the spine in the forward direction when walking.
Walking downhill becomes problematic as the spine arches and pushes the
spinal cord closer to the vertebrae and causes increased symptoms.
The Treatment of Stenosis
If
you or a loved one suffers from spinal stenosis, you're probably
looking for the best treatment options. The main treatment approaches
for spinal stenosis typically involve:
- The traditional medical treatment of analgesics, bed rest, applied heat, and the use of muscle relaxants
- The conservative chiropractic approach that relies on spinal manipulation, specific stretching and strengthening exercises, and techniques of administering self-care, or
- Surgery.
Often,
it is the source of spinal stenosis that determines its treatment
approach. For starters, medication can be effective in providing
temporary pain relief; however, it can also worsen the patient's sense
of balance. Surgery may be recommended in cases where the patient has
issues with bladder and/or bowel control, experiences acute leg pain,
undergoes progressive loss of function, or has a spinal cord tumour.
These patients often report improvement right after the surgery. Even
so, many surgeries have to be repeated since symptoms are likely to
return after a period of time. Surgery can also change the structure of
the back, occasionally creating other problems.
Over the long
term, studies show that outcomes are similar between surgery and
conservative care. Since spinal stenosis is viewed as a chronic
condition, it cannot be cured - but it can be managed. Improvement can
be marked and sustained on a long-term basis. A holistic view of the
condition allows for seeking ways to improve the patient's overall
quality of life while reducing symptoms. A doctor of chiropractic
focuses on this holistic approach.
Conservative care is
appropriate for people with mild to moderate symptoms, while surgery is
reserved for patients with severe symptoms. You and your health
practitioner would need to work together to decide which course of
treatment is best for you. I will tell you that while I am an advocate
for conservative care, I have observed spinal stenosis surgery and for
the most part, it is as mild a surgery as any surgery could be. But
because there are always risks associated with surgery, unless there is a
condition called Cauda Equina Syndrome (bowl or bladder incontinence),
trying conservative treatment is always the first way to go.
Chiropractic Management of Stenosis
- Non-invasive chiropractic care helps reduce pain and discomfort, while improving joint mobility. This is helpful with mild and moderate cases of stenosis.
- For more acute cases, computerized spinal decompression (spinal distraction), in particular, may help reduce discomfort in the legs. Traction employs a pulling force to help widen the space between the vertebrae and lower the pressure on affected spinal discs and nerves.
- Exercise recommendations such as stretching and strengthening exercises of the lower back and stomach are especially helpful. These can include riding a bicycle, and performing exercises that require flexing of the spine. The patient should seek to perform these exercises on a regular basis.
Ultimately, stenosis is a long lasting spinal disorder that cannot be completely eliminated, but it usually can be controlled and improved with the appropriate therapy plan, and improvement can be sustained over the long term. Patients will work with Dr. Pisarek, who will implement a specific functional spinal stenosis treatment and relief plan based on their individual needs to control and manage symptoms of spinal stenosis. This will most certainly lead to an improvement in the quality of life and spinal stenosis relief for the patient.
In the past, people thought that the ultimate resort in case of spinal stenosis is surgery. This is not the case anymore. With more people getting to know about chiropractic treatment, surgery is not the only option remaining. Chiropractic is a very safe and natural option in case of spinal stenosis. Chiropractors work by focusing on the mechanics and misalignment with associated nerve pressure (subluxation) of the spine. This is when a vertebrae does not function as good as it should be. The result of this is that the bone and the tissue around it apply pressure on the spinal cord and the nerves. Chiropractic manipulative adjustment helps in balancing the soft tissues about the spine such as the muscles, ligaments and nervous system, and getting the joints moving properly again. It also may lead to a reduction in the symptoms experienced during spinal stenosis. Using flexion based exercise and other techniques along with chiropractic treatment can help in faster recovery.
Chiropractors employ a conservative care approach devoid of surgery or drugs. When a chiropractor deems a condition to be outside of his or her scope of treatment, the patient is referred to another specialist. Dr. Pisarek may also seek your permission to contact your family physician to ensure coordinated care.
The ultimate chiropractic goal is to increase the patient's overall quality of life and not just the symptoms.
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