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Spinal stenosis

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In spinal stenosis, part of the spine narrows, putting pressure on your spinal cord or nerve roots. Knowing more about the spine's anatomy makes it easier to understand where and how this narrowing occurs. The main parts of your spine include:

  • Vertebrae. Your spine is made up of 24 bones stacked on top of one another, plus the sacrum and tailbone (coccyx). Most adults have seven vertebrae in the neck (cervical vertebrae), 12 at the back wall of the chest (thoracic vertebrae) and five vertebrae at the inward curve of the lower back (lumbar vertebrae). The sacrum consists of five fused vertebrae between the hip bones. The tailbone is composed of three to five fused bones at the very end of the spine.

  • Ligaments. These tough, elastic bands of tissue help keep the vertebrae in place when you move.

  • Intervertebral disks. These elastic pads of cartilage separate the vertebrae. They keep your spine flexible and act as shock absorbers to cushion the vertebrae when you move. Each disk consists of a ring of tough fibrous tissue (annulus fibrosis) surrounding a jelly-like center (nucleus pulposus).

Between each vertebra is an elastic pad of cartilage called an intervertebral disk. The disks consist of a tough, fibrous outer covering (annulus fibrosus) and a jelly-like center (nucleus pulposus)....Your back is composed of 24 vertebrae plus your sacrum and tailbone (coccyx), 31 pairs of nerves, 40 muscles, and a number of connecting tendons and ligaments. Between your vertebrae are fibrous,

  • Facet joints. Located on the sides, top and bottom of each vertebra, these joints connect the vertebrae to one another and stabilize the spine while still allowing flexibility. The joints are coated with a lubricant so that they slide smoothly.

  • Spinal cord. This long bundle of nerves extends from the brain stem at the base of your skull to the second lumbar vertebra in your lower back. When the spinal cord ends, another group of nerves (cauda equina) continues down the spinal canal. The nerves within the spinal cord (upper motor neurons) carry messages between your brain and the nerves that go to all the parts of your body below your head. Two spinal nerves — one leading to the right side of your body and one to the left side — extend out from the spinal cord between each vertebra. The nerves exit through openings on either side of the vertebrae (intervertebral foramina). In all, there are 31 pairs of spinal nerves in your neck and back. Some transmit information from your body to your brain. Others convey messages from your brain to your muscles, skin and other organs.

  • Spinal canal. This is a channel in the spine through which the spinal cord passes. Normally, the channel is spacious enough to accommodate the spinal cord, but degenerative changes in the spine can narrow the canal.

How spinal stenosis develops
Doctors categorize stenosis as either primary or acquired. Primary stenosis, which is relatively uncommon, results from disorders that are present at birth. Acquired spinal stenosis, on the other hand, develops later in life, usually as a result of degenerative changes in the spine that occur with aging. Most cases of spinal stenosis are caused by these degenerative changes.

The main cause of spinal degeneration is osteoarthritis, an arthritic condition that affects the cartilage that cushions the ends of bones in your joints. With time, the cartilage begins to deteriorate and its smooth surface becomes rough. If it wears down completely, bone may rub painfully on bone. In an attempt to repair the damage, your body may produce bony growths called bone spurs. When these form on the facet joints in the spine, they narrow the spinal canal.

Osteoarthritis can also affect the disks in your spine. By the time you're 30, your disks may start to show signs of deterioration. They begin to lose their water content, becoming flatter and more brittle.

Eventually, the tough, fibrous outer covering of the disk may develop tiny tears, causing the jelly-like substance in the disk's center to seep out (herniation or rupture). The herniated disk presses on the surrounding nerves, causing pain — which sometimes may be excruciating — in your back, leg or both. Sometimes you may also have numbness, tingling or weakness in the buttock, leg or foot on the affected side.

The ligaments in your back may also undergo degenerative changes, becoming stiff and thick over time. This loss of elasticity may shorten the spine, narrowing the spinal canal and compressing the nerve roots. Sometimes wear and tear on the disks and ligaments causes one lumbar vertebra to slip over another — a condition called spondylolisthesis. This often compresses the spinal nerves, leading to numbness, tingling and weakness in your legs, especially when you stand for long periods or when you walk.

Not all spinal stenosis is age-related. Other causes of narrowing in the spine include:

  • Spinal tumors. A tumor is a mass of abnormal cells. In the spine, these growths may occur inside the spinal cord, within the membranes (meninges) that cover the spinal cord, or in the space between the spinal cord and the vertebrae — the most common site. Tumors may also spread (metastasize) to the spine or the spinal cord from other parts of the body. Primary or metastastic tumors can occur anywhere along the spine, including the sacrum and thoracic spine, where osteoarthritis is rare.

  • Growing tumors may compress the spinal cord and nerve roots. This can cause severe back pain that may extend to your hips, legs or feet; muscle weakness and a loss of sensation — especially in your legs; difficulty walking or even paralysis; and sometimes loss of bladder or bowel function.

  • Injury. Car accidents and other trauma can profoundly affect the spine and spinal cord. Sometimes the spine or spinal canal may be dislocated, putting pressure on the cord and lower motor neurons. In other cases, fragments of bone from a spinal fracture may penetrate the spinal canal. Swelling of tissue after back surgery can also put pressure on the spinal cord or nerves.

  • Paget's disease of bone. Bone is living tissue engaged in a continuous process of renewal. During this remodeling process, old bone is removed and replaced by new bone. In Paget's disease, your body generates new bone at a faster-than-normal rate. This produces soft, weak bones that are prone to fractures. It can also create bones that are deformed or abnormally large. When unusually large bones develop in the spine, they compress the spinal cord or the nerves exiting your brain and spinal cord. The resulting pain is often severe and may radiate from your lower back into your legs. You also may experience numbness, tingling or weakness in the legs or, in some cases, double vision.

  • Achondroplasia. This genetic disorder slows the rate at which bone forms during fetal development and in early childhood. As a result, people with achondroplasia are of short stature — often no more than four feet tall when fully grown. They often have small hands and fingers and unusually short upper arms and thighs. They also have a small spinal canal, which puts pressure on the spinal cord. This can cause severe back and leg pain and may even lead to paralysis of the legs. In some cases, babies or children with achondroplasia die suddenly — often in their sleep — when compression of the upper end of the spinal cord interferes with their breathing.

Risk factors

In fact, age is the main known risk factor for the disorder.

Also at risk are people with skeletal fluorosis, a sometimes crippling bone disease caused by high levels of fluoride in the body. Although the disease is rare, the World Health Organization estimates that nearly three million people worldwide have the most severe form of the disorder. Fluorosis causes the spine to become nearly immobile and joints throughout the body to stiffen, making movement of any kind painful and difficult.

When to seek medical advice

Unfortunately, many people ignore the symptoms of spinal stenosis, believing that the pain and stiffness they experience are a normal part of aging. But discomfort, especially if it interferes with your mobility, is never normal. Seek medical advice if you have pain, stiffness, numbness or weakness in your back, legs, neck or shoulders that's not related to exercise or overexertion. Spinal stenosis is especially likely if you have leg pain that gets worse when you walk and improves when you sit or bend forward. Get immediate care if you suddenly have trouble controlling your bowels or bladder.


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