1/2/2015

11ThingseveryoneshouldknowaboutspinalstenosisDr.Lumbago

11Thingseveryoneshouldknowaboutspinalstenosis
September03,2012

cervical,exercise,exercises,lumbar,spinalstenosis,surgery,symptoms,treatment,treatments

0Comment

Whatisspinalstenosis?
SpinalstenosisLumbarspinalstenosis
StenosisisaGreekwordthatmeansnarrowingorconstrictingspaceorchocking.Inamedicalsense,spinalstenosisis
thenarrowingorconstrictingofthespaceinthespinewherethespinalcordandnerverootsarelocatedthatcausesthemto
bepressedonandirritated,andinthissensechocked.Simply,spinalstenosisisanarrowingwithinthespinethatpinches
orotherwiseirritatesapartofthenervesystem.Thisnervepressureisusuallycausedbyosteoarthritisinadeeperareaof
thespine,givingrisetosymptomsinwhateverpartofthebodytheirritatednervestravelto,likethearms,neck,legsandlow
back.

Typesofspinalstenosis
Therearetwoprimarytypesofspinalstenosislumbarspinalstenosisandcervicalspinalstenosis.Lumbarspinalstenosis
occursinthelowerpartofthespineandisthemostcommontypeofspinalstenosis.Cervicalspinalstenosisoccursinthe
neckregionofthespine.Althoughthelocationsaredifferenteachtypeofspinalstenosisarisesinasimilarmanner,affects
thespineandnerverootsinasimilarway,andcausesimilarsymptoms.

Lumbarspinalstenosisvs.Cervicalspinalstenosis
Whenlumbarstenosiscompressesthelowerbacknerverootspainwilloccuralongthepathwayofthemajorlowbacknerve
network,calledthesciaticnerve,resultinginsciatica.Thesymptomsofsciaticaarepain,numbness,tinglingandweakness
thatcanradiatedownfromthelowbackandintothebuttocksandbackofthelegstothetoes.Sciaticaproblemsareeasily
triggeredinlumbarspinalstenosiswithanyactivitythatcompressesthespineprolongedstanding,carryingaheavy,
weight,prolongedforwardflexion.
Approximately75%ofspinalstenosisoccursinthelumbarspine(lowback),withthemostoftheother25%occurringinthe
neckorcervicalspinerarelydoesspinalstenosisaffecttheupperbackorthoracicspine.
Whencervicalstenosiscompressesthespinalcordandnerverootsitisfarmoredangerousbecausethespinalcordinthe
neckismuchlarger,andcarriesmoreimportantpartsofthenervenetwork(nervesupplytoandfromtheheartandlungs,the
vagusnerve,etc.).Ifthespinalcordiscompressedintheneckitcanhavedireconsequencesonlyslightlylessdramaticthan
whensomeoneisexecutedbyhangingbecausebeinghungwitharopearoundtheneckseverelycompressesonthe
spinalcordoftheneckandstopsallheartandlungfunction.Sincethespinalcordendsintheupperpartofthelumbarspine,
thespinalcordisnotinjeopardybylumbarspinalstenosis.
Spinalstenosis,thedevelopmentofdegenerativearthriticchangeswithinthespinethatpressesonnervetissue,usually
becomessignificantafter50yearsofageandslowlyprogressesasaproblemasthearthritisofthespinealsoprogresses.
data:text/htmlcharset=utf8,%3Ch1%20class%3D%22singlethumbnailtitle%20posttitlecolor%20gdltitle%22%20style%3D%22margin%3A%2040px%200p

1/5

1/2/2015

11ThingseveryoneshouldknowaboutspinalstenosisDr.Lumbago

Sincelumbarspinalstenosisisamuchmorecommonproblem,mostofthisdiscussionwillfocusonthisarea.

