Stenosis (narrowing) can affect both blood vessels and the spinal canal. In the case of cardiovascular stenosis, fatty deposits resulting from metabolic disorders give rise to a narrowing of the vessels, while in spinal stenosis, the narrowing of the spinal canal can be caused by four factors: (i) Heredity (ii) Development (iii) Degeneration (iv) Trauma.
Cardiovascular stenosis often co-exists with spinal stenosis and is particularly common in older patients. Usually, the patient can walk up to 100 metres without difficulty, but then problems such as severe cramps in the calf can appear. When spinal stenosis is caused by heredity or developmental factors, the shape of the canal can be triangular or the neural arcs in the vertebrae can fail to develop properly (as in spondylothesis). A collapsed disc may give rise to stenosis and if it is an anterior herniation (generally caused by a physical trauma) then this would be one of the rare cases requiring surgical treatment.
Spinal stenosis caused by degeneration is usually limited to the L4/L5 level and often affects women who are 50yrs old or more. The condition can easily affect the root canals of the spinal nerves and not just the column. Osteophytosis which results in a growth of the bony spurs of the spine usually on the posterior part of the vertebrae can also give rise to stenosis. In older patients however, a natural stiffening of the vertebral column can paradoxically make the condition asymptomatic.
Some conditions are dormant and asymptomatic and therefore care must be taken before acting on the results of MRI scans or x-rays which can often give a false impression as to the causes of the patient's pain. If surgery is carried out based on the results of such scans (and it often is), it will not provide any cure if in fact the patient's pain is due to some other cause.
The general approach to treatment is to test the mobility of the joints at the affected levels and to ascertain whether the pain is localised or referred. Secondary symptoms such as numbness, temperature of the limbs, muscular weakness and other neurological deficit can guide the correct approach to be adopted. The passive mobility of the affected joints must be restored physically for each of the six possible ranges of movement: flexion, extension, lateral flexion either side, and rotation. Sometimes in order to treat a complicated condition and depending on the pathology of the case, a manual or mehanical method of traction can be applied to lengthen the spine after mobilisation has been carried out. This all helps to reduce neurological symptoms so that the patient for example can walk more easily. Repetitive traction is mistakenly carried out in some hospitals but this should be avoided because it can cause hyper-mobility in the joints.
The patient is asked to practice specific spinal exercises to strengthen the abdominal muscles which help to control (50%) of the stability of the spinal column.
It is to be noted that lumbar disc herniations and spinal stenosis have different clinical symptoms, while stenosis may sometimes be caused by a tumour or an aneurysm. Surgical methods attempt to restore the stability of the affected area using decompressive laminectomy (see our links section for more information on this procedure). In our experience spinal surgery for this condition is counter-productve.
It can safely be said that for the vast majority of spinal conditions surgery is neither necessary nor effective, as it almost always leads to long term complications and suffering for the patient, out of all proportion to the original condition. The use of metal rods, screws and plates and the cutting away of parts of the spine, even the heating of discs to cause them to shrink (IDET procedure) represent a rather crude approach to the treatment of spinal problems and is not a method of 'treatment' that we can ever recommend.
The procedures of Orthopaedic Medicine outlined above do not involve operating on a patient, and all treatment is safe and manageable as well as being highly effective.