Spinal Stenosis is a fundamental term used to define a situation which causes narrowing of the spinal canal. Spinal stenosis is much more common in patients over the age of 55 years. However, it may also occur in younger patients who have asymmetrically small spinal canals as a kind of birth defect. It generally causes leg pain & back pain which comes & goes with basic regular activities such as walking. According to reports, patients with spinal stenosis can be successfully treated with non-surgical treatments but for long-term relief, surgery is required.
Spinal stenosis is a condition which causes abnormal narrowing (stenosis) of space within the spinal canal. This restriction of spinal canal puts undue pressure on the vital motor nerves that originate from spinal cord & are responsible for control of the limbs. Spinal stenosis is mostly seen in lower (lumbar) region of the back. Osteoarthritis is often the main cause for the development of spinal stenosis.
There are a number of causes that are suspected to be responsible for development of spinal stenosis, some of which are discussed below.
- Aging – Advancing age causes ligaments in the body to thicken. Bone spurs (abnormal growth) can be seen in bones including vertebrae. This also causes the supporting inter-vertebral disc to begin deteriorating with time. Facets (flat surface) of vertebra are responsible for keeping normal movement of the spine. These are also responsible to keep the spine in healthy shape & these facets are also known to get misshapen with age. All these factors are related to aging in a person & can therefore cause spinal stenosis.
- Arthritis – Osteoarthritis & rheumatoid arthritis affect vertebrae as well as other major weight-bearing joints such as knees & hip. Arthritis affecting the spinal column can give rise to spinal stenosis.
- Spondylolisthesis – When any of the vertebrae or the inter-vertebral discs slip away from the normal aligned position in the spinal column, it can lead to spinal stenosis by narrowing the spinal canal.
- Spinal Tumors – Uncontrolled (cancerous) tissue growth near or on spinal canal can adversely affect the size of the spinal canal. This tumor tissue also increases risk of bone re-sorption, which causes bone deterioration due to overactive bone cells & even displacement of bone which might be risky for the stability of the spinal column.
- Trauma – Injury / trauma to the back can cause dislocation / fracture of vertebrae. This may cause broken pieces of bone to put undue pressure on the spinal cord & surrounding nerves, resulting in spinal stenosis.
There are various physical & neural signs & symptoms seen after development of spinal stenosis.
- Difficulty in standing
- Pain in hand / arm / shoulder
- Numbness or tingling sensation in lower body
- Weakness in limbs & back
- Loss of bladder control
- Loss of bowel control in severe cases
- Difficulty in walking
- Loss of reflex, especially in arms
Doctors will need to check patient’s medical history to look for any other underlying conditions that may induce similar symptoms. A thorough physical examination is followed after this. Doctors might also need to conduct certain imaging tests on spine in order to determine the location & extent of stenosis as well as the cause for narrowing of the spinal canal.
- X-ray – This test helps to create a clear image of the spine & its components so as to help check for damage to various parts of the spinal column.
- Magnetic Resonance Imaging (MRI) – This test creates a better image of softer tissues such as nerves, spinal cord, discs & muscles for observation of abnormalities or damage.
- Computerized Tomography (CT) Scan – Doctors may often also order additional tests such as computerized tomography (CT) scan to see vertebral bone structure more closely.
- Myelogram – Myelogram test is also performed to see for abnormalities in the nervous structure around spine. Myelogram uses a special dye injected into the spine to highlight nerves during imaging.
Treatment Alternatives for Spinal Stenosis
There are various types of treatments available for spinal stenosis. Exact type of treatment for any particular case will largely depend upon various factors such as age, overall physical health, extent & location of stenosis along with patients’ preference & doctor’s / surgeon’s advice.
Non-surgical treatments for spinal stenosis are aimed at alleviating pain & restoring function to spine. Although non-surgical treatments are not so effective in treating narrowing of spine, they are however found to be successful in relieving other painful symptoms.
- Physical Therapy – Exercises for stretching, massage & other back strengthening programs are helpful in relieving pain.
- Lumbar Traction – Lumbar traction has been found to be effective in many cases so as to relieve pain.
- Anti-Inflammatory Drugs – Since stenosis of the spinal canal causes painful symptoms it helps to relieve these through decreasing the inflammation around the spinal canal. Non-steroidal anti-inflammatory drugs (NSAIDs) are found to provide pain relief in initial stages of this disorder.
