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Stenosis, Spinal

Synonyms of Stenosis, Spinal

  • Cervical Spinal Stenosis
  • Degenerative Lumbar Spinal Stenosis
  • Familial Lumbar Stenosis
  • Lumbar Canal Stenosis
  • Lumbar Spinal Stenosis
  • Lumbosacral Spinal Stenosis
  • Spondylotic Caudal Radiculopathy
  • Stenosis of the Lumbar Vertebral Canal
  • Tandem Spinal Stenosis
  • Thoracic Spinal Canal Stenosis

Disorder Subdivisions

  • No subdivisions found.

General Discussion

Spinal stenosis is a rare condition characterized by abnormal narrowing (stenosis) of the spaces within the spinal canal, spinal nerve root canals, or bones of the spinal column (vertebrae). Affected individuals may experience pain in the lower back and/or the legs. In some cases, affected individuals may have difficulty walking. Spinal stenosis may occur as a result of spinal injury, surgery, abnormal bone growth, or deterioration. In some cases, spinal stenosis may be inherited as an autosomal dominant genetic trait.

Symptoms

Pressure or squeezing (compression) of spinal nerves and/or blood vessels associated with spinal stenosis results in back pain and difficulty walking, including episodes of limping. Walking downhill can be especially painful. Other symptoms may include the inability to control urination (incontinence), temporary paralysis of the legs, and pain or burning sensations in the lower back and/or legs. A progressively awkward gait (ataxia) and gradual numbness in the legs may also occur.

Causes

Acquired spinal stenosis may occur as a result of spinal injury, surgery, abnormal bone growth, or deterioration (i.e., osteoarthritis or Paget's disease). Occasionally this condition is progressive. Some symptoms are, the result of inflammation of nerves that are compressed. It most often affects people over 50 years of age.

In addition, spinal stenosis is a symptom or sign of several other disorders such as achondroplasia, a disease of cartilage and bone formation that results in a particular form of dwarfism.

Some people are born with conditions, such as a small spinal canal or a curved spine, that may lead to spinal stenosis. In those cases, people younger than 50 may be affected.

Affected Populations

Spinal stenosis is a neurological condition that affects females more often than males. It is usually found among middle-aged or elderly people, although the congenital form may be present at birth. Individuals who participate in extremely rough contact sports (i.e., football or hockey) may be at greater risk for developing spinal stenosis than the general population.

Related Disorders

Symptoms of the following disorders can be similar to those of spinal stenosis. Comparisons may be useful for a differential diagnosis:

Sciatica is characterized by pain that travels along the sciatic nerve from the back, down into the legs. Pain can occur as the result of nerve root compression (i.e., spinal disc abnormalities), tumors, or infection.

Cauda Equina Syndrome is a rare neurological disorder characterized by dull pain in the lower back and the loss of sensation in the buttocks, genitalia, or thighs. Bowel and bladder function may also be impaired. This condition is caused by pressure on the lower end of the spinal cord (cauda equina), below the first lumbar vertebra. Symptoms are sometimes successfully managed with surgical decompression.

A herniated disc (or "slipped" disc) refers to the abnormal protrusion of the fibrous tissue into the spinal canal, resulting in local compression and nerve injury. It is the major cause of severe chronic or recurrent lower back and leg pain. Symptoms may include stiffness, loss of feeling in the legs, weakness or severe pain that radiates from the back into the thighs, calves, or feet. This painful condition is common, and may require surgical intervention.

Ankylosing Spondylitis is a rare inflammatory arthritis affecting the lower back, joints, and spine. Symptoms may include muscle spasms, morning stiffness, or back pain that is typically worse after periods of rest or during the night. As the disease progresses, areas of the spine become immobile (ankylosis) and may prevent normal bending. (For more information on this disorder, choose "Ankylosing Spondylitis" as your search term in the Rare Disease Database.)

Spondylolisthesis is the forward slippage of one vertebra onto another. Symptoms may include low back pain or pain in the buttocks and thighs. The severity of the pain is related to the amount of slippage that has occurred.

The following disorders may precede the development of Spinal Stenosis. They can be useful in identifying an underlying cause of some forms of this disorder:

Achondroplasia is a rare inherited disorder, present at birth, which results in short stature (dwarfism) due to impairment in the ability of cartilage to form bone (endochondral bone formation). Infants typically have an arched (vaulted) skull to adapt to the abnormally enlarged brain (megalencephaly), characteristic of this syndrome. Excessive accumulation of fluid around the brain (hydrocephalus) may also be present. Spinal stenosis is common in children with Achondroplasia. (For more information on this disorder, choose "Achondroplasia" as your search term in the Rare Disease Database.)

