CAUSES OF CHRONIC BACK PAIN: Spinal Stenosis

Anatomy

The vertebrae are the "bony elements" that surround the spinal cord. In an adult human, there are approximately 25 bones that make up the spine. 7 cervical (neck), 12 thoracic (mid-back), 5 lumbar (low back) and 1 sacral ("tailbone"). The vertebrae are composed of several elements: vertebral body, pedicles, lamina, transverse process, spinous process & superior/inferior articular processes (which make up the facet joint). The vertebral body is a "hourglass" shaped bone which we commonly associate with the spine. The pedicles and lamina make up the posterior "ring" of the vertebrae which is responsible for housing the spinal cord. The transverse processes are sites for muscle/ligament attachment and rib attachment (in the thoracic spine). The spinous process is the bony "bump" you can feel on your back, this is also a site for muscle/ligament attachment. The superior & inferior articular processes form the posterior joints called the facet joints. The facet joints help guide motions in our spine such as bending forward/backward, bending sideways and turning from side to side. Like any other joint in your body, the facet joints are covered with a layer of cartilage, surrounded by a joint capsule (made of ligaments) and bathed in a lubricating fluid called synovial fluid. In addition to all the "bony" elements commonly associated with the spine, there are many "soft tissue" elements that support the spine by both restricting motion (i.e. ligaments) and enabling motion (i.e. muscles). Some of these soft tissue elements (ligaments) can calcify ("turn to bone") secondary to arthritis or degenerative disc disease and actually "pinch" the spinal nerves that exit from your spine and/or the actual spinal cord itself. When this occurs the end result is spinal stenosis.

Condition: Spinal Stenosis

Stenosis is a process describing "narrowing" of a structure. The most familiar example is Heart Disease where the arteries of the heart "narrow" which can result in a heart attack. Like arteries, spinal structures such as the ones that surround the spinal cord (called the "vertebral foramin") or the ones that surround the exiting spinal nerves (called "intervertebral foramin") are also subject to "narrowing". This usually occurs secondary to arthritis or degenerative disc disease or it can occur congenitally ("from birth"). Arthritis causes biomechanic changes to your spine which result in bone growths called osteophytes ("bone spurs") and calcification ("turning to bone") of ligaments. These structures narrow the opening that contains the spinal cord and spinal nerves. The end result is "pinching" of these sensitive neural structures. The typical presentation is a patient in their late 50's or older. The main complaints are back and leg pain. The pain is either in one leg or both and is not specific. Leg pain is often initiated during walking and is relieved after resting 15 to 20 minutes or bending forward at the waist ("hunched forward") also called flexion.

Diagnosis: Spinal Stenosis

Diagnosis of spinal stenosis depends on the region of the vertebrae that is being narrowed ("pinched"). Degeneration of the facet joints causes laxity (loosening) of the joint capsule which can lead to a type of spinal stenosis called lateral canal stenosis. Lateral canal stenosis can cause "pinching" of the spinal nerve at the intervetebral foramin where the spinal nerves exit your spinal cord to "innervate" or attach to the extremities (legs/arms) causing arm/leg pain and/or numbness/tingling. Further degeneration of the facet joints can cause bony outgrowths in the spine called osteophytes or "bonespurs". This can lead to another type of spinal stenosis called central canal stenosis. When this occurs, it is not the spinal nerves that are "pinched" (as in lateral canal stenosis), it is the actual spinal cord. Central canal stenosis can cause a variety of symptoms depending on its location. As you can see, these bone spurs narrow the spaces that contain the spinal cord and nerves. Diagnosis of this condition can be made with an X-ray, a CT scan or MRI.

