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Spinal Stenosis Illustration

Spinal Stenosis Overview

Spinal stenosis is defined as “narrowing of the
spinal canal.”

The most common causes of spinal stenosis are age-related changes including a bulging or collapsed
disc, increase in the size of your bones and joints, formation of bone spurs and hardening or
thickening of the ligaments that help support your spine.

Nerves can become pinched and irritated, causing symptoms including back or neck pain, pain that
radiates down your leg, arm or leg weakness, a weakening of the foot called foot drop, and muscle
cramping or numbness that appears in your back, neck, arms, legs, buttocks or shoulders.

Spinal Stenosis Overview

North American Spine’s AccuraScope procedure treats Spinal Stenosis

North American Spine’s AccuraScope procedure treats Spinal Stenosis by shrinking and repairing bulging discs, removing spinal nerve compression.

Many patients feel immediate relief after the outpatient AccuraScope procedure, and return to light activities the following day.

In cases where Spinal Stenosis-related pain is originating from a cause other than a bulging disc, your North American Spine patient coordinator will discuss an advanced, minimally invasive treatment offered by our highly trained specialists.

The best treatment for spinal stenosis is to identify and address the underlying cause. Allow North American Spine to help you by requesting a free MRI review.

“I walked out of my procedure with no pain…”

John B., Age 57, Location: OH.
Pre-Surgery Lifestyle: My lower back and hips were in constant pain and I could not walk more than 50 to 75 yards or bend down to pick anything up without increasing the pain. I was a very active person before my back problems and this pain put a damper on my life style.

Post-Surgery Outcome: I walked out after my procedure with no pain and the
only pain I have had was in the front of my legs because I was walking right
again and stretching my legs out as I walked as I did before my back pain started.
To date I have no pain and life is great.

Spinal Stenosis Information

What is Spinal Stenosis?
Spinal stenosis is a medical condition characterized by a narrowing of the spine – often in the lumbar (lower back) or cervical (neck) spinal regions – that pinches or otherwise irritates the spinal nerves and causes pain.

In many cases, this narrowing of the spine is the result of osteoarthritis; the cartilage that cushions the spine’s joints deteriorates, leaving the bones in the joint exposed. When the bones in the joint rub against each other without the protective cushioning that your cartilage had provided, you likely will experience pain, swelling and tenderness. Spinal stenosis is a progressive condition, meaning that without treatment, it can worsen over time and negatively affecting your daily activities. Based on your symptoms and a full spine evaluation, your physician will characterize the possible spinal stenosis as mild, moderate or severe. However, once it has been diagnosed, spinal stenosis can be treated effectively so that you can get back to normal.

Mild

Even as your spine may have begun to narrow, you may not experience any symptoms in the early stages of spinal stenosis. Eventually, however, the narrowing of the spine will compress nerve roots and possibly the spinal cord, leading to pain in the back, neck or leg. While this pain is typically sporadic rather than constant, it is not severe enough to inhibit your normal activities. Treatment for mild spinal stenosis is conservative in nature and would likely include rest, non-steroidal anti-inflammatory medication, core-strengthening exercises, hot/cold compresses and massage. Should these conservative approaches fail to alleviate your symptoms, your physician may try more interventional therapies including epidural spine injections and/or prescription medications.

Moderate

If spinal stenosis has progressed to the moderate stage, you may experience problems standing or moving without pain. Whether the spinal narrowing is caused by osteoarthritis or other spinal conditions such as disc herniation, the resulting compression of the spinal nerves and/or spinal cord can cause chronic pain that likely will intensify with time. Other symptoms of moderate spinal stenosis, including constant pain or numbness in the neck, back, shoulders, arms or legs, stiffness and reduced mobility, can negatively impact your quality of life and will require more interventional treatment from your physician. At this stage, epidural steroid injections may be administered to reduce the inflammation and corresponding pain. With the painful symptoms under control, you can continue the exercise or physical therapy regimen your physician has prescribed to strengthen your spine and core muscles.

Severe

Once spinal stenosis has advanced to the severe stage, you may be unable to do the simplest of tasks without acute pain. You have probably already tried more conservative treatment options, including rest, physical therapy, non-steroidal anti-inflammatory and/or pain-killing medications and even epidural steroid injections, but the narrowing of the spine has become so pronounced that the only way to alleviate your symptoms is through surgery.

After a complete physical examination and one or more diagnostic tests, such as MRI, CT scan or x-ray, to evaluate the severity of your spinal stenosis, your physician may recommend traditional open back surgery.

