Lumbar spinal stenosis : causes, diagnosis , treatment , complications
Diseases Of The Spine / / August 12, 2017
term "stenosis" is commonly used to describe the narrowing of the spinal canal.This problem is most common in people over the age of 60 years.However, it can occur in younger people who have abnormally small spinal canal as a type of birth defect.This problem usually causes pain in the back and legs, and that there are, for example, by walking.
reasons spinal canal stenosis
Although there is some space between the spinal cord and the edge of the spinal canal, there are many different ways how this space can be reduced.This tube, which can be expanded if the spinal cord and nerves require more space.If something starts to narrow the spinal canal, the risk of irritation and spinal cord injury or nerve increases.
Some of the reasons that could lead to a narrowing of the spinal canal: infections, tumors, trauma, herniated disc, arthritis, thickening of ligaments, bone spurs growth and degeneration of the disc.
stenosis usually occurs in older people after many years of wear and tear (d
stenosis can also develop from trauma, infections or tumors.Some people are even born with a narrow spinal canal - an anomaly, which leads to the appearance of symptoms of stenosis.
narrowing of the spinal canal can lead to irritation of the spinal nerves.This can cause problems and pain nerves, preventing them from functioning properly.Lack of space between the spinal cord and the spinal canal can also cause a decrease in blood flow and oxygen to the spinal cord.When the spine when a person needs increased activity in high blood flow, the blood vessels can not transmit more blood spine.This can lead to numbness and pain of the spine in the affected nerves.Furthermore, when the reduced space for the nerves, they lose part of their mobility.This leads to irritation and inflammation of the nerve.Stenosis can occur in all areas of the spine, but it is most common in the lumbar spine.
Symptoms of spinal stenosis
main symptoms of spinal stenosis include: a feeling of heaviness, weakness, pain when walking or prolonged standing.Over time, these symptoms often disappear.They arise from the nerve roots and disturb the normal signals that travel from the brain to the body.Irritation of the nerves in the spinal canal is enhanced when standing or walking due to mechanical stretching and compression of nerves.
of the most common smptomov stenosis can be identified:
- Intermittent claudication (unilateral or bilateral)
- lumbalgia (pain)
- Lyumbaishialgiya characterized by the occurrence of pain, heat or coldness in the waist area and legs.
- sensory disturbances in the lower extremities
- Violations of the sensitivity in the anogenital area
- Paralysis of the lower limb muscles
- Wasting of muscles of the lower extremities
- Symptoms of tension
- Violations functions sphincters
- Spasms (cramps), lower limb muscles.
Diagnostics spinal canal stenosis
doctor can diagnose the patient's condition and develop a treatment plan for him.It is necessary to conduct a complete diagnostic evaluation.There are many possible reasons for the internal pain.It is important to determine what is and what is not the root of the problem.When the doctor already has an idea of what is causing the patient discomfort, some diagnostic tests may be recommended.
- The history of the disease. Firstly, the patient will be asked to complete diagnostic examination of his condition.The doctor may ask the patient some questions related to his pain.The more information the doctor will give the patient about himself and about the symptoms of their disease, the easier it will be to diagnose the problem.Medical history is important because it helps the doctor understand: when the pain started, which could cause injury, what is the way of life of the patient, what are the physical factors that may be causing the pain, what a family history of such problems.After reading a written history of the disease, the doctor may ask the patient more questions on the information that he gave.
- Medical examination. After studying the medical history, the doctor will conduct a physical examination of the patient.This will allow the doctor to rule out possible causes of pain and try to determine the source of the problem.Areas of the body that the doctor will examine, - these are the areas in which the patient experiences pain - neck, lower back, arms, legs, etc.
The following are some factors that are tested on a typical inspection.
movement of the spine and neck: whether the pain occurs when the patient turns (turns), bends down or move at all.If so, where.Whether the patient has lost some flexibility.
weakness, muscle strength will be checked: the patient may be asked to try to push something to raise your hand or arm or leg, with any source of resistance.
pain: the doctor may try to determine whether the patient's weakness in certain areas of the body.
Sensory changes: whether the patient may feel certain sensations in specific areas of the feet or hands.
Reflex changes: verification may be exposed tendon reflexes - for example, reflexes under the kneecap and under the Achilles tendon.
ability to move: the doctor may ask the patient to do on his toes or heels walk.
Special features: the doctor will also check for any patient on the "red flag" (a system of "red flags" - a set of symptoms, cast doubt on the benign or primary nature of a pain; their presence requires further examination of the patient), which can indicate not only on the back problemsor particularly vertebrae, but also other problems.Some signs of other problems: pain in certain areas, increased body temperature, abnormal pulse, chronic steroid use (leads to loss of bone mass) or too rapid weight loss.
