Spinal Stenosis

Homeopathic_doctor_chandigarh_spinal stenosis
Spinal stenosis is defined as decrease in space of the spinal canal passage that is the narrowing of the passage from where spinal nerves pass is defined as spinal stenosis.

Stenosis word itself represent blockage or decrease of particular space as it is connected to spinal column so the term is used as spinal stenosis.

In spinal stenosis due to spinal stenosis, the space for vertebral canal is narrowed due to which vertebral canal is unable to adjust spinal cord and nerves passing through vertebral canal.

There are many type of spinal stenosis but the most common types are
 Lumbar stenosis.
• Cervical stenosis.
Lumbar and cervical stenosis is most common and most frequent. Out of both lumbar stenosis is commonest and cervical stenosis is dangerous.
In lumbar stenosis cauda equina part of spinal cord is compressed whereas in cervical stenosis there is compression of spinal cord that’s why cervical stenosis is more dangerous.

Pathophysiology
Due to degenerative changes in vertebrae of vertebral column, along with this when mechanical compression joins it both lead to spinal cord dysfunction.

Generally aging is the factor for vertebrae degeneration but other diseases can also cause this change. When with increasing age intervertebral disk degenerates and collapse, and due to this spur is formed.

The most common disc spaces involved are at the level of C5-6 and C6-7. As the bone grows the spur start applying pressure on spinal cord and on the other hand bone changes in the vertebrae occur. Osteophytes start changing the structure of vertebrae and the deformed vertebrae decreases the vertebral canal space and ultimately spinal cord is compressed.

Sometimes along with this derangement there occur synovial cysts and hypertrophy of facet joints of vertebrae.

The spinal canal contains the spinal cord, the cerebrospinal fluid (CSF) of the thecal sac, and duramaters which enclose all these structures.

Other factors related to changing the space of spinal canal are tumours of spinal cord or vertebrae.

Age / Sex groups affected by Spinal Stenosis

Lumbar stenosis usually affects individuals at old age that is after the age of 50 years. Both females and males are equally affected.

In cervical stenosis usually affects at the age group of 40-60 and both the genders are affected.

Races affected by spinal stenosis

Individuals of any race can be affected by spinal stenosis.

Causes of Spinal Stenosis

Primary stenosis is uncommon occurring only in few patients. Causes of primary stenosis are as follows.

First of all we include genetic defects of vertebral canal. This include congenital malformations that are as follows
• Osteopetrosis.
• Achondroplasia.
• Segmentation failure.
• Spinal dysraphism (incomplete vertebral arch closure).

Then comes the developmental deficits and are as follows
• Thoracolumbar kyphosis.
• Apical vertebral wedging.
• Osseous exostosis.
• Anterior vertebral breaking (Morquio syndrome).
• Shortened pedicels.
• Early vertebral arch ossification.

Secondary stenosis occurs due to any underlying disease. And the causes for secondary stenosis are usually due to degenerative changes in certain diseases and the diseases are as follows.
• Pagets disease.
• Acromegaly.
• Fluorosis.
• Neoplasm.
• Ankylosing spondylitis.
• Tumor infiltration.
• Metastatic diseases of spine.
• An abscess in vertebral canal leads to compression of spinal cord.

Some skeletal diseases also lead to spinal stenosis and that are as follows
• Ankylosing spondylitis.
• Ossification of posterior longitudinal ligament (OPLL).
• Rheumatoid arthritis.

Spinal Stenosis Signs and Symptoms

• Chronic pain in back.
• Weakness is associated symptom.
• Midline back pain.
• Injury to urinary bladder and rectum can produce associated symptoms that are involuntary urination, frequency of urine, involuntary passage of stool.
• When there is abscess in spinal canal, it leads to regional pain.
• Mild proximal lower extremity weakness.
• Neck pain in cases of cervical stenosis, along with that pain in arms.
• Difficulty in standing and sitting suddenly.
• Painful stretching of back.
• Pain is relieved when patient stoop or lean.

Investigations of Spinal Stenosis

Physical examination
Negative finding in the physical examination include following points
• Turgor.
• Temperature.
• Distal lower extremity pulses.
• Skin color.

Vascular claudication include 5 P’s
• Parasthesia.
• Pallor.
• Pain.
• Paralysis.
• Pulseness.

Diagnosis is confirmed by 
• X-ray back lumbar and cervical region.
• CT scans of vertebral column the one which is affected cervical or lumbar.
• MRI of vertebral column.

Complications of Spinal Stenosis

In cases of lumbar stenosis complications are
• Disability can occur in severe cases.
• Intractable axial pain.
• Weakness and numbness in lower extremity.
• Cauda equine syndrome.

Complications that can occur after surgery
• Hematoma of epidural space.
• Pulmonary embolism.
• Progressive spinal deformity.
• Ridiculer and sustained axial pain is present.
• Leakage of CSF (cerebro spinal fluid).

Treatment of Spinal Stenosis

• Analgesics can help to relieve pain for some time.
• In chronic cases long term monitoring is very important.
• Physical therapy is one of the ways to relieve the pain of the patient.
• Surgical intervention is done in severe  cases and surgeries done are as follows
Lumbar decompressive surgery.
• Epidural steroid injections.

Prognosis of spinal stenosis

Both upper(cervical) and lower(lumbar ) stenosis leads to motor weakness and chronic pain.Severe disability can occur if spinal stenosis get affected by minor trauma as it leads to central cord syndrome.

Differential diagnosis of spinal stenosis

•Myofascial pain

•Mechanical low back pain

•Spondylodiskitis

•Spondylolisthesis

•Osteoarthritis

•Lumbar facet arthropathy

•Lumbar spondylolysis and spondylolisthesis

•Lumbar compression fracture.

•Lumbar degenerative disk disease.

•Rheumatoid arthritis

Homeopathic treatment for Spinal Stenosis

Calcarea fluorica
• Patient had a long history of pain in back (lumbago).
• Pain in the back is aggravated when patient begin to move.
• Pain is relieved in continous motion.
• Tumors of vertebrae(osseous tumors) i.e. exostosis.
• Pain in the lumbar( lower) region of back with burning sensation.

Petroleum
• Nape of neck is stiff and painful.
• Patient feels weakness in lumbosacral region of back.
• There is cracking in joints.
• Coccyx region is painfull.

Silicea terra
• Spine of the patient is weak and needs support.
• Patient is very susceptible to slight affects on back. Recurrent history of back troubles.
• Patient have pain in coccyx.
• There is irritation of spine in patient with history of spine injury.
• Well indicated medicine for pott’s disease of vertebrae.
• Also indicated for diseases of vertebrae.

Zincum metallicum
• Patient complains of pain in lumbosacral region.
• Patient cannot bear to be touched on back.
• Well indicated medicine for spinal irritation due to myelitis.
• There is burning sensation along the spine.
• Dull pain is present in the lumbar region.
• Tearing pain is present in shoulder blades.

Cocculus indicus
• On moving head there is cracking of cervical vertebrae.
• Lumbosacral pain is of paralytic type.
• There is brusing type of pain in shoulders and arms.
• Pressure is felt on scapulae and nape of neck.
• Patient feels stiffness on moving the shoulders.

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