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Spinal Stenosis Disorder

Spinal stenosis is a narrowing of spaces in the spine (backbone) that results in pressure on the spinal cord and/or nerve roots. This disorder usually involves the narrowing of one or more of three areas of the spine: (1) the canal in the center of the column of bones (vertebral or spinal column) through which the spinal cord and nerve roots run, (2) the canals at the base or roots of nerves branching out from the spinal cord, or (3) the openings between vertebrae (bones of the spine) through which nerves leave the spine and go to other parts of the body. The narrowing may involve a small or large area of the spine. Pressure on the lower part of the spinal cord or on nerve roots branching out from that area may give rise to pain or numbness in the legs. Pressure on the upper part of the spinal cord (that is, the neck area) may produce similar symptoms in the shoulders, or even the legs.

This disorder is most common in men and women over 50 years of age. However, it may occur in younger people who are born with a narrowing of the spinal canal or who suffer an injury to the spine.

The normal vertebral canal provides adequate room for the spinal cord and cauda equina. Narrowing of the canal, which occurs in spinal stenosis, may be inherited or acquired. Some people inherit a small spinal canal or have a curvature of the spine (scoliosis) that produces pressure on nerves and soft tissue and compresses or stretches ligaments. In an inherited condition called achondroplasia, defective bone formation results in abnormally short and thickened pedicles that reduce the diameter (distance across) of the spinal canal. Acquired conditions that can cause spinal stenosis are explained in more detail in the sections that follow.

Degenerative Conditions

Spinal stenosis most often results from a gradual, degenerative aging process. Either structural changes or inflammation can begin the process. As people age, the ligaments of the spine may thicken and calcify (harden from deposits of calcium salts). Bones and joints may also enlarge: when surfaces of the bone begin to project out from the body, these projections are called osteophytes (bone spurs).

When the health of one part of the spine fails, it usually places increased stress on other parts of the spine. For example, a herniated (bulging) disk may place pressure on the spinal cord or nerve root. When a segment of the spine becomes too mobile, the capsules (enclosing membranes) of the facet joints thicken in an effort to stabilize the segment, and bone spurs may occur. This decreases the space (neural foramen) available for nerve roots leaving the spinal cord.

Spondylolisthesis, a condition in which one vertebra slips forward on another, may result from a degenerative condition or an accident, or, very rarely, may be acquired at birth. Poor alignment of the spinal column when a vertebra slips forward onto the one below it can place pressure on the spinal cord or nerve roots at that place.

The following conditions that are not related to degenerative disease are causes of acquired spinal stenosis:

• Tumors of the spine are abnormal growths of soft tissue that may affect the spinal canal directly by inflammation or by growth of tissue into the canal. Tissue growth may lead to bone resorption (bone loss due to overactivity of certain bone cells) or displacement of bone.
• Trauma (accidents) may either dislocate the spine and the spinal canal or cause burst fractures that produce fragments of bone that penetrate the canal.
• Paget's disease of bone is a chronic (long-term) disorder that typically results in enlarged and abnormal bones. Excessive bone breakdown and formation cause thick and fragile bone. As a result, bone pain, arthritis, noticeable bone structure changes, and fractures can occur. The disease can affect any bone of the body, but is often found in the spine. The blood supply that feeds healthy nerve tissue may be diverted to the area of involved bone. Also, structural problems of the involved vertebrae can cause narrowing of the spinal canal, producing a variety of neurological symptoms. Other developmental conditions may also result in spinal stenosis.
• Fluorosis is an excessive level of fluoride in the body. It may result from chronic inhalation of industrial dusts or gases contaminated with fluorides, prolonged ingestion of water containing large amounts of fluorides, or accidental ingestion of fluoride-containing insecticides. The condition may lead to calcified spinal ligaments or softened bones and to degenerative conditions like spinal stenosis.

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