Degenerative Spinal Stenosis

Degenerative Spinal Stenosis

With an aging US population, spinal disorders related to degeneration are increasing. This is especially true for a condition called spinal stenosis. 

Degenerative spinal stenosis is the process in which the canals (holes) in the spinal canal (which houses the spinal cord and nerves) become smaller, thus encroach upon the spinal cord and nerves. Smaller spaces (when nerves get compressed) may result in swelling. The further compress or irritate the nerves, which may then result in any of the symptoms associated with stenosis, including pain, numbness, pins and needles, weakness and even bowel and/or bladder problems. 

Degenerative stenosis is by far the most common spinal disorder and accounts for more than 90% of spinal stenosis cases. The spine starts degenerating early in life and is accompanied by extra bone (sclerosis), widening fo the vertebrae (traction spurs) and thickening of the ligaments in/around the spinal column. This leads to a progressive encroachment of the spinal cord and/or spinal nerves. With positions that extend the spine (example-standing), the canals are even further shut down, resulting in symptoms. Patients often feel better when they sit down, lean forward (create space) or move (walk), thus getting blood flow around the nerves.

Studies have shown that movement, exercise and positioning are effective treatment strategies in managing and even slowing down the progression of spinal stenosis. Physical therapists will design personalized exercise programs aiming to increase and maintain space in/around the spinal canal as well as exercise designed to "slide and glide" the nerves in the area to enhance circulation to the nerves. Additionally, patients will be advised to make appropriate life-style changes to pace activities that require prolonged loading. Aquatic therapy is also often used to help unload the spine, create space for the nerve, and increase blood flow to the spine and help with general fitness and well-being. 

In severe cases of stenosis, patients may not respond well to physical therapy. In such cases, it is not uncommon for physicians to utilize epidural steroid injections. These injections are mostly performed under x-ray (fluoroscopy) and is aimed to reduce the swelling the nerves produce as they get encroached upon. These injections may reduce the swelling (create space) and allow for more effective physical therapy rehabilitation. If symptoms persist, patients may be referred onto a spine surgeon for consultation. If surgery is indicated, the surgeon often performs a procedure called a laminectomy, whereby he/she cuts out a little piece of the bone in the area of the encroachment, which will help relieve pressure on the nerve and ease the pain. 

*For more information- ask your physical therapist. This is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional. 

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