spinal stenosis

Spinal Stenosis

Recently, Carrie Ann Inaba, one of the judges of the show Dancing With the Stars publicly announced that she has been suffering for quite some time from cervical spinal stenosis– a condition in which the canal that encases the spinal cord in the neck narrows and obstructs nerve tissue.  She explained how her condition impacts her life, limiting her from doing the things she loves to do.  To Carrie Ann’s dismay, she no longer dances with a partner for fear of getting whiplash and paralysis.  That’s quite unfortunate for someone whose entire career revolved around dancing.

Although spinal stenosis is a generalized term for narrowing of the spinal canal by any cause, the most common type, which will be discussed here, is the type caused by osteophytes— growth of bony projections that narrow the openings where nerves pass through.  Advanced osteophytic activity is also referred to as spondylosis.  When it is severe enough to narrow the spinal canal (foramen) it then creates the condition known as spinal stenosis.  For your information, other forms of spinal stenosis are those caused by herniated discs, spondylolisthesis, tumors or any mass that encroaches into the spinal canal.

In her article, Carrie Ann mentioned that spinal stenosis is a form of arthritis and that she is anxious to find a cure for it.  Unfortunately spinal stenosis is not one of those conditions that can resolve on its own with rest, exercise and time and other non- invasive measures.  And since the inflammation from spinal stenosis is secondary to irritation of nerves, it is technically not a type of arthritis.  That is why anti-inflammatory medications have minimal effect on the pain associated with spinal stenosis, which is typically deep, sharp and radiating in nature.

Spinal stenosis occurs when vertebrae, the bones that comprise the spinal column gradually morph in a way that constricts the spinal foramen (canal), or space where the spinal cord resides.  When there is less space for the spinal cord to move, it is subject to more abrasion with spinal movement; i.e. bending and turning your neck.  The cord (actually, meninges or covering of the cord) rubs against sharp edges of the bony projections into the foramen with movement causing inflammation and injury to the nerve tissue, sometimes causing sclerosis (hardening).   In advanced cases, especially  cases of lumbar spinal stenosis (due to the more significant weight burden) the narrowing gets so advanced that there is constant pressure on the nerve roots.  At this point, it is an emergency situation as renal function and sensation to the legs are affected.

Signs of advanced spinal stenosis include paresthesias, sharp pain with movement, weakness in the extremities, and muscle atrophy in legs and/or arms.  Symptoms can be permanent if not treated early.

And what is the treatment for spinal stenosis?  First of all, doctors will usually order MRI and x-ray to determine extent of narrowing.  If it is caught early, physical therapy and lifestyle modification is recommended.   The goal is to slow down or stop the progression of the narrowing.

Surgery is the only option for advanced cases.  Since spinal stenosis involves physical structures compressing nerve tissue, there are surgical procedures that can enlarge the spinal canal by scraping off the encroaching bone material and buy the patient more time.  Since bone is comprised of live cells, the movement of bony projections (called osteophytes) into the spinal canal is still likely after surgery and many who have had such spinal decompression surgeries develop the same problem several years later.

It’s not quite evident why some people suffer from spinal stenos more than others.  But those who have a history of physical trauma to the spine like car accidents, sports injuries and falls are at a higher risk.  The theory is that the injury event disrupts the normal alignment of the spinal segments resulting in accelerated wear and tear over time;  much like how a loose screw in a machine accelerates mechanical failure.  Some orthopedists hypothesize that the appearance of bony projections is the body’s attempt to fuse and stabilize adjacent vertebrae so they can no longer move separately; thus reducing the probability of injury.  However, the nerves that share the space with the vertebrae get damaged in the process.    If this theory holds true, then it is an inherent design flaw of the body’s self-healing mechanisms.

Also, heavy smoking and obesity, and general poor health can increase your chances of developing spinal stenosis.

I’m sure more than one doctor broke the news to Ms. Inaba that there basically is no “cure” for spinal stenosis once it is in its advanced stages, which appears to be her case based on her own description of her symptoms.  It is a mechanical condition that mandates mechanical intervention.  No amount of drugs will cure spinal stenosis from advanced osteophyte formatioin.   Her only option at this point is spinal decompression surgery to widen the spinal canal and hope that the nerve tissue did not sustain permanent damage.

The best strategy for dealing with spinal stenosis is prevention.  If you sustained injury to your spine from a car accident (even a low impact one that did not require medical treatment), a sports injury (including repetitious trauma like that related to gymnastics and football) or slip and fall, realize that “the seed” for spinal stenosis may have been planted in you already.  If your injury event was over five years ago, get an x-ray to identify any levels where osteophytes are present; these are the sentinels of potential areas of spinal stenosis as they identify areas of biomechanical weakness.  If there are some, the first course of action is to not worsen things.  Avoid or reduce activities that regularly place trauma to your spine.  Engage in specific exercises that strengthen the neck and lower back to offer more stability.  Stretch often (yoga is a great choice) and take care of the insides of your body as well with proper diet, nutrition, hydration and adequate rest.

Lastly, the Cervical and Lumbar Posture Pump is a home rehabilitation device that tractions and separates vertebrae to hydrate the discs and increase nutrient absorption which can slow down the progression of spinal stenosis if done diligently on a regular basis.  I have personally used them in my practice, and patients reported positive results.

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