Stenosis, Spinal

Stenosis, Spinal

National Organization for Rare Disorders, Inc.

Important

It is possible that the main title of the report Stenosis, Spinal is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

  • Cervical Spinal Stenosis
  • Degenerative Lumbar Spinal Stenosis
  • Familial Lumbar Stenosis
  • Lumbar Canal Stenosis
  • Lumbar Spinal Stenosis
  • Lumbosacral Spinal Stenosis
  • Spondylotic Caudal Radiculopathy
  • Stenosis of the Lumbar Vertebral Canal
  • Tandem Spinal Stenosis
  • Thoracic Spinal Canal Stenosis

Disorder Subdivisions

  • None

General Discussion

Spinal stenosis is a rare condition characterized by abnormal narrowing (stenosis) of the spaces within the spinal canal, spinal nerve root canals, or bones of the spinal column (vertebrae). Affected individuals may experience pain in the lower back and/or the legs. In some cases, affected individuals may have difficulty walking. Spinal stenosis may occur as a result of spinal injury, surgery, abnormal bone growth, or deterioration. In some cases, spinal stenosis may be inherited as an autosomal dominant genetic trait.

Symptoms

Pressure or squeezing (compression) of spinal nerves and/or blood vessels associated with spinal stenosis results in back pain and difficulty walking, including episodes of limping. Walking downhill can be especially painful. Other symptoms may include the inability to control urination (incontinence), temporary paralysis of the legs, and pain or burning sensations in the lower back and/or legs. A progressively awkward gait (ataxia) and gradual numbness in the legs may also occur.

Causes

Acquired spinal stenosis may occur as a result of spinal injury, surgery, abnormal bone growth, or deterioration (i.e., osteoarthritis or Paget's disease). Occasionally this condition is progressive. Some symptoms are, the result of inflammation of nerves that are compressed. It most often affects people over 50 years of age.



In addition, spinal stenosis is a symptom or sign of several other disorders such as achondroplasia, a disease of cartilage and bone formation that results in a particular form of dwarfism.



Some people are born with conditions, such as a small spinal canal or a curved spine, that may lead to spinal stenosis. In those cases, people younger than 50 may be affected.

Affected Populations

Spinal stenosis is a neurological condition that affects females more often than males. It is usually found among middle-aged or elderly people, although the congenital form may be present at birth. Individuals who participate in extremely rough contact sports (i.e., football or hockey) may be at greater risk for developing spinal stenosis than the general population.

Standard Therapies

Diagnosis

The diagnosis of spinal stenosis relies on the use of imaging procedures such as magnetic resonance imaging (MRI), computerized tomography (CT scan), electromyelography (EMG), and intraoperative spinal sonography (IOSS). The early diagnosis and treatment of spinal stenosis may prevent intractable pain and permanent neurological impairment.



Treatment

Treatment of spinal stenosis may include the injection of a steroid drug into the spaces around the spinal cord membranes (epidural space). This may reduce inflammation and pain in some individuals. However, these injections may not be given too frequently and close monitoring by the physician is warranted. This form of treatment may take more than a week to begin having an effect on pain. Nerve blocks are frequently administered for temporary relief from pain by anesthetizing the nerve being pinched. These and several forms of alternative medicine offer temporary relief. In some individuals, surgery remains the only option to relieve compression.



Surgery to relieve the pressure on the spinal canal (laminectomy) may be recommended in moderate to severe cases of spinal stenosis. Small pieces of bone are removed from the vertebrae during this procedure. Pain relief is often dramatic, allowing most individuals to return to their normal activities. Long-term pain relief obtained from this surgery depends on the amount of bone regrowth and the stability of the spinal column. Surgery involving older persons carries with it the risks associated with trauma on the aged. Other risks involve tearing of the ligaments that hold the vertebrae in place, and infection.



Other treatment is symptomatic and supportive.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.



For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:



Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com



As of May 2005, there were three clinical trials involving spinal stenosis posted on NIH's clinical trials web site. Additional information is available at www.clinicaltrials.gov.



One study, sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Disorders, is comparing outcomes of surgical and non-surgical treatment options. A second, sponsored by Greenwich Hospital in Connecticut, is designed to compare the efficacy of Greenwich Lumbar Stenosis SLIP operation with and without inserted metal supports after laminectomy. The third study, sponsored by the Medtronic Bakken Research Center, is designed to compare the results of two forms of bone fusion techniques.

References

TEXTBOOKS

Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:476, 478.



Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:569, 571, 574.



Larson DE. ed. Mayo Clinic Family Health Book. New York, NY: William Morrow and Company, Inc; 1996:516-17.



Rowland LP. ed. Merritt's Neurology. 10th ed. Lippincott Williams & Wilkins. Philadelphia, PA. 2000:424.



REVIEW ARTICLES

Jensen RL. Cauda equina syndrome as a postoperative complication of lumbar spine surgery. Neurosurg Focus. 2004;16:e7.



Wang MY, Green BA. Open-door cervical expansile laminoplasty. Neurosurgery. 2004;54:119-23; discussion 123-24.



Szpalski M, Gunzburg R. Lumbar spinal stenosis in the elderly: an overview. Eur Spine J. 2003;12 Suppl 2:S170-75.



Gunzburg R, Szpalski M. The conservative surgical treatment of lumbar spinal stenosis in the elderly. Eur Spine J. 2003;12 Suppl 2:S176-80



Sengupta R, Haldeman S. Lumbar spinal stenosis. Treatment strategies and indications for surgery. Orthop Clin North Am. 2003;34:281-95.



Various Authors Spinal Stenosis. Phys Med Rehabil Clin N Am.2003;14:17-155.



Binder DK, Schmidt MH, Weinstein PR. Lumbar spinal stenosis. Semin Neurol. 2002;22:157-66.



FROM THE INTERNET

Chen AL. Medical Encyclopedia: Spinal Stenosis. MedlinePlus. Update Date:4/28/2004. 2pp.

www.nlm.nih.gov/medlineplus/ency/article/000441.htm



Health Topics: Questions & Answers About Spinal Stenosis. NIAMS. NIH. Publication Date: November 2004. 14pp.

www.niams.nih.gov/hi/topics/spinal_sten.htm



Hsiang JNK. Spinal Stenosis. emedicine. Last Updated: February 7, 2005. 7pp.

www.emedicine.com/med/topic2889.htm

Resources

March of Dimes Birth Defects Foundation

1275 Mamaroneck Avenue

White Plains, NY 10605

Tel: (914)997-4488

Fax: (914)997-4763

Tel: (888)663-4637

Email: Askus@marchofdimes.com

Internet: http://www.marchofdimes.com



National Scoliosis Foundation

5 Cabot Place

Stoughton, MA 02072

Tel: (781)341-8333

Fax: (781)341-8333

Tel: (800)673-6922

Email: nsf@scoliosis.org

Internet: http://www.scoliosis.org



NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases

Information Clearinghouse

One AMS Circle

Bethesda, MD 20892-3675

USA

Tel: (301)495-4484

Fax: (301)718-6366

Tel: (877)226-4267

TDD: (301)565-2966

Email: NIAMSinfo@mail.nih.gov

Internet: http://www.niams.nih.gov/



Genetic and Rare Diseases (GARD) Information Center

PO Box 8126

Gaithersburg, MD 20898-8126

Tel: (301)251-4925

Fax: (301)251-4911

Tel: (888)205-2311

TDD: (888)205-3223

Internet: http://rarediseases.info.nih.gov/GARD/



For a Complete Report

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