|
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 body and two are on the left side of the
body. Two adjoining vertebral bodies joined together
continue up the spine.
Factors making a 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 continues to progressively
worsen with time and gravity. There are many perfectly
normal backs after childhood development that is
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 L5 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. Steno tic 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 is
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.
Stewart G. Eidelson, M.D.
Surgical Care of the Spine
|
