The Who, What, When and Where of Spinal Stenosis

What is Spinal Stenosis?

There are spaces in the spinal cord and in between the vertebrae that allow for fluid movement of the bones against each other. When there is restriction in these spaces due to inflammation of soft tissue around the vertebrae, wearing away of the bones or disc erosion, the tightening of the spinal column causes pressure on the nerves, which results in pain and discomfort for the patient. This is referred to as spinal stenosis.

Spinal stenosis most often occurs in the cervical vertebrae in the neck and lumbar vertebrae in the lower back.

Underlying Causes

Herniated disc: the discs between the cervical or lumbar vertebrae could rupture, causing inflammation that presses on the nerves.
The most common cause of spinal stenosis is osteoarthritis and the formation of bone spurs due to the condition. These extraneous growths constrict the spinal space.
Direct trauma to the spine can inflame the soft tissue or fracture the bone, causing spinal stenosis.
Tumors of the spinal cord, being unfavorable growths, cause inflammation and irritation of the nerves.
Older people who have lived largely sedentary lives are more at risk for the condition.

Symptoms

Pain in the neck or lower back (or sometimes, both)
Tingling and jabbing pain in the arms and legs
Loss of sensation in the limbs
Leg cramps eased by sitting
Complications when untreated could lead to muscle weakness, permanent loss of sensation in the limbs, and paralysis.

Treatment Options

Treatment will aim to relieve the pain associated with the condition, and treat the underlying cause to prevent relapse.

Pain Medication

Steroids like prednisone and corticosteroid injections and non-steroidal medication like ibuprofen and naproxen are great for treating mild to moderate pain. Where the pain is more debilitating, opioids like oxycodone can be given to the patient under strict supervision.

Physical Therapy

Exercise regimens designed for endurance, stretching and flexibility are encouraged-even when medication is being taken.

Surgery

Decompression surgery can relieve the pressure around the affected area by removing some calcified growths and ligaments. It is minimally invasive and has great success rates of recovery.

Direct surgery to relieve the inflammation, and replace the worn out discs is also recommended for serious cases. In this instance, the surgery can remove some parts of the vertebrae, replace a slipped or ruptured disc, or remove the offending bone in a way that will ease up the pressure on the nerve.

The Rundown on Sciatica

What is Sciatica?

Sciatica is a condition that is not a disease or sickness in itself, but rather is a symptom of an underlying problem.

Major enervation of the legs, buttocks and lower back are by the sciatic nerve, which is the largest single nerve in the body. It originates from a nerve cluster in the spinal cord that combines in the lower back to run through the buttocks and send branches of nerve endings all through the lower limbs, down to the toes.

When the sciatic nerve is compromised in any way, the resulting pain affects all of the muscles connected to it, causing a radiating pain that originates in the lower back and radiates down the leg to the foot.

Causes and Symptoms

The major cause of sciatica is from a lumbar disc herniation, which is when there is a rupture of the disc supporting the lumbar vertebrae in the lower spine. This can cause the disc to press on the sciatic nerve.

Other causes may include:

Slipped disc (called isthmic spondylolisthesis) where one vertebrae can slip forward over another due to a small fracture or stress to the disc.
Spinal and disc degeneration due to age is normal, but it can be severe in some individuals. This can be due to genetics, a lifetime of medication, lack of exercise, or have no cause at all. The degenerated disc and bones can pinch the nerve and cause sciatic pain.
Arthritis due to age, which may cause spinal stenosis (enlargement of the disc and soft tissue surrounding the disc) and attendant pain due to pressure on the nerve.

Other less common causes are built-up trauma to the leg over time (like with athletes), tumors, infections that affect the lumbar spine, internal bleeding around the sciatic nerve and bone interference in the path of the nerve (like with a fracture or shift), causing irritation and pain.

The symptoms of sciatica are mostly pain related and include:

Radiating pain that affects the leg and foot.
Lack of sensation and difficulty in movement of the lower limbs.
Sharp pain when standing or trying to walk, which gets worse on sitting down.
Neurological symptoms like progressive loss of sensation in the leg and lack of bowel and bladder control, which are signs of a more serious underlying condition.

Treatment Options

Most times, sciatic pain is not serious enough to warrant a hospital visit, and it goes away after a matter of weeks. However, the pain can become all-consuming for some patients, and they will seek relief. Treatment for sciatica is mostly non-surgical, aiming at reducing and eliminating the pain it causes.

Therapy

Steroid injections can be given directly into the affected lumbar area to reduce inflammation and pain relief. The effects can be short-lived, but it helps the patient to be able to focus on their daily lives and also take part in other therapy options like exercise.
Massage can help to increase circulation, release endorphins that cancel out pain, and relax the muscles that may be contributing to the pinched nerve. It is a recommended alternative treatment for sciatica, however short-lived the effects.
Acupuncture is an approved method of pain relief, not just for sciatica but for other pain-causing conditions too. It would be prudent to employ the services of a registered practitioner.
Some special exercises can help with lumbar spine alignment and pain relief. Stretching and aerobic exercises are recommended to the patient, with a regimen than can last weeks or months.

Surgery

When sciatic nerve impairment gets so serious that the patient is losing sensation in the lower limbs, or cannot move at all, then surgery might be needed to immediately free the sciatic nerve and prevent permanent nerve injury.

The Problem With Painkillers

For some, reaching for the tablets every morning is as much as a habit as turning off the alarm clock or popping on the kettle. It becomes the only way chronic pain sufferers believe they can function. But worryingly, the dose that patients take over the years tends to gradually increase. And quite often, the more painkillers people take, the more they need to take.

Almost like an addiction, people who routinely take painkillers may even find themselves waking up during the night to take them! But what people don’t always realise is that the very drugs promising to ease pain are often prolonging it.

It is estimated that around 500,000 women and 100,000 men suffer from daily headaches as a result of the overuse of painkillers. These people are not overdosing on their medication; they are simply taking the pills for long periods of time. The more a painkiller is taken, the more resistant the body becomes and so the sufferer resorts to a stronger type of medication. When the medication wears off, withdrawal reactions (known as ‘rebound’ headaches) can develop, prompting them to take more medication. So it is actually the absence of the medication that is causing the headache.

Although this issue can affect anyone, the problem is thought to be more common among women. This is mainly because women are five times more likely to be affected by migraines than men. Women are also more likely to report their symptoms.

It’s important to remember that although painkillers can be effective in managing your headaches, they shouldn’t be your first port of call!

How a chiropractor may help?

A chiropractor may do one or more of the following if you suffer from a primary headache:

Perform spinal manipulation or chiropractic adjustments to improve spinal function and reduce the stress on your system.
Provide nutritional advice, recommending a change in diet and perhaps the addition of B complex vitamins.
Offer advice on improving posture, ergonomics exercises and relaxation techniques.

This advice may help to relieve the recurring joint irritation and tension in the muscles of the neck and upper back.

Chiropractors undergo years of extensive training to help their patients in many ways beyond treatment for lower back pain. A good chiropractor will understand how tension in the spine relates to problems in other parts of the body, and they can take steps to relieve those problems.