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The term "spinal stenosis'' is heard quite frequently in South Florida
because of the concentration of elderly in our populace. 'Spinal stenosis'
is primarily an aging process. Many years ago it was called creeping
paralysis. It was accepted that if one got old enough, one could acquire
it and have to 'live and die with it.'
The two words are separated primarily for clarification. "spinal"
giving the location, and "stenosis'' meaning the condition. Stenosis
is derived from the Greek meaning, ''narrowing of a normally larger
opening.'' The term 'stenosis' is widely used in medicine for different
parts of the body.
The primary area discussed here is stenosis of the spine, which can
occur in the cervical, thoracic, or lumbar region. We will address
the lumbar area in this article because of the greater percentile that
we see.
There are three motion segments between two lumbar vertebral bodies
- one being the well known "disc'' or "shock-absorber space" between
two vertebral bodies, and the lesser known two "facet joints" that
adjoin just posterior to the disc space. These two joints are similar
to most other joints in our bodies. The facet joints are where one
vertebrae actually touches or connects to the vertebrae above or below
with a thin layer of cartilage that is in between the bony surfaces.
Each lumbar vertebral body has four joints, with two joints superior
or toward the head, and two joints interiorly or toward the feet. Two
are on the right side of the lady and two are on the left side of the
body. Two adjoining vertebral bodies joined together continue up the
spine.
Factors making 'person predisposed to acquiring spinal stenosis
can start in the womb as a result of genetics or congenital problems
acquired from the mother. Generally, any of these factors result in
lower back problems early in life and can continue to progressively
worsen with time and gravity. There are many perfectly normal backs
after childhood development that are mechanically ruined due to many
self-destructive modes, but not all self controlled.
Some of these being poor posture. poor body mechanics, overweight,
physical abuse, smoking, poor diet, all the way to many disease processes
that we have no control over, such as osteoarthritis, rheumatoid arthritis,
osteoporosis, scoliosis, and lordosis (sway back). The end result in
many of these problems is spinal stenosis on the left, right, central,
or all of the above, at any one given joint segment, primarily in the
lumbar spine.
This leads us to ask, ''what does spinal stenosis effect, or what
effects does spinal stenosis have?'' Primarily we are looking at the
central part of the dural sac and/or the right and left nerve roots
that exit between the two vertebral bodies. Each root gets its name
by passing over the vertebral body and exiting through an opening between
the two adjoining bodies called the "foramen,'' i.e. the L.5 root passes
over the 5th lumbar vertebral body and exits L5-S1 foramen. One degenerative
scenario would be that the disc collapses over time thus causing the
facet joints to become inflamed or angry with their normal joint space
being reduced. One motion segment cannot be disrupted without affecting
the other two. When this occurs the inflammation causes spurring around
the entire facet joint which causes it to become larger, thus invading
the central part of the spinal canal, as well as, the root foramen,
which lies just beneath the facet joint. Stenotic problems can then
occur .
Then we have progressive subtle loss of motor or muscular use of
one or both of our lower extremities or parts of those extremities.
This occurs slowly, so that an aged person can hardly tell that it
is happening until they have a fall or complain of weakness in one
or both of their legs. It is tolerable for some and accepted as the
aging process by others. Sometimes a cane or walker are supplemented
to help ambulate. It is when the leg pain begins that people become
alarmed about their condition, Then, fearing that they may have cancer
or some other destructive problem, they elect to seek medical attention.
The diagnostic work-up is obtained through physical exam, a thorough
medical and life history, x-rays, MRI - if deemed necessary, CAT scan
- if available, and blood tests that help us to bring about a diagnosis.
Based on the patient's medical condition at that time, a treatment
plan is decided upon and begun, starting with the most conservative
methods of physical therapy, epidural, and medications. If all else
fails to resolve the problem, surgery must be considered.
Spinal
Stenosis at Spineuniverse.com
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