Neurological Disorders: Stenosis of the Spine

Stenosis of the Spine (also commonly called as Spinal Stenosis) is not an uncommon nervous system disease and results from shrinkage of the spinal canal. Shrinkage or stenosis or narrowing of the spinal canal results in pressure or compression of the spinal cord or the spinal nerves (depending upon the location of the stenosis) and may manifest with neurological deficits which may include weakness, sensory loss, numbness, bowel or bladder deficits etc.

Spine or back bone is actually a column produced by several individual bones named as vertebrae. In humans there are generally 33 such vertebra. From above downwards they are labeled as cervical (neck area), thoracic (chest area), lumbar, sacral and coccygeal in the lower back areas.

There are 7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 4 coccygeal vertebrae. The 5 sacral vertebrae are united to form a single sacrum bone while the 4 coccygeal bones are united to form a single coccyx bone.

The space inside the spine or spinal column is called as spinal canal and it lodges and protects the spinal cord. Various spinal nerves emerge from the spinal cord and exit the spine through narrow holes called as intervertebral foramina.

As pointed above spinal stenosis is nothing but the shrinkage or narrowing of the spinal canal. In normal people there is only a small extra space around the spinal cord and its coverings called as meninges. However if anything compromises this space then the result is spinal-stenosis.

This condition can occur focally confined to a small area or more diffusely, means it can occur at one vertebral or its disc level or at multiple levels.

Depending upon the location;

• Cervial stenosis
• Thoracic stenosis
• Lumbar stenosis
• Sacral stenosis
• Combination of above

The thoracic spinal stenosis is uncommon, but in other regions it is not uncommon.

Depending upon what causes it;

• Congenital stenosis
• Acquired stenosis

Congenital means someone born with this condition. Acquired is due to certain pathologies developing later in life (more details see below).

Depending upon the severity;

• Mild stenosis
• Moderate stenosis
• Severe stenosis

This condiion can be simply due to a congenital narrowing of the spinal canal. In the acquired variety - degenerative spine disease is the commonest cause. A herniated disc, spinal tumors, epidural abscess, bleed etc can cause focal stenosis.

• Pain (lower back or cervical)
• Radiculopathy symptoms (shooting pain from the neck to the arms OR from the lower back to the legs like an electrical shock)
• Numbness in the arms or legs
• Tingling feeling (pins & needles)
• Bowel & bladder disturbances
• Weakness of arms or legs
• Difficulty with walking
• Neurogenic claudication etc.

Not all patients will present with each and every symptom mentioned above.

Neurogenic claudication means the pain, tightness and discomfort that occurs while a patient with lumbosacral spinal stenosis is walking; mostly felt in the calves, and doesn't get better just by stopping the walking and actually sitting down is required.

In contract a similar situation called s vascular claudication presents somewhat similarly with pain in the legs while walking, however the patient need not sit down, just stopping the walking will result in pain improvement. This condition is due to the result of compromised arterial blood supply to the legs.

Neurogenic claudication is a characteristic symptom of spinal stenosis occurring at the lower back area.

A neurologist is commonly involved in the management of spinal stenosis patients.