Back pain is the most prevalent type of pain worldwide.It is estimated that 60% to 80% of the world’s population will suffer it at least once in their lifetime. One third of the people who suffer from low back pain report considerable discomfort, with a value higher than 5 if they were to place it on a scale of 1 to 10.
Within this type of discomfort, approximately 80-90% is acute (transitory), while 10-20% of patients suffer from chronic discomfort, that is to say, continuous over time. Curiously, the prevalence of back pain decreases in later life (after 70 years of age), presumably due to the “survivor effect” or because other pathologies take over the general sensation of pain.
With all these data, we wanted to draw an indisputable general picture: back pain is extremely common in society in general, especially in middle-aged and older people. Today we come to bring you the causes, symptoms and treatment of spinal stenosis, a pathology linked to back pain with diverse clinical particularities..
What is spinal canal stenosis?
Vertebral canal stenosis (also known as spinal canal stenosis) is caused by a narrowing of the space through which the spinal cord and nerve roots pass.These are responsible for transmitting nerve impulses to the 31 pairs of spinal nerves, which communicate the brain with the rest of the body. This pathology ranges from the occipito-cervical to the lumbo-sacral area.
A slightly narrower than usual spinal canal does not necessarily cause symptoms, so many people present without showing any clinical signs. Unfortunately, other patients report pain, tingling, numbness and prolonged muscle weakness. Two types of spinal canal stenosis are distinguished according to their location, and we will tell you about them briefly below.
1. Stenosis at the lumbar or dorsal level
Almost all the people in the world experience lumbar pain (in the lower back) at some point in their lives. Some of these discomforts find their origin in a lumbar stenosis, when the stenosis itself occurs in the lower back. This is the result of a reduction of the space surrounding the spinal cord, generating pressure on the spinal cord itself and on the spinal nerves.
Generally, lumbar spinal stenosis is a natural product of aging. As people get older, the soft tissues and bones in the spine may stiffen or have additional growth. These slowly but steadily advancing degenerations can lead to stenosis, among many other pathologies.
2. Cervical stenosis
In this condition, the narrowing occurs in the upper part of the spine, thus compromising structures such as the neck. Again, it is usually caused by age-related “disc bulging,” so it is more common in patients over the age of 50.
As we have said, both cervical and lumbar stenosis are largely related to the normal aging process, but these need not be the only possible causes, although they are certainly the most common.
For example, stenosis may be congenital and present from birth, due to alterations in the tissues of the lumbar spine.due to alterations in the tissues of the spine acquired during physiological development. It can also be the result of direct trauma, which has damaged the vertebral tissues and caused irreversible alterations in them. The last of the causes considered are neoplasms, the formation of tumors in the spine, which “pinch” the spinal cord and spinal nerves in a manner similar to that of a degenerative stenosis.
The symptoms of stenosis vary slightly depending on whether it is a cervical or lumbar stenosis.but we can unite them in the following significant clinical signs:
- Numbness and tingling in the hand, arm, foot or leg.
- Weakness in certain extremities.
- Difficulty walking and loss of balance.
- Neck pain.
As you can imagine, cervical stenosis more directly involves the arms, neck and hands, while dorsal stenosis causes more problems in walking and legs. In any case, both are highly correlated, as the muscle contractures generated by the misalignment can cause discomfort beyond the area of the stenosis.
Not all patients are symptomaticand those who do present symptoms usually do so slowly over months or years. On the other hand, if the cause is trauma, the onset will naturally be much more sudden.
In many cases, surgery is not considered in the first instance, as it is usually the last option when other treatments do not work. In addition, there are certain changes in the daily routine that can help the patient to cope with the pain: exercise, physical therapy and changes in the way physical activities are done to reduce pain are often small additions to the daily routine. to reduce pain are often small additions that make the symptomatology somewhat more tolerable.
Of course, it is not all about individual willpower. If the pain prevents the patient from functioning, the relevant professional will prescribe analgesics, anticonvulsants, opioids and even antidepressants, all with the aim of alleviating the chronic discomfort that stenosis can generate. Even the injection of steroids into the affected area is considered, as these can reduce the inflammation of the involved nerve root if other treatments are ineffective.
If none of the above works, it is time for surgery.. Decompressive laminectomy is the most commonly used procedure in these cases, as it is based on the removal of excess vertebral bone tissue and thickening in order to avoid compression and irritation of the spinal cord and nerves involved. 3 months after the operation, clear improvements begin to be observed and pain decreases considerably for at least 4 years after the operation.
In any case, it should be kept in mind that all surgery involves risks, especially if it is performed on an elderly patient (as is the case of many of those with stenosis). Some of the complications in the operating room or after surgery may include the following: deep surgical wound infections, blood clots, nerve damage, fibrous tissue tears and even permanent chronic pain. While most people do not experience these events, they need to be reported.
The prognosis of spinal canal stenosis depends entirely on the severity of the stenosis and the underlying cause. Typically, the severity of a stenosis is inversely linked to the walking distance the patient can walk without pain: it is considered severe if discomfort occurs at 200 meters walking distance and very severe if this value decreases to 50.
Unfortunately, surgery for stenosis does not ensure that the patient will forget about it for the rest of his or her life.. It is possible that the stenosis may occur elsewhere in the spine, that the procedure itself may not completely alleviate the symptoms, or that the previously treated tissues may thicken again. In this case, there is no choice but to undergo a surgical procedure again and hope that the effects will be more long-lasting.
As you will have seen, the approach to spinal canal stenosis is delicate, the approach to spinal canal stenosis is a delicate one.The operation is not without risk and the treatment requires an interdisciplinary integration of subjects: psychology, physiotherapy and medicine merge to try to help the patient learn to manage his pain and at the same time manage to reduce it. If this discomfort becomes chronic and does not improve with the previously described options, surgery is the only remaining option.
Unfortunately, stenosis is an inevitable phenomenon that occurs in many people simply because of the passage of time. It can be addressed with certain changes in routine and medication, but the patient may have to become accustomed to relative back discomfort for years to come. Sometimes, fighting the passage of time is not a very viable option if the potential risks of an intervention outweigh the benefits.