Screening and diagnosis
Spinal stenosis can be difficult to diagnose because its signs and
symptoms are often intermittent and because they resemble those of many
age-related conditions. To help diagnose spinal stenosis and rule out
other disorders, your doctor will ask about your medical history and
perform a physical exam that may include checking your range of motion
and leg reflexes.
You are also likely to have one or more of the following tests:
Although an X-ray isn't likely to confirm that you have spinal
stenosis, it can help rule out problems that cause similar symptoms,
including a fracture, bone tumor or inherited defect.
resonance imaging (MRI).
In many cases, this is the imaging test of choice for diagnosing
spinal stenosis. Instead of X-rays, an MRI uses a powerful magnet
and radio waves to produce cross-sectional images of your back. The
test can detect damage to your disks and ligaments as well as the
presence of tumors.
tomography (CT) scan.
This test uses a narrow beam of radiation to produce detailed,
cross-sectional images of your body, including the shape and size of
your spinal canal. Because this test exposes you to more radiation
than does a regular X-ray, it's not recommended if you're pregnant.
This may be the most sensitive test for detecting spinal stenosis,
but because it poses more risks than MRI or CT, it may not be your
doctor's first choice. If you're contemplating surgery, however,
your doctor may recommend a CT myelogram to assess the severity of
the stenosis. In a myelogram, a contrast dye is injected into your
spinal column. The dye then circulates around your spinal cord and
spinal nerves, which appear white on the X-ray. A myelogram can show
herniated disks, bone spurs and tumors.
In this test, a small amount of a radioactive material that attaches
to bone is injected into a vein in your arm. The material emits
waves of radiation that are detected by a gamma camera. The camera
then produces images of your bones. In a sense, a bone scan is the
opposite of a standard X-ray, in which radiation passes through your
body to create an image on film. A bone scan can detect a number of
bone disorders, but often can't distinguish among them. For that
reason, it's usually performed with other tests.
Sometimes your doctor may inject you with a spinal nerve block or
epidural steroids. If your symptoms improve after the injection —
you can walk without pain, say — spinal stenosis is likely the cause
of your discomfort. The problem with this approach is that a
negative finding doesn't mean you don't have spinal stenosis.
Nerve compression sometimes causes a loss of feeling in your feet or
legs. As a result, cuts or wounds may become seriously infected because
you're not aware of them. In addition, spinal stenosis sometimes
interferes with bowel or bladder function — a problem that can affect
your quality of life. And although treatment can relieve symptoms of
spinal stenosis, it doesn't stop degenerative changes. Some of these
changes, such as muscle atrophy, may be permanent, even after the
pressure is relieved.
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