If your case of spinal stenosis gets this serious, then your physician may recommend traditional open back surgery in an effort to relieve your pain and discomfort. While this type of surgery is an effective way to remove the spinal debris, such as bulging disc material or bone spurs, that are compressing your nerve roots and causing your symptoms, there are several risks associated with this approach.

Many surgeons still perform traditional spine surgery, or “open spine surgery,” despite the sophistication and proven effectiveness of minimally invasive spine surgery in diagnosing and treating spine conditions. While every patient’s circumstances are unique, open spine surgery involves numerous risks that most patients can avoid by electing minimally invasive surgery. Open spine surgery, by its nature, is very invasive: the surgeon must cut through skin, muscle, ligaments, bones, blood vessels, nerves and normal disc tissue before even starting to correct the source of the patient’s symptoms. Because of the trauma imposed on the body during open spine surgery, hospitalization is required. Recovery can be very long and very painful. Patients may develop significant scar tissue, which introduces new problems. And the success rate is considerably lower than what minimally invasive procedures deliver.

At North American Spine, our experts have successfully helped alleviate the symptoms caused by severe spinal stenosis with minimally invasive spine surgery procedures.
 
 

Prevention
While you cannot necessarily prevent osteoarthritis, the primary cause of spinal stenosis, there are steps you can take to maintain spinal health and thereby reduce the severity of back problems.

First, keep your body moving! Regular stretching and exercise such as walking, cycling, swimming, yoga and Pilates keep your body flexible while strengthening core muscles essential to a strong spine.

Second, minimize any undue stress on your spine by maintaining a healthy weight. Excess pounds mean excess pressure on your spine.

Third, watch your posture; keep your spine straight when sitting or walking.

Fourth, take care when lifting heavy objects. Use your legs to absorb the weight.

Fifth, if you smoke, talk with your physician about a smoking cessation program. Cigarette smoking is a known contributor to bone deterioration.
 
 

Symptoms of Spinal Stenosis
The symptoms of spinal stenosis vary, but typically involve pain or numbness in the extremities, as well as in the shoulders and back. Older adults with spinal stenosis caused by osteoarthritis also may experience bowel and/or bladder incontinence. Other symptoms may include inflammation; pain that radiates from your neck or back to your hips, legs and feet; muscle spasms; swelling; and, stiffness in the muscles and/or joints. Because spinal stenosis – a narrowing of your spine – can compress spinal nerves, you may also experience symptoms associated with sciatica. Sciatica refers to a combination of symptoms including tingling, aching or burning down one side of your lower body that result when the sciatic nerve is compressed or otherwise irritated.

If you have spinal stenosis, the symptoms you experience will result from the location of the spinal narrowing and how severe the condition has become. Spinal stenosis is most common in the lumbar (lower back) and cervical (neck) regions. If you have spinal stenosis in the lumbar spine, you will likely feel symptoms in the lower back, buttocks, legs and even feet, depending on the degree to which your spinal nerves are compressed. If your condition is in the cervical spine, your symptoms typically will be concentrated in your neck, shoulders, arms and even hands. Whether you have spinal stenosis in the lumbar or cervical region, common symptoms of this condition include:

  • Pain in the area of the spinal narrowing
  • Pain radiating from the spine to hips, shoulders, hands and/or feet
  • Numbness
  • Stiffness
  • Leg cramps
  • Problems with balance or walking
  • Muscle weakness
  • Headaches

The symptoms of spinal stenosis resemble those of other spinal conditions, so it is important to be examined by a physician to ensure you receive a conclusive diagnosis and begin proper treatment.
 
 

Causes of Spinal Stenosis
Every case of spinal stenosis is unique, so we cannot point to one single cause for this narrowing of the spine. Some people are born with a congenital disorder of the spine that leads to spinal stenosis; for most patients, however, the condition results from years of wear and tear on the spine. Osteoarthritis – a condition where protective cartilage deteriorates, leaving bones to rub against one another – is the most prevalent cause of spinal stenosis. Other causes can include:

  • Bone spurs (osteophytes)
  • Bulging discs
  • Herniated discs
  • Injury or trauma to the spine
  • Spondylolisthesis
  • Spinal tumors

Whether you believe your back and neck pain is due to spinal stenosis or another spinal condition, it is important that you see your healthcare provider to receive a proper diagnosis.
After a physical and neurological examination, your physician likely will order a CT scan or an MRI to pinpoint the cause of your symptoms. From there, getting the right treatment is necessary to relieve your symptoms and to prevent the symptoms from worsening. Fortunately, spinal stenosis can be treated effectively with minimally invasive techniques. At North American spine, our experts can provide more information about the mild procedure known as the AccuraScope™ D.N.D. and help you determine whether this option might be best for you.