Treatment: Spinal Stensosis

Traditional treatment includes pain killers such as: Non-Steroid Anti-Inflammatories (NSAID's), Physical/Chiropractic Therapy, Injections or Surgery. NSAID's have an inherent risk of Gastrointestinal ("stomach" and "intestine") disorders such as: ulcers, GI hemorrhage or perforation. In fact, an article in the New England Journal of Medicine reported that it has been conservatively estimated that 16,500 NSAID-related deaths occur every year in the United States and conservative calculations estimate that approximately 107,000 Americans are hospitalized every year due to NSAID-related GI complications. The number of deaths reported in the same study due to AIDS was 16,685. In addition to Gastrointestinal disorders, drugs such as VIOXX have been known to cause serious Cardiovascular (CV) events such as: Heart Attacks, Stroke and Heart Failure. There have been similar complaints from other NSAID's such as: Bextra and Celebrex.

Epidural injections ("injection within the epidural space of the spinal cord") can be mildly effective but are most often temporary and require repeat injections, several per year, not to mention the chances of contracting a spinal infection which can lead to meningitis.

Surgery is an option when other therapies have failed. This type of invasive intervention is aimed at removing many of the support elements of the spine and "fusing" multiple levels of the spine together. A study to determine the effects of single level (2 vertebrae) and 2-level (3-4 vertebrae) spinal fusion success rates reported 53% with "good" and "fair" results with single level fusion and no "good" results with 2-level fusions.This can lead to a loss of range of motion, further pain, further degeneration and a condition known as failed back surgery/post-operative pain syndrome which is a very disabling and troubling reality of surgical intervention.

Now that you have read about the possible side effects of what traditional treatments have to offer, you may want to consider the drugless, non-surgical approach that Non-Surgical Spinal Decompression has to offer.

Non-Surgical Spinal Decompression: Spinal Stenosis

The following is the rationale, based on anatomical and physiological principles of Non-Surgical Spinal Decompression . Non-Surgical Spinal Decompression offers to treat the root cause of the disease-narrowing of the intervertebral foramin and narrowing of the diameter of the spinal cord. When the pressure is relieved from the disc, it is called Non-Surgical Spinal Decompression. When pressure is relieved from the joints, it is called Spinal Distraction. You cannot have one without the other. Non-Surgical Spinal Decompression, or "distraction", of the degenerated facet joints can alleviate the pain in several ways. In lateral canal stenosis when the facet joints are degenerated, the intervertebral foramin (the opening from which the spinal nerves exit the spinal cord) are narrow (like a small circle) due to bone spurs or calcification of ligaments. As a result, the spinal nerves become "pinched" in this bony "circular" opening causing back pain and extremity (arm/leg) pain and/or numbness/tingling. Non-Surgical Spinal Decompression causes distraction of the vertebral joints thus converting the small, narrowed, circular intervertebral foramin into a larger, oval shaped intervertebral foramin in which the spinal nerves have ample room to exit the spinal cord without being "pinched". In central canal stenosis, the spinal cord is being pinched from bone spurs or calcified ligaments. This decreases the space in which the spinal cord and nerves travel through. Research has shown that a flexed posture ("bent forward at the waist") increases the diameter of the space in which the spinal cord and nerves travel through. Non-Surgical Spinal Decompression is aimed at increasing flexion in the lumbar spine (increasing the sagital diameter of the vertebral foramin) thus relieving pressure from the spinal cord. This is why people with this condition find relief of back and leg pain when they bend forward.

Thus, Non-Surgical Spinal Decompression for spinal stenosis is based on the following principles:

For lateral canal stenosis

(1) Distraction of the degenerated facet joints causes a widening of the
intervertebral foramin (the opening where the spinal nerves
exit the spinal cord).
(2) Pressure is relieved from the spinal nerves exiting from
the spinal cord as the small, circular, "bony" opening is widened
to form a larger, oval shaped "bony opening".
(3) Since the spinal nerves innervate (attach to) the skin and
muscles of the extremities (arms/legs), the pain and/or numbness
in these areas is decreased or eliminated.

For central canal stenosis

(4) Distraction and flexion (bending forward) of the spine causes
an increase in the space housing the spinal cord or nerves.
(5) This increase in space is called "increase in sagital diameter of the
vertebral foramin."
(6) This increase in space causes a relief of pressure of bony structures,
such as bone spurs or calcified ligaments, on the spinal cord or nerves.
(7) A relief of pressure from the spinal cord or nerves causes pain to
decrease.

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