Stenosis is a spinal disease that’s more common as we age. What is it? Is surgery the answer? How can we manage it? Here are some facts and tips, courtesy of the Unified Virginia Chiropractic Association. Stenosis means “narrowing.” Spinal stenosis exists when the space for nerves is less than optimal.
Mechanisms of spinal stenosis:
• Congenital stenosis. In this form of stenosis, you were born with smaller spaces for your nerves and/or spinal cord. Aging, or trauma (sports injury, car accident), can reveal symptoms suggesting the underlying predisposition.
• Acquired stenosis. Though trauma such as sports injuries or major accidents can cause stenosis, acquired stenosis occurs mostly due to degenerative changes associated with aging and physical stresses. Most commonly this happens when the discs of the spine desiccate (dry out), discs herniate (bulge), osteoarthritis causes bone spurs that narrow space for spinal nerves, or ligaments thicken due to mechanical stress or disease processes.
Locations where spinal stenosis occurs:
1. Central canal stenosis: Exists when the space for the spinal cord (the tube-like “canal” running up-and-down the spine’s length from neck to low back) becomes restricted or narrowed. This can easily affect all structures beyond, i.e. low back (lumbar) central canal stenosis can affect both legs.
2. Foraminal stenosis: Characterized by narrowing of the opening between the vertebrae, such as by bone spurs (osteophytes) or desiccated (dried out) discs causing decreased space between the vertebrae.
3. Lateral recess stenosis: Characterized by choking of the nerve and related structures after it has left the foramen (see above), such as by a herniated disc or (in some cases) a bone spur.
How do you know if you have spinal stenosis? First, the condition is most common in seniors1, especially if you have spinal arthritis/degeneration. Back or neck pain is a possible consequence. Common peripheral (arms/hands; legs/feet) symptoms include burning, radiating pain, numbness, loss of feeling/sensation, weakness, cramping pain, or shooting pain. Diagnosis begins with a thorough history and examination by a doctor trained in the spine (doctors of chiropractic are a prime example), and may proceed to include diagnostic imaging (x-ray, MRI, CAT scan) to determine what site(s) are narrowed, and how much.
Treatment options are numerous. Surgical options include making the spaces for the nerves larger via removing whatever tissues are causing the stenosis, possibly removing substantial bony elements and/or inserting metal or other synthetic spacers between bones. A Dartmouth-based study of surgery for lumbar (low back) stenosis showed good pain and functional outcomes for patients through 4 years post-surgery;2 however, surgery has its risks, and not all patients benefit. The federal government lists “a tear in the membrane covering the spinal cord at the site of the operation,” infection, or blood clot as the most common surgical complications.3 Risks also include more severe complications and death; which is why more frail and/or older patients may be poor candidates.
Non-surgical options exist, and are very promising. The goal of non-surgical management is to open space for the nerves and related vessels (blood vessels and lymphatics) to optimize nerve function, decrease pain and symptoms, and slow progression of the condition. Doctors of chiropractic use gentle hands-on methods (spinal adjustments) to optimize space between bones, and may also use soft-tissue manipulation to free up entrapped nerves beyond the spine. Published literature shows promise for the chiropractic approach in cases of cervical and lumbar spinal stenosis.4,5 NIAMS, a division of NIH (National Institutes of Health, United States Dept. of Health & Human Services) summarizes the research on chiropractic by stating it is as effective as any other form of noninvasive, non-operative treatment for back pain.6 In addition, NIAMS also notes that acupuncture has shown promise for these conditions.7
Doctors of chiropractic and their patients have a responsibility to be aware of and share safe, effective options for a variety of conditions. Please, share this information with someone who deserves to make an informed decision. And even if you don’t suffer from stenosis (yet?), remember that your doctor of chiropractic’s role is to help you feel and FUNCTION at your best—whether you are in pain, feeling better, or feeling great. For more information on ways to help your entire family live better, ask your chiropractor for guidance; or visit http://virginiachiropractic.org to find a highly-qualified chiropractor near you.
1 Spinal stenosis prevalence and association with symptoms: the Framingham Study. Kalichman L, et al. Spine J. 2009 Jul;9(7):545-50.
2 Weinstein, J, et al. Surgical Versus Nonoperative Treatment for Lumbar Spinal Stenosis Four-Year Results of the Spine Patient Outcomes Research Trial. 2010: SPINE Volume 35, Number 14, pp 1329 –1338.
4 Chiropractic treatment of lumbar spinal stenosis: a review of the literature. K Stuber, et al. J Chiropr Med. 2009 June; 8(2): 77–85. 5 Kruse RA, Gregerson D: Cervical Spinal stenosis resulting in radiculopathy treated with flexion-distraction manipulation: A case study. J of the Neuromusculoskeletal System 2002;10(4):141-7 6 http://www.niams.nih.gov/Health_Info/Spinal_Stenosis/default.asp#spine_i 7 Ibid.
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