Central spinal canal stenosis is a disordered condition the reason behind which is the narrowing of the central canal of the vertebral column. This disorder takes place because of the degeneration of intervertebral discs and joints of the vertebral column. In this disorder, osteophytes or bone spurs grow in the central vertebral canal. The facet joints of the spine also become inflamed and enlarged. This factors also cause a decrease in the space available for nerve roots. The ligaments of the back also become thickened and stiffened which reduce the mobility of the back.
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Symptoms of Central Canal Stenosis
There may be many symptoms of central vertebral column stenosis. Some of which are described as following
- Weakness, numbness, pain and tingling sensations in the buttocks, legs, calf muscles and feet.
- Cramp formation in the calf muscles especially during walking which demands you to take frequent short breaks of rest during walking.
- Pain resembling sciatica, i.e. the pain radiates into buttocks, one or both thighs and legs.
- In some cases, the sphincter function of bowel and bladder is also disturbed resulting in urinary and faecal incontinence. Motor function of legs may also be disturbed causing difficulty in walking. These symptoms appear due to nerve compressions.
- In some patients, pain improves on leaning forward, lying down or sitting.
- Shooting pain that resembles an electric shock in case of cervical stenosis specifically during the flexion of the neck.
- Feeling of pins or needles in the buttocks and affected region.The symptoms of central canal stenosis appear similar to those of disc herniation but the difference is that disc herniation is an acute event. Its symptoms appear suddenly while canal stenosis is a chronic event. Its symptoms develop slowly over a period of time.
Adjacent Structures That Can Be Damaged
Central vertebral column stenosis is not merely confined to the vertebral column itself. It also leads to the destruction of adjacent structures.
- Intervertebral discs can collapse or bulge out leading to disc herniation.
- One or more vertebrae can slip out of its normal anatomical space.
- Ligaments of the vertebral column may become harden and thicken.
- Joints may be inflamed. Bones may become enlarge leading to bony spurs.
Causes of Central Canal Stenosis
- Bone undergoes degenerative changes with aging. Osteoarthritis may occur due to age-related degenerated changes which are the leading cause of spinal stenosis.
- The intervertebral discs which provide the cushioning effect may be dried out and shrunk. This also leads to canal stenosis.
- Other degenerative conditions like spondylosis or spondylolisthesis also lead to stenosis of the spinal canal. Other causes may include vertebral injury, traumatic fracture, joint dislocation, rheumatoid arthritis and metabolic conditions like the excessive level of fluoride in the body, fluorosis and Paget’s disease, etc.
Who is affected more?
Central canal stenosis affects both males and female in equal ratio and it commonly takes place after the age of 50 years. It also may happen in the younger persons who congenitally have stenosis of the canal.
How it is diagnosed?
The doctor makes a diagnosis of spinal canal stenosis after taking a complete history and performing a thorough physical examination. Physical examination is made to know the source of pain and the need for investigations. The doctor can advise one or more of these investigations, X-Ray, CT scan, MRI scan, myelogram, and arterial Doppler study.
Magnetic Resonance Imaging
It is a test in which magnetic field and radiofrequency waves are used which show the detailed view of muscles and other soft tissues of the vertebral column. The advantage of MRI over X-Ray is that intervertebral discs and nerves are clearly visible in an MRI scan. It may be performed with a dye or without a dye. A dye is a contrast agent that is given to you by the IV route. MRI can also detect soft tissue anomalies like spinal cord tumours, abscesses or bony spurs.
It is a specific kind of X-Ray in which dye is given into the spinal canal. The image made by the dye is recorded by the fluoroscope. Many anomalies can be viewed by the myelogram like bony growths, spinal abscesses, spinal cord tumours or pinched nerves by herniated discs.
It is a safe test in which a computer and X-Ray beam is used to make the images of your vertebral column. It is important to view the abnormalities of the bony structures. It is also a non-invasive method.
This investigation uses sound waves which are reflected for the evaluation of blood. This test is used to detect any peripheral vascular disease.
How it is managed?
Following steps must be taken for the management of central canal stenosis.
- Self-care. Adopting correct posture keep your vertebral column straight is the best thing which you can do for your back.
- Physical therapy. The aim of physical therapy is to return your maximum physical activity as soon as possible. Physical therapists can guide you about proper lifting techniques, walking, running and sitting methods and they can teach you proper exercises to make your back and abdominal muscles stronger.
- You can use medicines after consulting your doctor. Commonly used medicines for this condition are NSAIDs which are excellent painkillers. They include ibuprofen, naproxen, and aspirin. Other analgesics like acetaminophen can also be used. Steroids are also prescribed commonly to reduce the inflammation of the nerves. Steroidal injections are also given. Injections of numbing agents along with steroids are given into the spine under ultrasound or X-Ray guidance. The drug is injected directly into the area of pain. Pain relief period varies ranging from weeks to years.
- Surgical Treatment. During the surgery for central canal stenosis, bony growths are removed to reduce the pinching or pressure from the spinal nerves. In spinal decompression surgery (laminectomy), an incision is given in the mid part of the back. Vertebrae are exposed by moving aside the muscles. Lamina of vertebrae is cleared. Bony growths and thickened ligaments are removed. If there is any herniated intervertebral disc, discectomy is done. Spinal decompression surgery has a success rate of 75 to 80 percent.
- Non-Surgical Treatment. If you want to avoid invasive treatments like surgery, you should get Backrack™ spinal treatment device. Backrack™ works on the whole spine and treat problems like spinal stenosis and herniated disc without any medication on invasive treatments.