Spinal Stenosis - Definition

Article by Adjunct A/Prof Hee Hwan Tak

Spinal Stenosis - Definition

Adjunct A/Prof Hee Hwan Tak

Orthopaedic Surgeon
National University of Singapore(NUS) 1990
Royal College of Surgeons of Glasgow 1995
Royal College of Surgeons of Edinburgh 1995
2000 Clinical Fellowship in Spinal Surgery in USA, training at the Tulane University, New Orleans, Louisiana and the University of Kentucky in Louisville and Lexington 
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Lumbar spinal stenosis (narrowing of the space for the nerve in the lower back) is a disease affecting mainly the middle aged and beyond, and is due to the gradual narrowing of the space for the nerves. The structures that cause the compression include the thickened yellow ligament in the spinal canal, enlarged facet joints located behind the nerves, and bulging discs residing in front of the nerves.

Signs and Symptoms

Typically, a person with spinal stenosis complains about developing pain in the legs or calves, and lower back after standing and walking. This is relieved by sitting down or leaning over. When the spine is bent forward, more space is available for the nerves, causing a reduction in symptoms. Spinal stenosis leads to significant impairment in the quality of life.

Surgery

Surgery should be considered immediately if a patient has numbness or weakness that interferes with walking, impaired bowel or bladder function.

The purpose of surgery is to relieve pressure on the nerves, as well as restore and maintain alignment of the spine. This can be done by decompressive laminectomy, i.e. removal of the lamina (roof) of one or more vertebrae to create more space for the nerves. If the affected spinal segment is also unstable e.g. spondylolisthesis (forward slip of the vertebra) or lateral subluxation in degenerative scoliosis (sideway slip of the vertebra), fusion may also be performed at the same setting. Fusion often involves the use of the patient’s own bone from the removed lamina or facet, supplemented by placement of titanium screws into the vertebrae.

Various methods may be used to enhance fusion and strengthen the unstable segments of the spine following decompression surgery, e.g. the use of cages placed in the intervertebral disc spaces. We may also use BMP (bone morphogenetic protein) to improve the fusion success rate, especially in patients with higher risks of the vertebrae not uniting e.g. in diabetics, smokers, multi-level surgeries, and revision surgeries.

Non-fusion surgery and minimally invasive surgery can be used in the surgical treatment of lumbar spinal stenosis in carefully selected patients. Non-fusion surgery is possible with the use of dynamic devices (e.g. interspinous spacers inserted between the spinous processes of the back) in conjunction with decompression laminectomy, in order to restrict but not completely eliminate spinal motion at the affected level. This can be done via minimally invasive means, with potentially shorter hospital stay and faster recovery.

Minimally invasive spine fusion is now also possible with the use of specially designed ports and screw systems, and this can be offered to patients with single or double level spinal stenosis or compression of the nerves.

Tests and Diagnosis

Surgery should be considered immediately if a patient has numbness or weakness that interferes with walking, impaired bowel or bladder function.

The purpose of surgery is to relieve pressure on the nerves, as well as restore and maintain alignment of the spine. This can be done by decompressive laminectomy, i.e. removal of the lamina (roof) of one or more vertebrae to create more space for the nerves. If the affected spinal segment is also unstable e.g. spondylolisthesis (forward slip of the vertebra) or lateral subluxation in degenerative scoliosis (sideway slip of the vertebra), fusion may also be performed at the same setting. Fusion often involves the use of the patient’s own bone from the removed lamina or facet, supplemented by placement of titanium screws into the vertebrae.

Various methods may be used to enhance fusion and strengthen the unstable segments of the spine following decompression surgery, e.g. the use of cages placed in the intervertebral disc spaces. We may also use BMP (bone morphogenetic protein) to improve the fusion success rate, especially in patients with higher risks of the vertebrae not uniting e.g. in diabetics, smokers, multi-level surgeries, and revision surgeries.

Non-fusion surgery and minimally invasive surgery can be used in the surgical treatment of lumbar spinal stenosis in carefully selected patients. Non-fusion surgery is possible with the use of dynamic devices (e.g. interspinous spacers inserted between the spinous processes of the back) in conjunction with decompression laminectomy, in order to restrict but not completely eliminate spinal motion at the affected level. This can be done via minimally invasive means, with potentially shorter hospital stay and faster recovery.

Minimally invasive spine fusion is now also possible with the use of specially designed ports and screw systems, and this can be offered to patients with single or double level spinal stenosis or compression of the nerves.

Treatment and Drugs

In the absence of severe or progressive nerve damage, we can manage spinal stenosis using the following conservative measures:

 

  • Non steroidal anti-inflammatory drugs to reduce inflammation and relieve pain. Other medications that modulate the nerve pain can also be used.
     
  • Spinal injections or nerve root blocks near the affected nerve(s) to temporarily relieve pain
     
  • Prescribed exercises and/or physiotherapy to maintain motion of the spine, strengthen abdominal and back muscles, and build endurance, all of which help stabilize the spine. Some patients may be encouraged to try slowly progressive aerobic activity such as swimming or using exercise bicycles.
     
  • A lumbar corset or back brace to provide some support and help the patient regain mobility. This approach is sometimes used for patients with weak abdominal muscles or older patients with multi-level degeneration of the spine. The corset should be used on a temporary basis only, as prolonged use may weaken the back and abdominal muscles.
     
  • Acupuncture involves stimulating certain places on the skin by a variety of techniques, in most cases by manipulating thin, solid, metallic needles that penetrate the skin.

‚ÄčIn many cases, the conditions causing spinal stenosis cannot be permanently changed by nonsurgical treatment, even though these measures may relieve pain for a period of time.

 

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