SPINAL STENOSIS – Cause, Symptoms, Treatment & Surgery
Our spine comprises a stack of vertebrae and the canal that is formed by the central openings in these vertebrae. This spinal canal which runs from the head to the pelvis is divided into three parts: the cervical spine in the neck, the thoracic spine in the middle back and the lumbar spine in the lower back.
This canal holds the very important organ that is the spinal cord which passes from the brain through the spinal canal down to the lower back. Between the vertebrae, there are nerves exiting. Nerves that exit from the neck control the arm movement and the ones that exist in the low back, regulate the movement of legs.
What is spinal stenosis?
It is a condition that is characterized by abnormal narrowing in the spinal canal. It is observed to occur mostly in the cervical and lumbar spine. This narrowing limits the space, thereby exerting pressure on the spinal cord and nerves. As this condition becomes severe, the cord and nerves get compressed and squeezed. This disorder usually occurs due to degenerative arthritis or happens in elderly people due to the ageing of bones and tissue. It becomes severe as the person’s age progresses. People that perform strenuous work or have a history of spinal complaints of pain etc. are likely to develop this condition.
Symptoms due to compression of the spinal cord are called myelopathy. The person suffering from this might experience loss of balance, frequent falling or dropping objects, loss of control of the bowel or bladder or loss of control over the movement of arms and hence might have difficulty in dealing with smaller objects like shirt buttons or coins.
Symptoms due to compression of the nerves that exit the spinal cord are called radiculopathy. These might be pain, numbness or tingling sensation along the path of that particular nerve.
If the compression occurs in the neck, it is called as cervical spine stenosis and along with myelopathy the person might experience weakness or cramps in arms or hands, numbness and pain.
If it occurs in the lower back it is called lumbar spinal stenosis and this might cause weakness or cramps in the legs and feet, which increases with activities like walking.
If these symptoms are observed for more than 4 weeks and do not seem to subside, it is an indication to seek medical advice.
As per the protocol, the doctor would first derive the medical history as to the nature of symptoms, duration, kind of lifestyle, any past injuries or trauma, when were the first signs etc. This helps them to analyze the nature, intensity, and trigger of stenosis.
This is then followed by the physical examination that includes testing nerve function, sensations, reflexes and strength of muscles.
Once the doctor arrives at some analysis, the patient is asked to undergo imaging tests like X-ray and Magnetic Resonance Imaging (MRI), rarely CT scan if needed, Nerve condition studies are conducted to ascertain the damage to nerves.
At the initial stage, it can be cured by limiting activity, appropriate rest, medications, therapeutic hot or cold packs and exercises. The symptoms gradually lessen and there will be a relief.
If the non-surgical treatment fails and the symptoms begin to worsen, the patient would have to undergo surgery. Depending on the location and type of compression, there are a number of surgical options that aim to increase the space in the canal for the spinal cord or the nerves that are being compressed.
Surgery for Lumbar Spinal Stenosis
This is known as laminectomy. A small portion of the vertebra is removed to create additional space for the nerve. If a bigger part of the bone needs to be removed, or if there is extra space causing unwanted motion between bones, a combined surgery of decompression and fusion is done to support the spine.
Surgery for Cervical Spinal Stenosis
An anterior cervical discectomy and fusion (ACDF) is the most widely used treatment method. Bone overgrowth that exert pressure on nerves or cord along with the disc between the vertebrae are removed. This space is then filled with a bone graft or a cage made of PEEK material in place of the disc and a metal plate may be also used to fix the vertebrae to facilitate bone growth and fusion.
In the case of multiple locations of compression, the vertebrae is removed and it is replaced with a bone graft and a metal plate. This process is called corpectomy.
The next option is laminoplasty where the back of spinal canal is opened and more space is created. It is left open and supported by bone grafts and metal plates.
Duration: The surgery requires a hospital stay of 4-5 days and another 2-3 weeks for recovery.
A follow-up is extremely crucial for the doctor to observe the results of surgery and restoration. Immediately after surgery, there are frequent follow-up sessions to monitor the spine and trace for relapse in compression. These sessions might reduce after there is an observed improvement. But the follow-up process can go for more than a year.
Cost of surgery
Depending on the category of the hospital, city, country, doctor, the severity of stenosis, the number of compression spots treated, the cost of surgery for spinal stenosis would vary. Approximately it may range from 2.5 to 4.5 lacs INR or 7000 to 9000 USD.
To get an exact estimate as per your MRI images, syptoms and patient condition, please contact us at +91-9891778811