Paget's Disease of Bone is a chronic, slowly progressive skeletal condition of abnormally rapid bone destruction (osteolysis) and reformation (osteoblastosis). The new bone is structurally abnormal, dense, and fragile. The spine is frequently effected and spinal stenosis may occur. The symptoms may include bone pain, joint pain, and headaches. Physical signs may include enlargement and bowing of the thighs and lower legs. (For more information on this disorder, choose "Paget's" as your search term in the Rare Disease Database.)

Standard Therapies

Diagnosis
The diagnosis of spinal stenosis relies on the use of imaging procedures such as magnetic resonance imaging (MRI), computerized tomography (CT scan), electromyelography (EMG), and intraoperative spinal sonography (IOSS). The early diagnosis and treatment of spinal stenosis may prevent intractable pain and permanent neurological impairment.

Treatment
Treatment of spinal stenosis may include the injection of a steroid drug into the spaces around the spinal cord membranes (epidural space). This may reduce inflammation and pain in some individuals. However, these injections may not be given too frequently and close monitoring by the physician is warranted. This form of treatment may take more than a week to begin having an effect on pain. Nerve blocks are frequently administered for temporary relief from pain by anesthetizing the nerve being pinched. These and several forms of alternative medicine offer temporary relief. In some individuals, surgery remains the only option to relieve compression.

Surgery to relieve the pressure on the spinal canal (laminectomy) may be recommended in moderate to severe cases of spinal stenosis. Small pieces of bone are removed from the vertebrae during this procedure. Pain relief is often dramatic, allowing most individuals to return to their normal activities. Long-term pain relief obtained from this surgery depends on the amount of bone regrowth and the stability of the spinal column. Surgery involving older persons carries with it the risks associated with trauma on the aged. Other risks involve tearing of the ligaments that hold the vertebrae in place, and infection.

Other treatment is symptomatic and supportive.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

As of May 2005, there were three clinical trials involving spinal stenosis posted on NIH's clinical trials web site. Additional information is available at www.clinicaltrials.gov.

One study, sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Disorders, is comparing outcomes of surgical and non-surgical treatment options. A second, sponsored by Greenwich Hospital in Connecticut, is designed to compare the efficacy of Greenwich Lumbar Stenosis SLIP operation with and without inserted metal supports after laminectomy. The third study, sponsored by the Medtronic Bakken Research Center, is designed to compare the results of two forms of bone fusion techniques.

Stenosis, Spinal Resources

Organizations:

References

TEXTBOOKS
Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:476, 478.

Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:569, 571, 574.

Larson DE. ed. Mayo Clinic Family Health Book. New York, NY: William Morrow and Company, Inc; 1996:516-17.

Rowland LP. ed. Merritt's Neurology. 10th ed. Lippincott Williams & Wilkins. Philadelphia, PA. 2000:424.

REVIEW ARTICLES
Jensen RL. Cauda equina syndrome as a postoperative complication of lumbar spine surgery. Neurosurg Focus. 2004;16:e7.

Wang MY, Green BA. Open-door cervical expansile laminoplasty. Neurosurgery. 2004;54:119-23; discussion 123-24.

Szpalski M, Gunzburg R. Lumbar spinal stenosis in the elderly: an overview. Eur Spine J. 2003;12 Suppl 2:S170-75.

Gunzburg R, Szpalski M. The conservative surgical treatment of lumbar spinal stenosis in the elderly. Eur Spine J. 2003;12 Suppl 2:S176-80

Sengupta R, Haldeman S. Lumbar spinal stenosis. Treatment strategies and indications for surgery. Orthop Clin North Am. 2003;34:281-95.

Various Authors Spinal Stenosis. Phys Med Rehabil Clin N Am.2003;14:17-155.

Binder DK, Schmidt MH, Weinstein PR. Lumbar spinal stenosis. Semin Neurol. 2002;22:157-66.

FROM THE INTERNET
Chen AL. Medical Encyclopedia: Spinal Stenosis. MedlinePlus. Update Date:4/28/2004. 2pp.
www.nlm.nih.gov/medlineplus/ency/article/000441.htm

Health Topics: Questions & Answers About Spinal Stenosis. NIAMS. NIH. Publication Date: November 2004. 14pp.
www.niams.nih.gov/hi/topics/spinal_sten.htm

Hsiang JNK. Spinal Stenosis. emedicine. Last Updated: February 7, 2005. 7pp.
www.emedicine.com/med/topic2889.htm

The information in NORD’s Rare Disease Database is for educational purposes only. It should never be used for diagnostic or treatment purposes. If you have questions regarding a medical condition, always seek the advice of your physician or other qualified health professional. NORD’s reports provide a brief overview of rare diseases. For more specific information, we encourage you to contact your personal physician or the agencies listed as “Resources” on this report.

Report last updated: 2008/04/14 00:00:00 GMT+0

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