ADVANCE NEUROSURGERY

Spinal Stenosis

Introduction

The spine is made up of 33 bones. These and the discs between them provide a passage for the spinal cord and nerves.

Spinal stenosis is a narrowing of spaces in the spine that results in pressure on the spinal cord and / or nerve roots.

Stenosis can affect any part of the spine, although it rarely affects the upper back. When the nar-rowed area is in the bones of the neck, it is called cervical canal stenosis. When the narrowed area is in the bones of the lower back, it is called lumbar canal stenosis.

Overview of Spinal Stenosis

This disorder usually involves the narrowing of one or two areas of the spine:

• 1. The spinal canal (central stenosis)
• 2. The intervertebral foramen (lateral stenosis)

Causes

Spinal stenosis can be a natural result of aging, as the spinal canal becomes compressed through years of wear and tear.

May be caused by soft tissue, bone or both compromising space leading to inadequate room for the spinal cord or cauda equina. This disorder is most common in people over 50 years of age, howev-er it may occur in younger people. Spinal Stenosis may be caused by inherited or acquired conditions.

Inherited

1. Scoliosis

Acquired

• 1. Disc herniation
• 2. Ligamentum flavum thickening
• 3. Spondylolisthesis
• 4. Compression fracture
• 5. Combination
• 6. Spinal segmental instability
• 7. Secondary effects of aging

Symptoms or Problems

The main symptoms of spinal stenosis are felt in the legs and include:

• 1. Heaviness
• 2. Weakness

Pain with walking or standing for a long time

The symptoms of spinal stenosis are caused by the nerve roots getting squeezed, which upsets the normal signals traveling from the brain to the body. Irritation of the nerves is worse when you are standing or walking due to pressure and stretching of the nerves. Symptoms often disappear with rest. Sitting down seems to take pressure off the nerve roots. The second and corresponding fea-ture of vertebral stenosis is that you must sit down (or better still squat) to get relief, before you can resume walking. Sitting flexes (bends) the lumbar spine which broadens the small bony canals through which the nerve roots exit the spine (the intervertebral foraminae) and this lets more blood through. As the nerves receive a fresh flush of blood the pain and difficulty in the legs quite quickly subside. You feel fine, until you are stopped again moments later, further down the track.

Treatment

• 1. Non Surgical Management
• 2. Exercise Considerations

Avoid aggravating the condition by avoiding extension or rotational movements

Literature suggests flexion is better than extension as it opens diameter of spinal canal

Pain Killers and Antiinflammatory medications (NSAIDS)

These medications help reduce swelling and inflammation around the nerves. Thus reduce pain. NSAIDs should be used cautiously and for short durations because of its side effect profile like gas-tritis, stomach ulcers, Renal dysfunctions and other side effects.

Epidural Steroid injections. (Pain Management Strategy)

Steroid is a powerful anti-inflammatory drug. Steroid injections around the nerves or in the "epidural space" decreases swelling, as well as pain. They may reduce numbness, but do not improve weakness, in the legs or feet. Patients should receive no more than three injections a year.

Acupuncture

Acupuncture can be helpful for mild cases of lumbar stenosis. Long-term success with this treatment has not been proven scientifically.

Surgical Treatment

Minimally Invasive Decompression

Dr. Asheesh Tandon and his team has developed extensive expertise is minimally invasive decom-pression techniques. The techniques reduces soft tissue injury as well as reduces instability in the long term. Patients are able to return to the activities in a shorter period. Unilateral approach for bi-lateral decompression also reduces the post operative pain.

Decompression with fixation

In a good percentage of patients along with Lumbar canal stenosis there is an element of spinal in-stability. In simple terms there is increased movement between different spinal segments. In such a clinical scenario , Dr Tandon along with his spinal unit need to stabilise the spine for pain relief and prevention of failed back syndrome or recurrence of pain.

Center of Minimally Invasive Neurosurgery at Jabalpur India is able to provide high end surgical care at a reasonable cost so that patients are able to get this treatment.

To discuss your case or to get second opinion please click on Discuss your case or Contact Dr Asheesh Tandon at drasheesh@gmail.com