Cervical and lumbar canal stenosis (Laminectomy and laminoplasty)

Spinal stenosis is an abnormal narrowing (stenosis) of the spinal canal that may occur in any of the regions of the spine. This narrowing causes a restriction to the spinal canal, resulting in a neurological deficit. Symptoms include pain, numbness, paraesthesia, and loss of motor control. The location of the stenosis determines which area of the body is affected. With spinal stenosis, the spinal canal is narrowed at the vertebral canal, which is a foramen between the vertebrae where the spinal cord (in the cervical or thoracic spine) or nerve roots (in the lumbar spine) pass through. There are several types of spinal stenosis: lumbar stenosis and cervical stenosis being the most frequent. While lumbar spinal stenosis is more common, cervical spinal stenosis is more dangerous because it involves compression of the spinal cord whereas the lumbar spinal stenosis involves compression of the cauda equina.

Types

The most common forms are cervical spinal stenosis, at the level of the neck, and lumbar spinal stenosis, at the level of the lower back. Thoracic spinal stenosis, at the level of the mid-back, is much less common.

In lumbar stenosis, the spinal nerve roots in the lower back are compressed which can lead to symptoms of sciatica (tingling, weakness, or numbness that radiates from the low back and into the buttocks and legs).

Cervical spinal stenosis can be far more dangerous by compressing the spinal cord. Cervical canal stenosis may lead to serious symptoms such as major body weakness and paralysis. Such severe spinal stenosis symptoms are virtually absent in lumbar stenosis, however, as the spinal cord terminates at the top end of the adult lumbar spine, with only nerve roots (cauda equina) continuing further down. Cervical spinal stenosis is a condition involving narrowing of the spinal canal at the level of the neck. It is frequently due to chronic degeneration, but may also be congenital or traumatic. Treatment frequently is surgical.

Signs and symptoms

Illustration depicting spinal stenosis and spinal cord compression

Common

  • Standing discomfort (94%)
  • Numbness (63%)
  • Weakness (43%)
  • Bilateral symptoms (68%)
  • Discomfort above and below knee (78%)
  • Buttock / Thigh only (15%)
  • Below the knee (7%)
  • “Shopping cart sign”- need to grab a shopping cart when going into a store in order to hold onto the cart and bend over relieving the pain in the legs.

Neurological disorders

  • Pinched nerve, causing numbness.
  • Intermittent neurogenic claudication  characterized by lower limb numbness, weakness, diffuse or radicular leg pain associated with paresthesis (bilaterally), weakness heaviness in buttocks radiating into lower extremities with walking or prolonged standing.  Symptoms occur with extension of spine and are relieved with spine flexion. Minimal to zero symptoms when seated or supine.

A human vertebral column

  • Radiculopathy (with or without radicular pain)  neurologic condition – nerve root dysfunction causes objective signs such as weakness, loss of sensation and of reflex.
  • Cauda equina syndrome  Lower extremity pain, weakness, numbness that may involve perineum and buttocks, associated with bladder and bowel dysfunction.

Other

  • Fever
  • Nocturnal pain
  • Gait disturbance
  • Structural deformity
  • Unexplained weight loss
  • Previous carcinoma
  • Severe pain upon lying down
  • Recent trauma with suspicious fracture
  • Presence of severe or progressive neurologic deficit
  • Lower back pain due to degenerative disc or joint changes
  • Narrowing of spinal canal, nerve root canal or intervertebral Canal Stenosis: Start with nonsurgical therapy. Cleveland ral foramina

Causes

Aging: All the factors below may cause the spaces in the spine to narrow,

  • Body’s ligaments can thicken (ligamentum flavum)
  • Bone spurs develop on the bone and into the spinal canal
  • Intervertebral discs may bulge or herniate into the canal
  • Facet joints break down
  • Compression fractures of the spine, which are common in osteoporosis
  • Cysts form on the facet joints causing compression of the spinal sack of nerves (thecal sac)

Arthritis: Two types,

  • Osteoarthritis
  • Rheumatoid arthritis—much less common cause of spinal problems

Heredity:

  • Spinal canal is too small at birth
  • Structural deformities of the vertebrae may cause narrowing of the spinal canal

Instability of the spine, or spondylolisthesis:

  • A vertebra slips forward on another

Trauma:

  • Accidents and injuries may dislocate the spine and the spinal canal or cause burst fractures that yield fragments of bone that go through the canal

Tumors of the spine:

  • Irregular growths of soft tissue will cause inflammation
  • Growth of tissue into the canal pressing on nerves, the sac of nerves, or the spinal cord.