Spinal stenosis refers to a condition in which the spinal canal becomes smaller. In the neck or cervical spine, this is a common result of cervical spondylosis. Here, bone spurs or osteophytes develop adjacent to the disc. As they enlarge, the compress either the spinal cord or the nerve roots which are exiting the spine. In the low back, spinal stenosis is most commonly secondary to arthritic changes in the joints of the spine. As these joints degenerate, they enlarge. In association with this, the ligaments that connect the bones together, especially the ligamentum flavum, enlarge. The combination of these changes leads to narrowing of the spinal canal as well as the foramina, or openings through which nerves exit the spine. The development of spinal stenosis is most common after 50 years of age.
Causes of Spinal Stenosis
The primary cause of spinal stenosis within the lumbar spine is osteoarthritis. There may also be some element of disc herniation. In older patients, the disk may form a hard ridge which protrudes into the spinal canal. In advanced cases of arthritis, the joints which help hold the spine together become dysfunctional. They may allow the bones of the spine to slip forward on one another. This action, called spondylolisthesis, further may aggravate the spinal stenosis. In the cervical spine, the principal cause of stenosis related to the disc and adjacent vertebral bodies. Here, bone spurs develop as the disc degenerates. They gradually intrude into either the spinal canal or the neuro-foramina, the openings through which nerves pass out of the spine. Similarly, spondylolisthesis can occur which may produce or aggravate spinal stenosis. Occasionally, thickening of the ligaments that form the back of the spinal canal will produce spinal stenosis. A rare cause of stenosis in the neck is ossification of the posterior longitudinal ligament (OPLL). The ligaments which connect the vertebral bodies together become thickened and calcified forming a layer of bone within the spinal canal.
Signs and Symptoms of Spinal Stenosis
In the neck, the symptoms include neck pain and pain radiating into the back of the head as well as the shoulder blades. Varying degrees of pain, weakness and numbness may occur in the arms. When the stenosis is severe, the spinal cord can be badly deformed. Unsteady gait, leg weakness and difficulties with urinating can occur. When the lumbar spine or low back is involved, the symptoms are principally in the legs. Pain, weakness and numbness can occur to varying degrees in the legs. Low back pain is usually present. The symptoms in the legs may be brought on or accentuated by standing or walking. Those symptoms brought on with exercise are referred to as neurogenic claudication. In severe cases, bowel and bladder function may become impaired and numbness may develop around the rectum and genitals.
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Medical Content Last Updated on 07/12/2008
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