- Steroid Injections – Steroid injections require administering cortisone, a powerful anti-inflammatory drug, directly in spaces around nerves. These cortisone injections are helpful in reducing swelling as well as in alleviating pain. Cortisone injections also decrease sensation of numbness in limbs.
If spine surgeons have suggested spine surgery for treating spinal stenosis, then patients need to follow the given guidelines.
- Avoid Smoking – Cigarette smoking may reduce patient’s ability to heal from spine surgery.
- Limiting Quantity of Alcohol – Consuming excessive amount of alcohol can also delay recovery of patients. Patients must restrict alcohol consumption or totally avoid it until they recover from surgery.
- Illnesses – Any illnesses patients may have, including flu, cold or herpes should be informed to surgeons prior to surgery.
- Avoiding Certain Medications – Patients should tell surgeons about any prescription or over-the-counter medicines that patients might be taking, including herbs & supplements.
Patients need to discuss every minute detail about their health conditions to spine surgeons. Surgeons may give special instructions to patients depending upon their health status.
Patients may ask the following questions to respective spine surgeons in order to understand treatment procedure of spinal stenosis.
- What is the root cause of my back pain?
- What measures can I take to prevent this pain from getting worse?
- Has stress aggravated this condition? What can I do about it?
- What are the available treatment alternatives?
- If spinal surgery is suggested, why is it required & what are the risks factors associated with it?
- What are the potential benefits of this surgical procedure?
- What lifestyle modifications do I require to make to keep my spine healthy?
- How can I manage my daily work so that it does not adversely affect my back?
- Can I suffer from permanent disability after this surgery?
Surgical treatment of spinal stenosis is advised for patients who are severely affected due to intense pain & excessive weakness in the back & limbs. Following are some surgical treatment options for spinal stenosis.
- Laminectomy – This procedure requires removing the rear part (lamina) from the damaged vertebra. This helps increase the space within the spinal canal & relieves pressure on the spinal cord & surrounding nerves.
- Laminotomy – This surgery requires removing only a part of the lamina (usually by making a small hole in the back of affected vertebra) to relieve pressure from the spinal cord.
- Laminoplasty – This surgical procedure is typically used for treating stenosis in the neck (cervical) vertebrae. This surgery involves scoring the lamina from one side till it becomes thinner & then proceeding to cut the same lamina from another side to create a ‘hinged door’ system. This lamina is opened to release pressure from the spinal cord. Surgeons use surgical-grade metal rods, plates & screws to hold the scored lamina in a permanently modified position.
- Spinal Fusion – This surgery requires making a gap between damaged parts of the vertebra to relieve pressure from the narrowed spinal canal. Next step involves injecting a ‘bone cement’ (bone adhesive material) to seal the gaps as well as to provide support to the weak vertebra till it gets healed & strengthens naturally.
Patients may need to stay in hospital for two to three days after surgery. Some patients may experience extreme pain & discomfort but spine surgeons can control it with help of essential medications. Patients will not feel better instantly, while the pain will go away in two to four weeks after surgery. Surgeons will instruct patients to carefully sit, rise, stand & walk. It is extremely important to give some time to body for healing. So, surgeons will probably suggest patients to limit physical activities. Patients should avoid strenuous activities like sports, heavy lifting or twisting during recovery phase. When patients observe complications like infection, fever or increased pain, they should directly contact the spine surgeons.
Surgical treatment for spinal stenosis & outcome is particular to the individual patient. Long-term results following surgery may vary. Patients may suffer from certain complications like nerve damage, blood loss & infection, loss of bowel control or blood clots. In addition to this, there are potential complications associated with the type of anesthesia given to the patient during spinal surgery. Sometimes, it is observed that vertebral bone & graft may not fuse properly resulting in failure of spine surgery. In such cases, patients may require additional surgery. Patients should consult with spine surgeons for understanding the warnings, precautions & side-effects of surgery for treatment of spinal stenosis.
Spinal fusion is typically an effective treatment for spinal stenosis. Results of surgery to rectify spinal stenosis are usually excellent. Generally, 70 to 80 percent of patients get relief from severe back pain after surgery. Surgery for spinal stenosis can help patients who are not able to participate in routine activities & also when non-surgical means have been unproductive. However, in most cases, surgery for spinal stenosis allows patients to return to more active & pain-free lifestyle.
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Treatment for Spinal Stenosis with Travcure Medical Tourism
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