Congenital Disorders

While most cases of spinal stenosis are acquired as the result of wear and tear to the spine over many years, some people actually are born with spinal abnormalities including primary spinal stenosis. When a child is born with a spinal cord that is narrower than normal, this congenital abnormality may not affect his or her life until adulthood, when back problems begin to appear. Whether the patient suffers from acquired spinal stenosis or primary spinal stenosis, symptoms will typically include pain of varying degrees; muscle weakness; loss of mobility; and, in severe cases, loss of bladder and bowel control.

Osteoarthritis

Most cases of spinal stenosis are caused by osteoarthritis, a condition associated with aging that affects up to 30 million Americans. Osteoarthritis refers to a deterioration of the cartilage that cushions weight-bearing joints like those in your spine, knees, feet and ankles. When the cartilage breaks down due to use and over-use of the joints, the bones lose the benefit of protection from rubbing against one another. As a result, the constant bone-on-bone contact can cause inflammation, bone spurs and corresponding pain. When this happens in the facet joints of the spine, it can cause a narrowing of the spine known as spinal stenosis. Depending on the severity of your symptoms, there are several ways spinal stenosis can be treated beginning with more conservative approaches, like anti-inflammatory medications, exercise and/or physical therapy and weight loss. In the event your symptoms are not relieved by conservative options, your physician may recommend epidural steroid injections and from there, minimally invasive spine surgery.
 
 

Diagnosis
Because the symptoms you may be experiencing can result from several different spinal conditions including spinal stenosis, getting an accurate diagnosis is critical before treatment begins.

To make an accurate diagnosis, your physician first will take a full medical history, which will include questions about your lifestyle, activities and family history of arthritis and other conditions that could be contributing factors to your spinal condition. Next, your physician will conduct a full evaluation of your spine to locate any noticeable abnormalities that could be causing your symptoms. Finally, to get a closer look at what’s happening with your spinal structure, your physician likely will request one or more tests to confirm the diagnosis, including:

  • X-rays to check for tumor, congenital abnormality or indications of trauma/injury
  • MRI to get a three-dimensional look at the spine including discs and ligaments
  • CT scan to evaluate the condition of your spinal canal
  • Myelogram, a procedure in which a contrast medium (or dye) is injected into the spinal column to highlight any herniations, bone spurs or tumors that may be present

When you see your physician, be sure to share all of the symptoms you are experiencing, even if they seem unrelated to your neck or back, as well as the duration of these symptoms and what, if anything, helps relieve them.
 
 

Treatments
At North American Spine, we believe that surgery only should be considered after patients have followed a conservative course of treatment and have not achieved the relief they desire. That’s why we follow a “continuum of care” characterized by holistic, conservative courses of treatment to relieve pain and other symptoms associated with spine problems. Most initial episodes of acute back pain will resolve on their own with time, rest and over-the-counter anti-inflammatories such as ibuprofen. Unfortunately, many patients will experience a recurrence of the back pain, usually within the first year. For those patients with continuing back pain, we proceed along the continuum of care, moving to more specialized treatments based on what will be least invasive and most effective in delivering the best possible outcomes.

Once conservative treatment options, including non-steroidal anti-inflammatory medications, epidural injections, physical therapy, lifestyle modification and alternative therapies such as massage and chiropractic care, have proven ineffective in relieving the symptoms of spinal stenosis, spinal surgery may be the next alternative.
Four surgical procedures are typically considered:

If you suffer from spinal stenosis, the minimally invasive AccuraScope procedure may be able to resolve your back pain issues, while avoiding some of the risks associated with traditional spinal surgery. Read testimonials about spinal stenosis and other conditions or contact us for a consultation at 877.474.BACK.

Laser Surgery: The AccuraScope® Discectomy and Neural Decompression (D.N.D.)

For many types of minimally invasive spine surgery, board-certified, specialty-trained surgeons are using lasers to remove damaged tissue. At North American Spine, our highly trained experts often use AccuraScope® Disceoctomy and Neural Compression (D.N.D.) both to diagnose and treat pain and other symptoms associated with spinal stenosis, degenerative disc disease, herniated discs and other lumbar conditions that compress the nerves.

