CNY Orthopedic Sports Medicine, PC: InjuryDetail: Spinal Stenosis
 
Injuries and Conditions: Back & Spine: Spinal Stenosis: Medical Details
 
Overview
The anatomy of the spine is divided into three major regions. These regions are made up of bones known as vertebrae. Each vertebra within the spine is given a letter and number label that describes its exact location. The neck, or cervical spine, is designated by the letter "C" and contains seven vertebrae, numbered 1 through 7.

The upper and mid-back represents the thoracic spine and each of the twelve vertebrae (numbered 1 through 12) are given the prefix of the letter "T". The lower back, or lumbar spine, has five vertebrae identified with the number "L" and the numbers 1 through 5. For example, L4 means that the area of the spine being evaluated is the lumbar spine at vertebrae number 4. The sacrum, lowest level of the spine, contains vertebrae that have grown (fused) together and are usually referred to as one single structure, though they are still numbered 1 through 5.

The vertebrae of the cervical, thoracic and lumbar spine are separated from each other by soft oval shaped cushions known as intervertebral discs. These discs are made up of a tough fibrous outer ring called the annulus fibrosus, and a soft jelly like center known as the nucleus palposus. These discs function in a similar manner to shock absorber in a car and allow the spine to bend, flex, and twist while decreasing or dampening the force and stress that these movements place on the spine. The sacral spine does not contain intervertebral discs since the segments are naturally fused.

Three major regions of the spine:
  • Cervical spine (neck)
  • Thoracic spine (mid-back)
  • Lumbar spine (low back)

    Structures involved in spinal stenosis:
  • Intervertebral Discs: pads of tissue between the vertebrae
  • Facet Joints: joints which connect the back of the vertebrae to each other
  • Ligaments: elastic bands that support and connect the vertebrae
  • Lamina: Arches of bone that form the roof of the spinal canal
  • Pedicles: Bones that form the walls or the sides of the spinal canal
  • Spinal Cord / Nerve Roots: major electrical pathways of the Central Nervous System (CNS)
  • Spinal Canal: A tunnel of bone through which the nerve root and spinal cord pass

    Narrowing of the spinal canal is usually the result of degenerative changes occurring within the spine. As a body ages, the intervertebral discs begin to shrink and dry out, ligaments which support the spine become less pliable and the body forms bony spurs on the vertebrae in an attempt to stabilize the segements.

    Spinal stenosis is most commonly located in the cervical and lumbar spine. These regions provide most of the motion of the spine and therefore are the most prone to wear and tear, and degenerative arthritis. The thoracic spine is more rigid due to the constraints imposed by the ribs and so spinal stenosis in the thoracic area is very uncommon.

  • Causes of Injury
  • The most common cause of spinal stenosis is osteoarthritis, which produces bony outgrowths (bone spurs) projecting into the spinal canal, compressing nerve roots and resulting in pain and irritation of the nerves and spinal cord.
  • Spinal stenosis can result from inherited conditions such as achondroplasia, in which the patient is born with a narrow spinal canal.
  • Arthritic changes within the spine, which are a direct result of a previous injury, including a fracture or herniation (post-traumatic arthritis).
  • Spondylosis, or a degeneration of the intervertebral discs and small joints between the vertebrae.
  • Spondylolisthesis, or a shifting of one vertebrae on top of another will also narrow the spinal canal and can result in spinal stenosis.

  • Diagnosis
    The signs and symptoms of spinal stenosis can also mimic other spinal disorders. Including a herniated disc, decreased circulation (claudication) or a tumor.

    To confirm the presence of spinal stenosis, an appointment with an orthopeadic suregon should be made. The doctor will perform a complete history and physical exam during the initial office visit. The physical exam will include tests that measure reflex response, motor and sensory function.

    The physical examination may strongly suggest spinal stenosis. To make an accurate and complete diagnosis, radiographic imaging studies may also be ordered. Without the use of imaging studies, spinal stenosis is difficult to confirm.

    Radiographic imaging studies include:

  • Plain X-ray films of the spine
  • Magnetic Radiographic Imaging (MRI)
  • CT Scan/Mylogram

  • Anatomy
     


     Product Considerations
    NSAIDs
    NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
  • Pain resulting from inflammation or swelling.
  • Pain after injury.
  • Joint pain and arthritis.


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