- Roentgen . X-rays - a painless diagnostic examination with the help of special equipment and radioactive materials, so you can take pictures of bone.If the doctor suspects vertebral degeneration, X-rays can be used to check: reducing the height of the space between the discs, bone spurs, nerve bundle sclerosis, faces hypertrophy (increase) and instability during flexion or extension of the limbs.X-ray translucent good bones, but the worst showing soft tissue.Thus, he will surely be used if there are or are suspected fractures or tumors.During X-ray of the spine to the patient will be asked to lie still on the table at a certain position, which indicate to him the health worker to the damaged bone was clearly visible.
- MRI (magnetic resonance imaging). MRI - a test that does not use radiation.With the use of magnetic and radio waves, MRI creates computer graphics.MRI-rays can "cut" several layers of the spine and display available soft tissue abnormalities - eg, nerves and ligaments.This test can also be used to check: loss of water on the intervertebral disk, stenosis (narrowing of the spinal canal), hernia (rupture or protrusion) of the intervertebral disc.
During MRI the patient should lie down on a special table that is inserted into the MRI machine, with a large circular tunnel.computer scanner can do a lot of photos of the subject area of the body, which are observed and monitored by specialists.Some newer MRI machines called "open magnetic resonance imaging" are likely to be more comfortable for patients who feel claustrophobic.The entire procedure usually takes 30-60 minutes.
- CT (computed tomography). CT scan - an X-ray test that is similar and MRI, and x-rays, because he can shine and show the doctors and bone and soft tissue of the patient.Computed tomography is also able to produce X-ray "slices" of the spine, which allows each section of the body organ to be examined separately.CT scanning generates a set of cross-sectional images that can show a problem with the disc and bone degeneration - for example, osteogenesis or hypertrophy (increase) in the cylindrical face bones.CT does not give such a clear image as X-ray or MRI.To the soft tissue easier to see the CT scan is often combined with myelogram.
As with MRI, CT scan when the patient has to lie on a table that is inserted into the scanner.Scanner substantially - a X-ray tube that rotates around and also makes the plurality of images.The procedure also takes 30-60 minutes.
sometimes used and other tests that can help to make sure that there are no additional problems that cause back pain.
Treatment spinal canal stenosis
What was originally to be found in the very first visit to a specialist - just how serious the problem of the patient.Some problems require a lot of attention of specialists and their immediate intervention - possibly even surgery.Fortunately, the vast majority of back problems require surgery.Spinal stenosis is a slow-progressing problem back.This disease may respond to conservative (non-surgical) medical assistance.
Various treatment options exist for spinal canal stenosis, and in most cases it is simpler methods.For example, a slight pain relief and relaxation - an effective means for the immediate relief of pain.The main goal of treatment - to the patient does not feel discomfort in the back and as soon as possible, in time, could return to their normal daily activities.
Medications for the treatment of spinal canal stenosis
mild sedative drugs may relieve pain when administered properly.However, it should be remembered that the drugs do not heal fracture.They just can help a sick person to cope with the pain.
recommend to consider the types of drugs used for back pain:
- Medications for back pain;
- epidural steroid injections.
Epidural steroid injections may be used to relieve the pain of stenosis and nerve root irritation, and to reduce inflammation.Injections may also reduce the swelling of a herniated disc.Steroid injections are a combination of a powerful anti-inflammatory steroid cortisone and local anesthetic.They are introduced into the epidural space - the space between the vertebral periosteum and the hard shell of the spinal cord, connective tissue and comprises a venous plexus.However, epidural steroid injections do not always successfully facilitate the symptoms of inflammation.They are used only when conservative treatments do not work.
Surgical treatment of spinal canal stenosis
stenosis over time may continue to worsen, intensify.In the end, as a treatment option, and surgery may be considered.It can be suggested for the treatment of spinal stenosis, if:
- the patient is experiencing an increase in weakness in foot (feet);
- the patient can no longer walk without pain in the foot (feet);
- the patient's problems begin with bowel or bladder control;
- the pain becomes unbearable.
Because spinal stenosis is more common in older people, it is important to check carefully before the operation overall physical condition of the patient.If the patient has a serious health problem, the doctor can not put a patient at risk of spinal surgery.The decision to hold the surgeon's patient surgery on the spine should be taken in conjunction with the patient and his regular doctor.
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main goal of any surgical procedure in the treatment of spinal stenosis is to remove the pressure on the nerve roots in the lumbar spinal canal.This means that the spinal canal tube must be increased, and bone spurs, which push the nerve roots must be removed.This type of surgery is usually called a "decompression of the lumbar spine" (decompression helps to eliminate compression of the roots or blood vessels) or "decompressive laminectomy of the lumbar spine."
This procedure can damage the spine, breaking its stability.In order to release or "unzip" the nerves requires prompt surgical intervention: the surgeon will remove a large bone from the back of the spine.The surgeon may need to remove also part of the back of the spine joints, which are time and lead to instability of the spine.
If the patient has, and spinal stenosis and lumbar instability, surgical procedures may include, along with nerves decompression - ie, the elimination of compression of the nerve roots, spinal fusion - a surgical treatment, aimed at the creation of immobility or fusion of adjacentFitting vertebrae using bone graft therebetween.