Stenosis of the spinal canal: causes, symptoms and treatment

Back pain is the most prevalent type of pain worldwideIt is estimated that 60% to 80% of the world's population will suffer it at least once in their entire lives. A third of people with low back pain report considerable discomfort, a value greater than 5 if they had to place it on a scale of 1 to 10.

Within this type of discomfort, approximately 80-90% are acute (transitory), while 10-20% appear in patients chronically, that is, continuous over time. Interestingly, the prevalence of back pain decreases in the last part of life (from the age of 70 years), presumably due to the “survivor effect” or because other pathologies take over the sensation of pain general.

With all these data, we wanted to draw an indisputable general picture: back pain is something extremely common in general society, especially in middle-aged people. Today we come to bring you the causes, symptoms and treatment of spinal canal stenosis, a pathology linked to back pain with various clinical characteristics.

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What is a spinal stenosis?

Stenosis of the spinal canal (also known as spinal canal stenosis) is caused by a narrowing of the space where the spinal cord and nerve roots pass, responsible for transmitting nerve impulses to the 31 pairs of spinal nerves, which thus communicate the brain with the rest of the body. This pathology ranges from the occipital-cervical area to the lumbo-sacral area.

A medullary canal that is slightly narrower than usual does not have to cause symptoms, so many people present it without showing any type of clinical sign. Unfortunately, other patients report pain, tingling, numbness, and prolonged muscle weakness. Two types of spinal canal stenosis are distinguished according to their location, and we will tell you about them briefly below.

1. Lumbar or dorsal stenosis

Almost everyone in the world experiences low back pain (in the lower back) at some point in your life. Some of these discomforts find their origin in a lumbar stenosis, when the stricture itself occurs in the lower back. This is the result of a reduction in the space that surrounds the spinal cord, generating pressure on the cord itself and on the spinal nerves.

Lumbar stenosis is generally a natural product of aging. As people get older, the soft tissues and bones in the spine may harden or have additional growth. These slow but continuous degenerations can lead to stenosis, among many other pathologies.

2. Cervical stenosis

In this condition, the narrowing occurs in the upper part of the spine, thus compromising structures such as the neck. Again, it is usually caused by age-specific "bulging discs," so it is more common in patients over 50 years of age.

Causes

As we have said, both cervical and lumbar stenosis are widely related to the process of normal aging, but these do not have to be the only possible causes, although of course they are the most common.

For example, stenosis can be congenital and present from birth, due to alterations in the tissues of the spine acquired during physiological development. It can also be the product of direct trauma, which has damaged the vertebral tissues and caused irreversible alterations in them. The last of the shuffled causes are neoplasms, the formation of tumors in the spine, which They “clamp” the spinal cord and spinal nerves in a way similar to a stenosis degenerative.

Symptoms

Symptoms of stenosis vary slightly depending on whether it is cervical or lumbar, but we can combine them in the following significant clinical signs:

• Numbness and tingling in the hand, arm, foot, or leg.
• Weakness in certain limbs
• Difficulties walking and loss of balance.
• Neck Pain.

As you can imagine, cervical stenosis affects the arms, neck and hands more directly, while the dorsal one causes more problems in gait and legs. In any case, both are highly correlated, since the muscle contractures generated by the mismatch can cause discomfort beyond the area of ​​the stenosis.

Not all patients are symptomaticThose who do have symptoms tend to do so slowly over months or years. On the other hand, if the cause is trauma, naturally, its onset will be much more sudden.

Treatment

In many cases, undergoing surgery is not considered in the first instance, as it is usually the last option when the rest of the treatments do not work. In addition, there are certain changes in the daily routine that can help the patient cope with their pain: exercising, going to physical therapy, and changing the way you do physical activities to reduce pain, there are usually small additions that make the symptoms somewhat more tolerable.

Of course, not everything is about individual will. If the pain prevents the functionality of the patient, the pertinent professional will prescribe analgesics, anticonvulsants, opioids and even antidepressants, all in order to alleviate the chronic discomfort that stenosis. Injecting steroids into the affected area is even contemplated, as these can reduce inflammation of the compromised nerve root if other treatments prove ineffective.

If none of this works, it's time to go to surgery. Decompressive laminectomy is the most commonly used procedure in these cases, as it is based on removing bone tissue spinal cord and excess thickened in order to avoid compression and irritation of the spinal cord and nerves involved. 3 months after the operation, clear improvements begin to be observed and the pain decreases considerably for at least 4 years after the intervention.

In any case, it must be taken into account that all surgery involves risks, especially if it is performed in an older patient (as is the case with many of those with stenosis). Some of the complications in or after the operating room may include the following: deep infections in the operating room surgical wound, blood clot formation, nerve damage, fibrous tissue tears, and even chronic pain permanent. While most people do not experience these events, they do need to be reported.

Forecast

The prognosis for spinal stenosis depends entirely on the severity of the stenosis and the underlying cause. Normally, the severity of a stenosis is inversely related to the walking distance that the patient can travel without suffering pain: it is considered serious if the discomfort occurs after 200 meters of walking and very serious if this value decreases to 50.

Unfortunately, surgery for stenosis does not ensure that the patient will forget about it for the rest of their life. It is possible that this is present in another part of the spine, which the procedure itself does not achieve alleviate the symptoms altogether or re-occur a previously thickening of the tissues addressed. In this case, there is no choice but to undergo a surgical procedure again and hope that the effects will last longer.

Resume

As you may have seen, the approach to a spinal stenosis is delicate, since the operation is not without risks and the treatment requires an interdisciplinary integration of subjects: psychology, physiotherapy and medicine are merged to try that the patient learn to manage their pain and in turn achieve decrease it. If this discomfort becomes chronic and does not improve with the previously described options, surgery is the only remaining option.

Unfortunately, stenosis is an inevitable phenomenon that occurs in many people because of the simple passage of time. This can be tackled with certain changes in routine and drugs, but the patient may have to get used to relative discomfort in the back in the years to come. Sometimes fighting the passage of time is not a very viable option if the possible risks of an intervention outweigh the benefits.