North American Spine is the exclusive provider of the Accurascope D.N.D. Here’s how it works. The surgeon will use a live x-ray for guidance, then make a very small incision at the base of the spine through which an endoscopic fiber-optic scope is in inserted. Resembling a small tube, the scope allows the surgeon to examine the inside of the spinal canal and the lumbar disks to locate any tears, ruptures, herniations, scar tissue, inflammation or other abnormalities that could be causing symptoms. Depending on what he or she finds, the physician then will use various instruments, including a laser, to shrink the damaged disc(s) or scar tissue, remove bone and disc material, or treat the spinal stenosis. The laser’s focused beam of light produces heat used instead of a scalpel to eliminate the extraneous tissues or fragments causing nerve compression. Within 30 to 40 minutes, during which the patient is mildly sedated and the surgical area numbed with a local anesthetic, the surgeon can effectively eliminate the source of pressure on the spinal nerve(s) affected Many patients notice immediate relief as they wait in the recovery area, and are typically discharged one hour after surgery. Patients typically walk the same day of their AccuraScope procedure. Many patients resume normal activities, as well as gentle physical therapy, the day after surgery and most can return to work within a week of the procedure.

One of several types of minimally invasive spine surgery, AccuraScope delivers several important benefits to our patients. First, the surgery is less invasive, which means fewer incisions, fewer chances of infection, less post-surgical pain and a faster recovery. Second, it eliminates risks associated with general anesthesia, as the patient is awake (though mildly sedated) during the procedure, allowing the surgery to talk with the patient during the procedure. And the procedure is performed on an outpatient basis, meaning no hospitalization time. Third, no hospitalization is required – the surgery is performed on an outpatient basis.

What makes AccuraScope different from other laser techniques?
Before considering minimally invasive spine surgery, it is important to realize that not all spine surgery techniques are equal. In fact, some “minimally invasive” techniques are anything but: they may damage and/or remove healthy tissue, or even worsen degenerative disc disease, which could result in the need for future procedures to correct the damage. Because the AccuraScope includes the use of a real-time x-ray, surgeons can see what is happening in the spine at that moment, rather than having to rely on a dated MRI whose images may not clearly depict the source(s) of the problem.

Unlike other types of minimally invasive surgery, the AccuraScope also allows surgeons to treat more than one area of the spine at a time, eliminating the need for multiple procedures.
 
 

Benefits of Minimally Invasive Surgery
Thanks to medical advancement, many of the spine procedures performed today can be done using a minimally invasive approach – even spinal fusion! Minimally invasive spine surgery (or MISS) is a general term for a group of procedures performed through small incisions. MISS has generally been found to have equivalent or better outcomes with fewer complications and lower risk. Open surgery requires more anesthesia, large incisions, muscle stripping, a long hospital stay and a longer recover period. Compare that to minimally invasive spine surgery, which usually means:

  • One (or a few) tiny scars instead of one large scar
  • Shorter hospital stay – may be performed outpatient in many cases
  • Reduced post-operative pain
  • Less blood loss during surgery
  • Reduced risk of infection
  • Shorter recovery time
  • Faster return to daily activities, including work

One common method of minimally invasive spine surgery is endoscopic spine surgery. Since the late 1970s and early 1980s, endoscopic techniques have been used for diagnosis and treatment in several surgical disciplines. These same endoscopic techniques have been advanced and refined for the treatment of spine disorders. During an endoscopic procedure, the doctor inserts a thin tube (endoscope) through a very small incision – usually, less than 2 cm — into the back, chest or abdomen. Through this tube, the doctor inserts a specialized video camera and medical instruments to access the spine and perform the needed procedure.
 
 

Get Started with a Free MRI Review
North American Spine works with leading spine experts who specialize in the diagnosis and treatment of conditions like sciatica. The first step is to register for more information. You will be assigned to a patient coordinator who will be able to review your medical history, answer your questions and guide you through the journey toward relief.

The second step is to submit your MRI or CT scan report for a free review. This will allow the medical team at North American Spine to understand your condition and provide a recommendation – which may or may not include a minimally invasive treatment like the AccuraScope procedure or one of the many other procedures offered by North American Spine. If you haven’t had a recent MRI, you can request one from your primary care physician.

If you know you have spinal stenosis, the next best step is to know your options for treating it.

Fill out the form on this page to get started.