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CT Scan of congenital stenosis, Note flattened canal space |
Spinal stenosis is a condition that involves impingement or pressure on nerve roots, the spinal canal or cord itself. This can occur anywhere in the spine but most commonly occurs in the lumbar area and involves compression of the nerve roots themselves as the spinal cord ends in the upper lumbar area. The disease itself may be congenital with the individual born with a narrow spinal canal in the front to back direction.
More commonly the disease is one of progressive degeneration where the disc spaces may become narrower with aging. Sometimes the facet joints or true joints of the spine enlarge like any arthritic joint and will narrow both the spinal canal and the neural foramen, or nerve root exit points, in the anterior to posterior direction. With disc space narrowing, the height of the nerve root opening is decreased in all directions causing pressure on the nerve.
Typically this occurs over years until the individual begins experiencing radiating leg pain
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CT Scan with more normal canal space with mild stenosis | sometimes referred to sciatica. Depending on the level of compression this pain may radiate down the back, sides or front of the leg. Generally pain increases with activity and as it progresses may force the individual to sit down to alleviate the symptoms. Often the pain will subside quickly and the individual may resume walking and their activity after several minutes. Sometimes persons may be able to walk farther with a cane or walker or using a grocery cart. This slight forward flexion of the spine will open the nerve foramen slightly and decrease overall impingement of the nerve.
There may be an associated burning or tingling with the pain but rarely is there any motor deficit or weakness. In extreme cases motor function and overall fitness may be impaired sufficiently to require the individual to use a wheelchair for locomotion. Bowel and bladder incontinence may also occur in the late stages of significant disease.
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