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Spaces within the spine can narrow without producing any symptoms. However,
if narrowing places pressure on the spinal cord or nerve roots, there may be a
slow onset and progression of symptoms. The back itself may or may not hurt.
More often, people experience numbness, weakness, cramping, or general pain in
the legs that occurs during flexing the lower back while sitting. (The flex
position "opens up" the spinal column, enlarging the spaces between
vertebrae at the back of the spine.) If a disk between vertebrae is compressed,
people may feel pain radiating down the leg (sciatica).
People with more severe stenosis may experience abnormal bowel and bladder
function and foot disorders. For example, cauda equina syndrome is a partial or
complete loss of control of the bowel or bladder and sometimes sexual function;
it is due to compression of the collection of spinal roots that descend from the
lower part of the spinal cord and occupy the vertebral canal below the cord. In
very rare instances, compression above the area where the lumbar vertebrae and
sacrum meet results in partial or complete paralysis of the legs.
How Is Spinal Stenosis Diagnosed?
The doctor may use a variety of approaches to diagnose spinal stenosis and
rule out other conditions.
Medical history - the patient tells the doctor details about symptoms and
about any injury, condition, or general health problem that might be causing the
symptoms.
Physical examination - the doctor (1) examines the patient to
determine the extent of limitation of movement; (2) checks for pain or symptoms
when the patient hyperextends the spine (bends backwards); and (3) looks for the
loss of extremity reflexes, which may be related to numbness or weakness in the
arms or legs.
X ray - an x-ray beam is passed through the back to produce a
two-dimensional picture. An x ray may be done before other tests to look for
signs of an injury, tumor, or inherited abnormality. This test can show the
structure of the vertebrae and the outlines of joints, and can detect
calcification.
MRI (magnetic resonance imaging) - energy from a powerful magnet
(rather than x rays) produces signals that are detected by a scanner and
analyzed by computer. This produces a series of cross-sectional images
("slices") and/or a three-dimensional view of parts of the back. An MRI is particularly sensitive for detecting damage or disease of soft tissues,
such as the disks between vertebrae or ligaments. It shows the spinal cord,
nerve roots, and surrounding spaces, as well as enlargement, degeneration, or
tumors.
Computerized axial tomography (CAT) - x rays are passed through the
back at different angles, detected by a scanner, and analyzed by a computer.
This produces a series of cross-sectional images and/or three-dimensional views
of the parts of the back. The scan shows the shape and size of the spinal canal,
its contents, and structures surrounding it.
Myelogram - a liquid dye that x rays cannot penetrate is injected
into the spinal column. The dye circulates around the spinal cord and spinal
nerves, which appear as white objects against bone on an x-ray film. A myelogram
can show pressure on the spinal cord or nerves from herniated disks, bone spurs,
or tumors.
Bone scan - an injected radioactive material attaches itself to bone,
especially in areas where bone is actively breaking down or being formed. The
test can detect fractures, tumors, infections, and arthritis, but may not tell
one disorder from another. Therefore, a bone scan is usually performed along
with other tests.
Who Treats Spinal Stenosis?
Nonsurgical treatment of spinal stenosis may be provided by internists or
general practitioners. The disorder is also treated by specialists such as
rheumatologists, who treat arthritis and related disorders; and neurologists,
who treat nerve diseases. Orthopaedic surgeons and neurosurgeons also provide
nonsurgical treatment and perform spinal surgery if it is required. Allied
health professionals such as physical therapists may also help treat patients.
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