Lumbarspinalstenosissymptoms
Somesymptomsoflumbarspinalstenosissymptomsareratherconsistentfrompatienttopatient.Becausespinalstenosisis
theexpressionofarthritispressingonnervesfromwithinthespinalcolumnitdoesnotbeginrapidlyoraftertrauma,asmany
otherlowerbackpainproblemsdoitdevelopsslowlyoveraperiodoftime,andincreasesfrequencyandseverityasthe
spinalosteoarthritisprogresses.Thepainoflumbarstenosiswillcomeandgo,dependingonactivitylevelsoftheindividual
andanythingthepersonmightdothatisfavorableorunfavorabletoaggravatethespinalarthritisspinalstenosispainisnot
continuous,asarule.Symptomswilloccurtypicallyduringcertainactivitiessuchaswalkingorprolongedstanding,orany
otheractionthatstressestheareaofthelumbarspinewheretheosteoarthritisislocated.Lastly,lumbarspinalstenosis
symptomstypicallycanbecontrolledbysimplylyingdownorsitting.Thepainwillslowlydisappearasthereductionof
weightbearingallowstheirritatedtissuetocalmdownandnolongerpressonthedelicatenervestructuresofthesciatic
nerve.

Spinalstenosistreatment
Surgeryisusuallynotnecessarytotreataspinalstenosisproblem.Thisisgoodbecausespinalstenosissurgerycanbe
complexanddangeroussinceitinvolvesgoingwithinthespinalstructureveryclosetothespinalcord.Dependingonthe
locationanddegreeofspinalosteoarthritisandtheseverityofsymptomsthatresults,spinalstenosiscanusuallybemanaged
wellusingnoninvasive,nondrugmethodswiththreecommonmethods.
Threecommonnonsurgicalspinalstenosistreatmentsinclude:
Ice/Heatapplications
Applystraighticetotheareaofthelowerbackatthelevelofgreatestpainandwherethesciaticaseemstostart(wherethe
spinalstenosisislocated),followingtheinstructionsforapplyingcold/heat.
Activitymodification
Thistreatmentforstenosisusuallyturnsouttobeanexerciseinbecomingawareofwhataggravatesthespinalstenosisand
whatmakesitfeelbetter.Thusyoushouldavoidwhateveraggravatesthebackpainanddowhatfeelsbettertotheback.
Theprimaryobservationthatpeoplewithspinalstenosismakeisthattheyfeellesspainandtheirbackismorerelaxedwhile
holdingthelowback,orneck,flexedforward.
Examplesofactivitymodificationastreatmentofspinalstenosis:firstthinginthemorningleanonthebathroomsinkbefore
washingtogetreadyforthedaybystretchingthelowerbackandrelaxingitsleeponyourleftorrightsidewhilebringingone
orbothkneesuptowardourchestlikeyourbodyisrolledupintotheshapeofaballleaningforwardatthehipsonawalker
orshoppingcartinsteadofwalkinguprightleaningforwardandbentoveronthehandlebarsofastationarybikeorother
exerciseequipmentinsteadofwalkingforexercisesitinareclinerthatisflattenedoutabitinsteadofonastraightback
chairwhensittingonacouchperiodicallybringyourfeetoffthefloorasyoubringyourkneesuptowardyourchestand
snugglywrapyourarmsaroundyourknees.
Withthistreatmentforstenosis,patientsareusuallycounseledtoavoidactivitiesthatcauseadversespinalstenosis
symptoms.Patientsaretypicallymorecomfortablewhileflexedforward.Examplesofactivitymodificationfortreatmentof
spinalstenosismightinclude:walkingwhilebentoverandleaningonawalkerorshoppingcartinsteadofwalkingupright
stationarybiking(leaningforwardonthehandlebars)insteadofwalkingforexercisesittinginareclinerinsteadofona
straightbackchair.
Spinalstenosisexercise
data:text/htmlcharset=utf8,%3Ch1%20class%3D%22singlethumbnailtitle%20posttitlecolor%20gdltitle%22%20style%3D%22margin%3A%2040px%200p

