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Mark A. Wolgin, MD, Orthopaedic Surgeon

Specialist (Fellowship Trained) in Spinal and Foot/Ankle Surgery, Albany, GA, Office Phone 229-883-4707

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Spinal Stenosis (Narrowing)
 
Spinal stenosis is a condition, where due to some type of process, either degenerative (wear and tear), for reasons related to either the discs or facet joints, or because of a change of position of the spine bones, the space for the nerves becomes more narrow.
 
 
In the illustration above, the area marked "spinal canal" is where the spinal nerves are located. 
 
MRI examples of stenosis: 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CT Myelogram (see below) examples showing stenosis:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The image here is from a CT myelogram, which is a test where radiographic dye (shown here in white) is injected into the spinal canal along with the spinal fluid, to help show how much room there is for the spinal nerves.  The vertebral bodies are in front, here facing left.
 
Narrowing at the L4-5 level can been seen
 
 
 
 
 
 
 
 
 
 
 
 
 
In this cross sectional view, note the dimensions of the column of fluid (dye in the spinal fluid space) in a region without stenosis.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
In this cross section seen at the L4-5 level, both the severe narrowing of the space available for the nerves, along with the enlargement and arthritic change of the facet joints can be seen. 
 
For more information on facet arthrosis (wear and tear), click here.
 
 
 
 
 
 
 
 
What often will occur in degenerative conditions is that due to the combination of the disc settling (think of the disc as a jelly donut, having the jelly dry out), the arthritic processes of the facet joints, and the subsequent infolding of the ligaments between the bones, the area for the nerves becomes too narrow.  
 
The effect on the nerves can best be understood by thinking of the analogy of a belt around your waist: if that belt started to tighten, the soft tissue underneath (your waist in this example) is compressed.

 

 

 

 

In these myelograms, which are studies where dye is placed in the dural sac where the spinal nerves reside, the narrowing can be seen lower in the spine.  Although these are different patients, the arrow can direct your attention to the area where the spinal canal is too narrow to even allow the fluid to be seen.


 

 
 
 
 
 
 
 
 
 
 
 
 
 
Symptoms:
Eventually, a person develops symptoms that frequently include heaviness in the legs, fatigue, leg pain, numbness, and weakness. Frequently, the symptoms are made worse by walking and standing, as the upright posture causes a small amount of increased compression on the nerves. Commonly, patients will have relief by sitting, as the forward flexion gives a little bit of increased volume to the spinal canal, which is where the nerves are located.  
 
These changes usually occur in patients over 50.  The changes can happen very slowly, often over years.
 
While non-operative treatments such as medications, physical therapy, and injections can help some, surgery is frequently needed to relieve the pressure on the nerves.
 
When non-operative treatments fail to help, often the patient will choose a surgical option, such as laminectomy, which is usually an open procedure, or with a minimally invasive approach, a microdecompression can be done in many cases.