Spinal Stenosis

Spinal stenosis is one of the most common conditions that affect the aging population, with an increased prevalence with the progression of age. The [Page 1597]word “stenosis” is derived from the Greek word stenos, which means “a narrowing.” Therefore, spinal stenosis can occur throughout the spinal column, mainly noted in the lower lumbar region, and is regarded as a narrowing of the spine's spinal canal, lateral recess, or intervertebral neural foramen. Such a narrowing of these anatomical structures can lead to compression of the spinal cord and/or exiting nerve roots, and subsequently the manifestation of symptoms.

The development of spinal stenosis is attributed to a variety of factors that alter the natural structure and function of the spinal column, leading to morphological alterations contributing to spinal stenosis. Spinal stenosis is categorized as being acquired or congenital. In acquired spinal stenosis, the condition is due to changes attributed to intervertebral disc (“shock absorbing” tissue between vertebrae) and/or facet (articulating processes between vertebrae) degeneration, metabolic alterations, post-traumatic event, spondylolytic spondylolisthesis, or iatrogenic causes. Conversely, in congenital spinal stenosis, the condition is considered idiopathic or present in achondroplastic dwarfs. However, the most common impetus leading to spinal stenosis is attributed largely to intervertebral disc and/or facet degeneration.

Clinically, there is no universal consensus as to what is deemed anatomically as spinal stenosis. The reason being is that individuals can undergo a variety of stenotic alterations and present with varying degrees of clinical manifestations. Symptoms can vary and as such demand thorough assessment of the patient's history, physical examination, differential diagnosis, and advanced imaging to determine the location and extent of spinal stenosis and in turn to devise the proper course of management. In individuals with acquired spinal stenosis, symptoms occur later in life, whereas individuals with congenital spinal stenosis present with symptoms much earlier in life (3rd or 4th decades).

In central canal stenosis of the lumbar spine (occurring mainly at the level of the intervertebral disc), neurogenic claudication is predominantly noted, whereas radicular symptoms with or without back pain is largely associated with lateral recess or foraminal stenosis. Symptoms may entail pain, numbness, motor weakness, burning, cramping, tingling, and dysreflexias of the lower extremities.

In lumbar stenosis, symptoms are exacerbated while standing and walking, but improve, in less severe cases, when laying down, sitting, or when the spine is in the flexed position. In contrast, symptoms are aggravated when sitting or in spinal flexion in individuals with degenerative disc disease or a herniated disc of the lumbar spine. In the early stages of spinal stenosis and dependent on the etiology of the condition, conservative treatment (i.e. activity modification, aerobic exercises, physical therapy, epidural steroid injections, selective nerve blocks, medication) can help alleviate the symptoms.

Surgical options to resolve symptoms associated with spinal stenosis are available; however, the choice to pursue such intervention is dependent on the location and extent of pathology, the degree and type of symptoms, the affects upon the patient's quality of life, response to conservative treatment, co-morbidi-ties, and the ability to undergo surgery. Nonetheless, due at times to the severity of spinal stenosis, surgical management of this disease process may not yield desirable neurologic recovery.

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