2/5

1/2/2015

11ThingseveryoneshouldknowaboutspinalstenosisDr.Lumbago

Spinalstenosisexercises(strengthening)Spinalstenosisexercisesareveryhelpful,buttheycannotdomorethan
controlandminimizetheproblemnotcureit.Theseexercisesareacriticalpartoftreatmentbecauseoftheimportanceof
remainingasactiveastheconditionwillallow.
Treatingsciaticafromspinalstenosisrequiresuseofforwardflexionorbendingexercises.Thispostureincreasesthesizeof
thecompressednervepassageways,allowingtheirritationorimpingementtosubside.Forthisreasonpeoplewithspinal
stenosiswillflexatthehipstofeelsciaticpainreliefaswellaslowerbackpainrelief.
Inmanywaysspinalstenosiscausesthenervestobecomepressedupon,orcompressed,resultinginwhatsomepeople
wouldcallapinchednerve,whetherinthelowbackortheneck.Thereareaseriesofsimpleandeffectivethingsaperson
withapinchednervecandothatcanbeveryhelpfulinmanycases.Reviewsomeoftheseideasforpinchednerve
treatmenttolearnhowtohelpyourselfandreduceoreliminatetheneedformoreaggressivemedicaltreatment.
Discusstheseexerciseswithyourdoctor,chiropractorortherapist:

Lumbarspinalstenosisexercise
1. Strengtheningthemusclesthatbringthespineintoflexion(forwardbending).Usingtwoofthesameexercisesthat
wereusedforstrengtheningthelowback,itispossibletostretchthelowerbackmusclesandothersofttissuethat
holdthespineinabackwardbendingposition.Thesestretchesareusuallyheldinagentleandeasyposturethatdoes
notprovokeanybackorlegpain,for30seconds.
Backflexion.Comfortablylieonapaddedsurfacefaceup,ontheback,gently
pullingbothkneestowardthechestuntilacomfortablestretchisfelt.After30
seconds,slowlyreturntothestartingposition.Doabout36repetitions.Asan
alternate,trypullingjustonekneetowardtheoppositeshoulderuntila
comfortablestretchisfelt.After30seconds,slowlyreturntostartingposition.
Doabout36repetitions.

Backflexion.Usingapaddedsurface,getdownonthehandsandknees.Rock
backsoyouaresittingbackdownonyourheels,allowingyourchesttocome
downclosetothefloorandyourarmsoutstretchedinfrontofyou.Donot
bounceonheels.After30seconds,slowlyreturntothestartingposition.Do
about36repetitions.

Abdominalmuscleandcorestrength.Liefaceuponapaddedsurface,with
bothkneesbentandfeetflatonfloor.Tightenabdominalmuscles.Slowly
raiseonefootoffthefloorabout46inchesandholdthatpositionfor510
secondsovertimeincreasetimethatfootisheldupofffloorto30seconds.
Returntostartingposition.Doabout36repetitions.

Backextension.Comfortablylieonapaddedsurfacefaceup.Tightenthelowbackandbuttockmuscleswhileallowingthe
lowbacktoflattenfirmlyagainstthefloor.Holdthatpositionfor510secondsovertimeincreasetimethatfootisheldupoff
floorto30seconds.Returntostartingposition.Doabout36repetitions.
data:text/htmlcharset=utf8,%3Ch1%20class%3D%22singlethumbnailtitle%20posttitlecolor%20gdltitle%22%20style%3D%22margin%3A%2040px%200p

3/5

1/2/2015

11ThingseveryoneshouldknowaboutspinalstenosisDr.Lumbago

Spinalstenosistreatmentwith
epiduralinjections
Aninjectionofcortisoneintothespaceoutsidethedura(theepiduralspace)
cantemporarilyrelievesymptomsofspinalstenosis.Whileinjectionscanseldombeconsideredcurative,thesespinal
stenosistreatmentscanalleviatethepaininabout50%ofcases.Uptothreeinjectionsoveracourseofseveralmonthscan
betried.Althoughtheyarenotconsidereddiagnosticinandofthemselves,generally,ifthepaincausedbyspinalstenosisis
relievedbyanepiduralsteroidinjection,thenthepatientcanalsobeexpectedtohaveagoodresultiftheylaterchooseto
havespinalstenosissurgery.

