Spinal Stenosis

What is Spinal Stenosis:

Spinal stenosis is the narrowing of the spinal canal. It is more common in older populations, mainly after 50 years of age. As the degeneration takes place in the vertebrae, the spinal canal narrows down. As a result, it may push the spinal cord inside the spinal canal. Spinal Stenosis usually occurs in the cervical and lumbar area. Patients may or may not show symptoms or restrictions in their daily routine. The presence, as well as the severity of signs and symptoms, depends on the severity of the condition and varies from person to person.

The causes of Spinal Stenosis are:

• Scoliosis
• Degenerative process
• Osteoarthritis
• Rheumatoid Arthritis
• Spondylolisthesis
• Herniated disk
• Direct trauma to the spinal canal in MVA

Clinical Features of Spinal Stenosis:

• Back pain that usually aggravates with bending backward(spinal extension) and relieves with bending forward (spinal flexion)
• Weakness and abnormal sensation in lower legs with lumbar spinal involvement, or in the neck or upper extremity with cervical spine involvement.
• Fatigue
• Leg cramps mainly nocturnal
• Impairment or loss of bowel and bladder function
• Saddle paresthesia
• Neurogenic claudication
• Cauda Equina Syndrome – rare but serious neurological condition where a patient loses sensation and movement of legs as well as loosed control of bowel and bladder.

It is important to note that the involvement of the cervical spinal cord is more serious than lumbar spinal involvement. Once again, the exact area of spinal involvement, as well as the amount or severity of spinal cord involvement, determines the exact symptoms.

Treatment Options for Spinal Stenosis:

After a thorough examination, diagnostic tests, and ruling out other spinal neurologic disorders, the diagnosis is confirmed for spinal stenosis. Just like clinical symptoms, the treatment options also vary based on severity or progressive neurological involvement.

Conservative medical management is often recommended and is successful in many cases.

Physical Therapy Treatment:

Physical therapy treatment is proven to be effective in spinal stenosis in early cases. Exercise can help in cases with the degenerative process and arthritis. Main physical therapy approach for spinal stenosis are as follow:

Pain Management:

Pain management is crucial. A physical therapist may choose to use heat therapy, electrical modalities, back isometric exercises, or dry needling treatment to control pain initially. Here is an article that discusses different pain management modalities a physical therapist may use.

Exercises:

• Spinal flexion exercises:

Spinal flexion or forward bending exercise is most helpful in relieving the symptoms. The idea is that forward bending relieves some pressure off of the spinal cord and so relieves the symptoms. It is a temporary fix and the effects do not last for a long time.

• Lumbar stabilization techniques:

Lumbar stabilization techniques can help not only in controlling the pain but also reduce muscle spasm. These exercises are proven to improve posture. You need to be careful about performing the stabilization exercises if you are suffering from severe stenosis. I advised that you perform these exercises only under the guidance of a physical therapist.

• Spinal strengthening & Stretching exercises :

Once the symptoms like pain and spasm are controlled, a physician or a physical therapist will move forward with gentle strengthening and stretching exercises. The spinal exercises are aimed at increasing the strength, improving the imbalance of muscles and correcting the body posture.

Postural Correction:

Posture correction is very important in cases with spinal stenosis. A person, by default, chooses to have “forward bend” posture (with excessive trunk flexion) to relieve the symptoms.  Additionally, this can cause other issues like higher fall risk, difficulty in breathing, unsafe swallowing, etc..

Here are few postural correction treatment options a physical therapist may recommend.

• Postural correction exercises:

Postural correction exercises are helpful not only to improve the posture but also reduce the pain. These exercises are done in initial stages or mild cases of stenosis. In severe cases, postural correction exercises are not very helpful.

• Braces (neck and back):

Braces for back or neck helps to reduce pain and spasm. There are certain braces that can help to prevent or limit a certain range of motion. Braces can be worn during the day while a person is active or at night while a person is asleep. Night braces prevent certain movement that may increase the pain or aggravates the symptoms.

• Environmental modification:

With severe spinal stenosis, it is crucial to make some environmental changes to fit the patient’s needs appropriately. Majority of the modifications include preventing reaching up or higher than a shoulder to avoid back extension. Making changes to accommodate the person’s daily lifestyle with some modifications allow a person to continue being active and symptom-free. This not only aids in functional independence but also makes a significant difference in a person’s psychological well-being. This is crucial, especially in the geriatric population.

Surgical Options to Treat Spinal Stenosis:

A physician may recommend some injections along with medications to help with pain and inflammation in early cases. The reason for a conservative approach is to treat the symptoms, retrain the muscles, and work on body positioning.

Since spinal stenosis is an anatomical problem, many times a surgical approach is required and recommended. When a person has a progressive neurological impairment, surgery is the only go-to option. A surgeon may discuss and recommend decompression of the spinal cord, or fusion of few vertebrae, etc depending on a patient’s age, quality of life, the severity of the symptoms and medical history.

We need to remember that every surgery comes with chances of complications.  Consequently, a person may have some limitations in range of motion which can cause limitation in performing some of the daily activities. But again, the surgical interventions may be necessary where a person is losing control of bowel or bladder or losing the ability to move. Above all, speak with your surgeon regarding any concerns you may have. And ask for a second opinion to make an informed decision.