Spinal stenosis

Diagnosis

The doctor will ask for your signs and symptoms, and your medical history before performing physical assessment. Some tests may also be ordered to properly diagnose spinal stenosis.

Imaging tests 

Diagnostic tests include: 

• X-rays. Shows bone spurs narrowing the spinal canal and exposing the body to a small amount of radiation.
• Magnetic Resonance Imaging (MRI). This modality shows the damage of disk and ligaments as well as tumors, but mainly, it shows spinal cord or nerves compression. MRI reveals cross-sectional images of the spine using a strong magnetic field and radio waves.
• Computed tomography (CT) Scan or CT myelogram. A CT scan may be ordered by the doctor if MRI is not possible. It is a combination of x-rays from various perspectives to create comprehensive images. CT myelogram on the other hand uses contrast dye injection to outline the spinal cord and nerves, and view bone spurs, tumors or herniated disks.

Treatment

Medications

You may be prescribed the following medications:

• Pain relievers. Pain and discomfort can be managed temporarily by ibuprofen, naproxen and acetaminophen.
• Antidepressants. Chronic pain may be relieved by a tricyclic antidepressant.
• Anti-seizure drugs. Gabapentin and pregabalin may help subside the pain from nerve damage.
• Opioids. Codeine-related ingredient in medications like oxycodone and hydrocodone can be a short-term pain reliever but if they are used in a long-term basis, it should be utilized cautiously due to serious side effects including addiction.

Physical therapy

Immobility caused by pain is very common in spinal stenosis which leads to weakness of the muscles and create more pain. Physical therapists may teach you to exercises in order to regain or improve your endurance, strength, flexibility, stability and balance.

Steroid injections

Steroid injection helps to subside pain and inflammation but it will not fix the spinal stenosis. Furthermore, once used repeatedly, it can make the bones and connective tissues weak.

Surgery

When other treatments have failed, surgery is the next option. Surgery is done to relieve pressure on the spinal cord and nerves. This can be achieved by making more space inside the spinal canal. An experienced spinal surgeon for spinal stenosis should be considered in order to have less chance of complications.

Spinal stenosis can be surgically corrected through these techniques:

• Laminectomy. Removes the damaged lamina (back part) of the vertebra. It is sometimes called decompression surgery because it releases the nerves from pressure and makes more space in the spinal canal. Metal hardware and bone graft can be used to combine the vertebrae to make it stronger in some patients.
• Laminotomy. Only a tiny part of the lamina is taken out which creates a small hole releasing the pressure at a certain area.
• Laminoplasty. Only done in the neck’s vertebrae (cervical spine) creating space in the spinal canal by making a hook to the lamina. Metal hardware fills the space in the spine’s open spots.
• Minimally invasive surgery. Removes the bone or lamina without creating injury to the normal tissues surrounding it. This procedure will less likely need fusion.
• Endoscopic decompress. Use endoscope to decompress neural element
• Microscopic decompression. Use microscope to decompress

Spinal fusion may stabilize the spine and alleviate the pain but there is also more chance of pain and inflammation after the surgery or damage in areas surrounding the spine. Minimally invasive surgery is more favorable due to a much lesser time needed to attain recovery.