Degenerative disease of the spine involves arthritic changes in the bone, joints and ligaments. The spine consists of the vertebral bodies, intervertebral discs, facet joints, several layers of ligaments. The spinal canal contains and protects the spinal cord and nerve roots. The vertebral column consists of: seven cervical vertebrae, twelve thoracic, five lumbar, the sacrum the coccyx. The intervertebral discs are located in between these vertebrae.
With aging, the intervertebral disc degenerates and narrows. This produces abnormal motion at that spinal level. In an attempt to repair this condition, the spine generates bone spurs and thickened ligaments. This process leads to gradual narrowing of the spinal canal, called spinal stenosis. Spinal stenosis can occur at any level of the spine however it is most common in the lumbar and cervical spine.
Signs & Symptoms
Cervical stenosis and lumbar stenosis cause very specific symptoms depending on the level of compression.
Signs and symptoms of cervical stenosis include spasticity in the legs, arm numbness, arm and leg weakness, arm pain, urinary incontinence, fecal incontinence, muscle wasting, loss of sensation, and increased and abnormal reflexes.
Signs and symptoms of lumbar stenosis include pain in the legs with walking which is relieved by bending and sitting, leg weakness, leg numbness, and decreased or absent reflexes.
Diagnosis
The diagnosis of spinal stenosis is made with imaging studies. MRI provides the best picture of the spinal cord and nerve roots. If MRI cannot be obtained, CT scan with myelography is an alternative.
Treatment
The treatment of spinal stenosis depends on which level and how many levels of the spine are involved. Conservative treatment is attempted first, unless there are significant neurological deficits. Rest and anti-inflammatory medications (ibuprofen, Motrin, Aleve) are helpful for mild symptoms. Exercise and physical therapy help rebuild fatigued muscles and encourage proper alignment of the spine. Most find relief with conservative therapy, however progressive pain and weakness are common.
Surgery For Cervical Stenosis
For cervical stenosis several different operations may be applicable. An anterior cervical discectomy and fusion (ACDF) is performed if the majority of the compression is from the anteriorly located intervertebral disc. This procedure involves an incision in the neck, which exposes the spine from the front. The disc is removed relieving any pressure on the spinal cord and nerve roots. Usually a bone graft is then placed in the space with a metal plate bridging the area.
A modification of this procedure involves actually removing the vertebral body in addition to the disc, followed by placement of a bone graft and metal plate. This is called a corpectomy and fusion.
If there is significant compression from the structures in the posterior part of the spine, such as the facets or ligaments, a laminectomy may be performed. This involves making an incision in the back of the neck and enlarging the spinal canal. If multiple levels need to be decompressed, then a posterior fusion may be performed, as well.
Surgery for Lumbar Stenosis
The most common surgery for lumbar stenosis is a decompressive laminectomy. In this procedure, an incision is made in the back and the lamina (back part of the bone over the spinal canal) is removed to create more space for the nerves.
The most common surgery for lumbar stenosis is a decompressive laminectomy. In this procedure, an incision is made in the back and the lamina (back part of the bone over the spinal canal) is removed to create more space for the nerves.
Occasionally it is necessary to perform a fusion if there is significant intervertebral disc disease or slippage of the vertebral bodies. A fusion permanently connects two or more vertebral bones. Wires, rods, screws, metal cages, and bone grafts may be used to hold the bones in place, while the bony fusion occurs.
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