Spinal stenosis is a term used to describe a tight or narrow spinal canal around the neural elements, which pass through it. It is usually degenerative in nature and develop with age, but it can be congenital and secondary to many other disorders which can affect the spinal canal like cysts, benign or malignant tumours etc.
The symptoms are not usually acute and progress with time. It is mainly what is described in medical terms as claudication which is progressive weakness or pain in the legs on walking which disappear by leaning forward or sitting for few minutes. The patient is usually fine at rest without any complaint, and clinical examination is usually normal in most cases unless in extreme cases when the neurological deficit start to develop permanently.
Conservative Management of spinal stenosis:
Once the MRI of the spinal canal confirmed the benign nature of the problem, functional assessment is the main factor to decide about the line of management.
Conservative management is considered if the symptoms are not affecting the life style significantly and if the walking distance is reasonable. The conservative management consists of education, physiotherapy, NSAID (Non-steroidal medication), Epidural injection, and general pain killers and muscle relaxants.
Surgical Treatment of spinal stenosis:
Surgical treatment is very effective in cases with very short walking distance, functional compromise, and if there is clear neurological deficit. In principles, it is generally similar to disc decompression surgery and yields very successful results. Surgery can be either via minimally invasive techniques, or formal decompression surgery in case of multiple bilateral levels or inter-spinous distraction device insertion in mild to moderate cases and in patients with high morbidity due to other illnesses.
Inter spinous Treatment:
Inter spinous spinal device insertion between the spinous processes tends to distract the spinous processes away from each other’s and thus creating more space in the spinal canal and alleviate the symptoms, this procedure can be done with MIS combined decompression or on its own but result are not promising in severe stenosis with short term benefit, it still have its preference in elderly and low demand patients with comorbidities with formal surgery.