GF19: Neuro Spinal Stenosis

Question 1

What is Spinal Stenosis?

Answer 1

• Spinal stenosis is the narrowing of one or more spaces within your spine.
• Less space within your spine reduces the amount of space available for your spinal cord and nerves that branch off your spinal cord.
• A tightened space can cause the spinal cord or nerves to become irritated, compressed or pinched, which can lead to back pain and sciatica.

Question 2

What are some causes of spinal stenosis?

Answer 2

• Overgrowth of bone
  
  • Bone spurs: can grow into spinal canal
  • Paget’s disease: a bone overgrowth disease that can intrude on spinal canal
• Herniated disks
• Thickened ligaments
  
  • The tough cords that help hold the bones of the spine together can become stiff and thickened over time
  • These thickened ligaments can bulge into the spinal canal
• Tumors
• Spinal injuries
• Osteoarthritis and Rheumatoid arthritis
• Birth defects

Question 3

What are the general s/s of spinal stenosis?

Answer 3

• Standing discomfort
• Discomfort/pain in shoulder, arm, hand
• Bilateral symptoms
• Numbness/paresthesia at or below the level of involvement
• Pain/weakness in buttock/thigh only
• Pain/weakness below knee

Question 4

Spinal stenosis usually develops slowly over time. It is most commonly caused by _____ or _____ changes that naturally occur in your spine as you age.

Answer 4

• Osteoarthritis
• “wear-and-tear”

Question 5

Depending on where and how severe the spinal stenosis is, the pt might feel

Answer 5

pain, numbing, tingling and/or weakness in the neck, back, arms, legs, hands or feet.

Question 6

Spinal stenosis can occur anywhere along the spine but most commonly occurs in two areas:

Answer 6

• Lower back (lumbar canal stenosis).
• Neck (cervical spinal stenosis).

Question 7

Symptoms of lumbar canal stenosis include pain, numbness or weakness in the legs, groin, hips, buttocks, and lower back. Symptoms usually worsen when _____ or _____ and might decrease when _____, _____, or _____.

Answer 7

• walking or standing
• lying down, sitting, or leaning slightly forward

Question 8

Spinal stenosis can develop in anyone but is most common in men and women over the age of __.

Answer 8

50

Question 9

What dx tests are run for spinal stenosis?

Answer 9

• X-rays
• MRI
• CT

Question 10

What will X-rays show related to spinal stenosis?

Answer 10

Changes in bone structure, such as loss of disk height and development of bone spurs that are narrowing the space in the spine

Question 11

What will an MRI show related to spinal stenosis?

Answer 11

Detailed images of the nerves, disks, spinal cord and presence of any tumors.

Question 12

What treatments are available for spinal stenosis?

Answer 12

• For mild s/s:
  
  • Self-care remedies
• For stronger s/s:
  
  • PT
  • Medication
  • Surgery (if all else fails)

Question 13

What are the self-help tx for spinal stenosis s/s?

Answer 13

• Apply heat
• Apply cold
• Exercise

Question 14

How does applying heat help relieve spinal stenosis s/s?

Answer 14

Heat increases blood flow, which relaxes muscles and relieves aching joints.

Question 15

How does applying cold help relieve spinal stenosis s/s?

Answer 15

• If heat therapy doesn’t work, cold therapy can be attempted
• Typically ice is applied 20 minutes on and 20 minutes off.
• Ice reduces swelling, tenderness and inflammation.

Question 16

How does applying exercise help relieve spinal stenosis s/s?

Answer 16

Exercise is helpful in relieving pain, strengthening muscles to support your spine and improving your flexibility and balance.

Question 17

What medications are used to help manage spinal stenosis s/s?

Answer 17

• NSAIDs: relieve pain and inflammation
  
  • ibuprofen (Advil®, Motrin®), naproxen (Aleve®), aspirin – or acetaminophen (Tylenol®)
  • Risk: acid reflux and stomach ulcers are sfx
• anti-seizure drug
  
  • gabapentin (Neurontin®) or
• tricyclic antidepressants such as
  
  • amitriptyline (Elavil®).
• Opioids, such as
  
  • oxycodone (Oxycontin®) or
  • hydrocodone (Vicodin®)

Question 18

When should a pt w/ spinal stenosis consider surgical options?

Answer 18

• Your symptoms are intolerable, you no longer have the quality of life you desire and you can’t do or enjoy everyday life activities.
• Your pain is caused by pressure on the spinal cord.
• Walking and maintaining your balance has become difficult.
• You have lost bowel or bladder control or have sexual function problems

Question 19

What are the surgical options for spinal stenosis?

Answer 19

• Laminectomy
• Laminotomy
• Laminoplasty
• Foraminotomy
• Spinal Fusion

Question 20

Describe Laminectomy.

Answer 20

• Aka: decompression surgery
• Most common surgery for spinal stenosis
• involves removing the lamina, which is a portion of the vertebra. Some ligaments and bone spurs may also be removed.
• The procedure makes room for the spinal cord and nerves, relieving your symptoms.

Question 21

Describe Laminotomy.

Answer 21

• This is a partial laminectomy.
• In this procedure, only a small part of the lamina is removed – the area causing the most pressure on the nerve.

Question 22

Describe Laminoplasty.

Answer 22

In this procedure, performed in the neck (cervical) area only, part of the lamina is removed to provide more canal space and metal plates and screws create a hinged bridge across the area where bone was removed

Question 23

Describe Foraminotomy

Answer 23

• The foramen is the area in the vertebrae where the nerve roots exit.
• The procedure involves removing bone or tissue this area to provide more space for the nerve roots.

Question 24

Describe spinal fusion:

Answer 24

• Spinal fusion surgery permanently joins (fuses) two vertebrae together.
• A laminectomy is usually performed first and bone removed during this procedure is used to create a bridge between two vertebrae, which stimulates new bone growth.
• The vertebrae are held together with screws, rods, hooks or wires until the vertebrae heal and grow together. The healing process takes six months to one year.