Leg pain with walking
(claudication) can be caused by either arterial circulatory insufficiency
(vascular claudication) or from spinal stenosis (neurogenic or
pseudo-claudication). Leg pain from either condition will go away with rest,
but with spinal stenosis the patient usually has to sit down for a few minutes
to ease the leg and often low back pain, whereas leg pain from vascular
claudication will go away if the patient simply stops walking.
Although occasionally the leg
pain and stenosis symptoms will come on acutely, they generally develop over
the course of several years. The longer a patient with spinal stenosis stands
or walks, the worse the leg pain will get.
Leg Pain and Numbness: What Might These
Symptoms Mean?
Flexing forward or sitting will
open up the spinal canal and relieve the leg pain and other symptoms, but they
recur if the patient gets back into an upright posture. Numbness and tingling
can accompany the pain, but true weakness is a rare symptom of spinal stenosis.
An older person leaning over the handle of their shopping cart while making
short stumbling steps often has spinal stenosis.
Spinal Stenosis Diagnosis
Diagnostic imaging studies for patients with cervical stenosis or lumbar
stenosis include either an MRI scan or a CT scan with myelogram (using an x-ray
dye in the spinal sack fluid), and sometimes both. CT scans that are plain or
not enhanced are of limited value unless made with very fine segmental scan
slices.
It can be shown that each form of spinal stenosis has a dynamic
(changing) effect on nerve compression, such as when bearing weight. Due to
this changing compression, spinal stenosis symptoms vary from time to time and
the physical examination generally will not show any neurological deficits or
motor weakness. Some recent scanning methods allow the upright body position to
study the effects of spinal loading.
Cervicalforaminal stenosis can be pinpointed not only by the CT and MRI scans, but by
injecting the suspicious nerve with a small volume of about 2 dozen drops of
local anesthetic (selective nerve root block). After the injection a remission
of the symptoms of cervical spinal stenosis when walking, along with true
temporary weakness of the limb, is clinically diagnostic and helps the patient
decide about stenosis surgery.
Since spinal stenosis at two or even three levels (sub-laminar,
foraminal and far lateral) can affect a single emerging nerve, a combination of
anatomical and clinical clarification is needed if spinal stenosis surgery is
contemplated in order to make sure that one surgical procedure will address all
contributing components of that particular case.
Many conditions can
lead to spinal stenosis, age being the most common. Others include
Osteoarthritis, disk degeneration and thickened ligaments.
The first line of
treatment is usually medication; non steroidal anti inflammatory drugs are
prescribed. Studies have shown that even anti depressants also help in
relieving pain. If the pain is severe, narcotics are also prescribed. Physical
therapy and steroid injections also help in relieving the pain. However, if
these options don’t work, surgery is recommended.
The surgery for
spinal stenosis works by relieving pressure on the spinal cord and nerves.
Laminectomy is the most commonly performed procedure to treat the symptoms
associated with spinal stenosis.
Laminectomy removes the lamina or the back portion of one
or more vertebrae which creates space and relieves the pressure. In many cases,
the surgeon would fuse two vertebrae together to maintain the strength of the
spine and the procedure is called spinal fusion.
Laminectomy with spinal fusion is the most commonly performed procedures
to treat spinal stenosis. The results of the operation are quite gratifying.
The surgery helps reduce pain and improve the functioning.
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