Spinal Stenosis is a narrowing of the spinal canal which can happen at any level in the spine. The narrowing can be either congenital, as seen in the condition known as Trisomy 13, or it can be acquired as part of a degenerative process. Stenosis consists of two primary forms - central spinal stenosis and lateral recess stenosis.
Central spinal stenosis, as the names suggests, causes blockage of the central spinal canal. In the cervical and thoracic spine, this blockage produces difficulty with balance such that one’s gait becomes awkward and spastic. In the lumbar spine, the central spinal stenosis causes rapid exhaustion of the legs with any attempted prolonged standing or walking. Patients will start off with normal leg strength that rapidly diminishes until they are forced to sit and rest. This diagnosis can be confused with vascular insufficiency, however, the difference is that with spinal stenosis, most patients seek out a chair or bench to rest while they recover, whereas the patient with vascular insufficiency merely needs to stop and rest while their legs recover. Sitting is usually not part of their typical recovery experience. Lumbar stenosis can also be confused with peripheral neuropathy which is loss of nerve function in the hands or feet attributed to medical conditions causing irreversible nerve failure. The neural symptoms arising from neuropathy are constant and not affected by walking or by activities.
Lateral recess stenosis, also known as foraminal stenosis, is the blockage of the side tunnels through the nerves escape to reach their end goal, be it for sensation, pain detection or for muscle stimulation. This type of stenosis causes direct nerve root entrapment and results in well-defined areas of neural injury, in contrast to central spinal stenosis in which the perceived distribution of the neural insult is more wide spread.
The treatment for both forms of spinal stenosis depends on clearly identifying the site of neural compression. Although anti-inflammatory medications and pain-relievers will lessen the symptoms, epidural steroid injections have become the initial mainstay of treatment. Ultimately, surgery may become necessary to eliminate the neural compression. Surgical options may include a foraminotomy, laminectomy or laminotomy. In each, the goal is the same – to eliminate the source of neural compression and to preserve the mechanical integrity of the spine.
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