Spinal Stenosis
Treatment In Dubai

Spinal Stenosis develops gradually over time, usually caused by wear and tear or degenerative changes.

What Is Spinal Stenosis?

Spinal Stenosis is the narrowing of spaces within the spinal canal. The narrowing of spaces leaves less space for the spinal cord or nerves to function well, causing a variety of symptoms. Compression of the spinal cord or nerves can cause pain to radiate down the arms or legs, pins and needles, and numbness. It can also cause bowel, bladder, or sexual dysfunction. Sometimes patients report difficulty with their balance, and in severe cases, they may find themselves repeatedly falling over.

Spinal Stenosis usually affects the neck (cervical spine) and lower back (lumbar region). It is mostly caused by wear and tear due to ageing and osteoarthritis.

Spinal stenosis is of two types, classified based on their site:

Cervical Spinal Stenosis

Cervical stenosis occurs in the neck region. Compression of the spinal cord in this region causes cervical myelopathy – symptoms due to compression of the spinal cord. Compression of nerves as they leave the spinal cord, on the other hand, causes cervical radiculopathy.

Lumbar Spinal Stenosis

The lumbar region or the lower back has no spinal cord – a condition where the cord has terminated, and only nerves are there. Compression of these nerves leads to lumbar spinal stenosis.

What Causes Spinal Stenosis?

Although spinal stenosis can be caused for several reasons, it shares the same fundamental cause, that is, nerve pinching due to the narrowing of spaces in the spinal canal. Spinal stenosis is caused for the following reasons.

Bone overgrowth/ Bone spurs

Osteoarthritis, or wear and tear of the spine, is the most common cause of spinal stenosis. The protective cartilage layer on the joint wears over time, and, as a result, the bones rub against each other. As a natural bodily response, uneven bone overgrowth replaces the wear and tear, which is called bone spur. The bone spurs extend into the spinal canal, decreasing the space in the canal and compressing the spinal nerves.

Bulging disc

Decreased height of the disc and bulging causes the canal to be narrowed, which in combination with bone spurs, can cause severe spinal stenosis.

Thickening of spinal ligaments

The ligaments are fibrous bands that bind the spinal structure. Arthritis may cause ligaments to thicken, harden, and bulge into the spinal space, causing spinal stenosis.

Symptoms

Spinal Stenosis is a gradual process. Its symptoms may come on all of a sudden, or they may gradually increase in time. Spinal stenosis affects different parts of the spine, and hence symptoms can vary:

Cervical Stenosis

Neck pain
Pain while moving the neck
Tingling sensations extending to arms and legs
Problems with balance

Difficulty walking
Reduced manual dexterity while writing, buttoning a shirt, or using other fine hand movements
Weakness and clumsiness in the hands and feet

Lumbar Stenosis

Pain in the lower back
Sciatica (pain radiating down below the knee)
Tingling sensations (pins and needles) that travel down one or both legs
Pain, heaviness, numbness or pins and needles on walking. These symptoms usually resolve on rest.

Diagnosis

Some symptoms of spinal stenosis are common to other spine disorders. Hence, our spine surgeon Dr. Sherief Eslayed looks into the finer details to discover the root cause of the problem. He begins the diagnosis by interrogating the complete medical history and physical examination.

Dr Sherief physically examines the area and asks the patient to perform a walking test or motion test involving certain bones and a set of muscles. To conclude better, he may seek the help of the following investigations:

X-ray – These use a small amount of radiation to obtain internal images of the spine. This may help the doctor to analyze bone spurs, thinning, deformities, fractures in the vertebrae, disc or cartilage deformity, or any other alteration in the axis.
MRI – Magnetic Resonance Imaging uses radio waves and in a magnetic environment to obtain more vivid, more internal images of the spine and nerves around the spine. It helps with the detailed analysis of nerves, discs, vertebrae, or tumours.
CT Scan Or Myelogram– This technology utilizes multiple X-rays to obtain detailed images of the spine in cross-section. Occasionally a contrast dye is used to aid visualization.

Treatment Of Spine Stenosis

Spine Stenosis is an age-related and common disorder. Many cases are helped with physical therapy, medicines, and sometimes steroid injections. However, delaying the stenosis treatment in Dubai may aggravate and lead to poorer outcomes in the long term.

The prescribed treatment depends upon the overall condition of the patient. Accordingly, the treatment is classified as

Oral Medication

Non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen and diclofenac help to relieve pain from spinal stenosis. The doctor may also provide muscle relaxant medications to treat muscle cramps and spasms.

Steroid Injections

When medications do not give as much pain relief as required, the doctor may administer corticosteroid injections, a steroid injection in the epidural space, to relieve pain. Steroid injections are chosen judiciously for use, as their excess usage may weaken bones.

Therapies

The doctor may or may not ask for therapy with medications. Therapy typically consists of physiotherapy in combination with home exercises. Exercise helps to increase blood circulation, may aid the release of nerve roots, and muscle spasms, and strengthens muscles and bones.

Spinal stenosis surgery

Surgery is an excellent option if leg symptoms are the predominant concern.

Occasionally urgent surgery is required – if there is weakness or loss of bladder/bowel / sexual function.

Surgery may also be suggested if there is

Instability in the spine
Unbearable pain while sitting or standing
Problems while walking and performing day-to-day activities
Spinal stenosis is worsening and not responsive to conservative treatment with medicine and therapies

Surgery aims to decompress the compressed nerves and stabilize the vertebrae to give a long-term solution to spinal stenosis. Some surgical methods used are

Laminotomy for decompression
Laminectomy for decompression
Spinal fusion – Anterior Lumbar Interbody Fusion (ALIF), Transforaminal Lumbar Interbody Fusion (TLIF), Lateral Lumbar Interbody Fusion (LLIF)