Spinalstenosissurgery
Theprimarygoalofspinalstenosissurgeryistoremovethosespinalstructuresthatarecompressingthenervesinthespinal
canalorvertebralforamen.Theprocedureusediscommonlyreferredtoaslumbardecompressionsurgery(foraminotomy,
laminectomyandlaminotomy).
Spinalstenosissurgeryisbestindicatedforanyonewhodoesnotimprovewithconservativemeasures(rest,exercise,
hot/coldapplications,stretching,chiropractic,etc.)orifsevereandrapidlyprogressiveweaknessorlossofbowelorbladder
functionoccurs.Dependingontheresultsofphysicalexaminationfindingsandimagingstudies,varioussurgicalprocedures
canbeusedtotreatthenonresponsivelumbarspinalstenosispatient,fromlaminectomytomultiplefusionprocedures.
Generally,stenosissurgeryismorereliableforreliefofsciaticalegsymptomsandlessreliableforreliefoflowerbackpain
symptoms.

Itiscriticalthatasapatientyoudiscussthesebasicpointswithyourdoctor
beforeyouagreetospinalstenosissurgery:
1.Getasenseofthelevelofconfidencethatthesurgeonhasaclearanddetailedunderstandingwhereyour
spinalstenosisislocated.Thedoctormustknowexactlywhathe/sheisgoingtodoandwheretheproblemis
locatedduringstenosissurgery.Thisisespeciallytrueifyoursisacomplexproblemwithmorethanonelocationthat
isbeingimpingedupon,orifbothsidesofthespinemustbeopened.Ifyourdoctorcannotspeakwithconfidenceabout
thesurgerythentheresultsmightnotmakeyoupleased.Youmightwanttofindadoctortodothespinalstenosis
surgerywhomoreclearlyunderstandsyourlowerbackpainproblem.
2.Askaboutthepossibilitythatthestenosissurgerymightcausenewproblemsorworseproblemsforyouthan
younowhave.Itisgoodtodiscussthepossibilityofinjurytonervesinthearea,orifthesurgerywillcauseinstability
andweaknessofthespinethatyoucurrentlydonothavenow.Alongthissamelineofthoughtyouwanttoassurethat
thisstenosissurgeryshouldnotcauseasituationthatmightrequireanadditionalsurgerylater.Ifyoulearnthatthere
areothertechniquesofspinalstenosissurgerythatwillcausefewerproblemslater,thenyoushouldfindanother
surgeonwhodoesthiskindofoperation..
3.Askthesurgeonifthemethodthatwillbeusedtocorrectorrelieveyourspinalstenosisistheleastinvasive
techniquethatisavailableandused.Askifthemethodofspinalsurgerywillbeminimallydestructiveofnormal
structuresintheareaandnearimportantnervestructures.Askifthetechniqueandmethodofstenosissurgerywill
leaveasmuchaspossibleofthenormalorslightlyabnormaltissuesalone.Ifyouaretoldthatthereareothermethods
thatdestroylessnormaltissue,thenyouneedtodeterminewhocandothatkindofsurgery.
4.Askifthesurgerycanbedoneunderanepiduralanestheticinsteadofgeneralanesthesia.Spinalstenosis
surgeryfordecompressionofnervetissuewhendoneundergeneralanesthesiaisstressfulforthepatientsinceitis
oftenamanyhourprocedure.Somepatientscannottoleratethiskindofmetabolicandphysicalstress.Ifyouarelearn
data:text/htmlcharset=utf8,%3Ch1%20class%3D%22singlethumbnailtitle%20posttitlecolor%20gdltitle%22%20style%3D%22margin%3A%2040px%200p

4/5

1/2/2015

11ThingseveryoneshouldknowaboutspinalstenosisDr.Lumbago

thatthissurgeonpreferstoworkwithapatientundergeneralanesthesia,besuretofindoutwhy,whatwouldbethe
reasonsthatyoucouldbeanexception,andthisriskisjustifiedinyourcase.Ifyouarenotsatisfiedwiththeanswers
thenitmightbebettertofindadifferentsurgeonwhocansafeguardyouduringyourstenosissurgery.

data:text/htmlcharset=utf8,%3Ch1%20class%3D%22singlethumbnailtitle%20posttitlecolor%20gdltitle%22%20style%3D%22margin%3A%2040px%200p

5/5