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Spinal Canal Stenosis

(Also known as Spinal Stenosis, Lumbar Stenosis, Foraminal Stenosis, Lumbar Spinal Stenosis, Vertebral Canal Stenosis)

What is spinal canal stenosis?

The spine comprises of many bones known as vertebrae each of which has a large hole in its center. Because these bones are situated on top of each other, their holes line up, forming the spinal canal. This canal provides protection and space for the spinal cord and nerves to travel from the brain to the rest of the body. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the disc centrally.
Occasionally, the spinal canal can begin to narrow. This is normally associated with ageing or osteoarthritis and is due to gradual wear and tear of the bones, joints, and discs. When this occurs, it is known as spinal canal stenosis. As the condition progresses, the narrowing may place pressure on the spinal cord resulting in a variety of symptoms.

Signs and symptoms of spinal canal stenosis
Spinal canal stenosis is usually seen in older patients who have degenerative changes to their spine. Patients with minor canal stenosis may experience little or no symptoms. As the condition progresses patients may experience low back pain and stiffness. In more severe cases involving spinal cord compression, pain, pins and needles, weakness or numbness may be experienced in the lower back, legs or feet.
Generally, patients with this condition experience an increase in symptoms during activities that repetitively or continuously straighten or extend the spine. Symptoms may also increase during activities that place weight on the spine (eg. lifting, prolonged standing, walking etc). Symptoms tend to ease during activities that bend the spine (e.g. sitting) or take weight off it (e.g. lying).

Diagnosis of spinal canal stenosis

Investigations such as an X-Ray, CT scan or MRI are usually required to confirm diagnosis of spinal canal stenosis.

Treatment for spinal canal stenosis
Patients with this condition are generally managed well with an appropriate physical therapy program. While little can be done to reverse the degenerative changes to the spine, patients can generally remain active by modifying their activities appropriately. The primary goal of treatment is to remain as active as possible without aggravating symptoms in order to maintain strength and mobility and to avoid deterioration. This can be achieved by having regular breaks from levels of activity that increase symptoms (e.g. excessive walking, standing, lifting) with positions of comfort (e.g. sitting or lying). Activities should be balanced ideally to prevent any increase in symptoms. A gradual increase in activity and exercise can occur as guided by the treating physiotherapist provided symptoms do not increase.
Alternative exercises placing minimal force through the spine should also be performed to maintain fitness provided they do not increase symptoms. Better activities include: cycling on a stationary bike and hydrotherapy exercises designed by a physical therapist. It is also important for patients to perform flexibility, strengthening and core stability exercises to ensure an optimal outcome. The treating physical therapist can advise which exercises are most appropriate for the patient and when they should be commenced.

Physical therapy for spinal canal stenosis
Physical therapy treatment for patients with spinal canal stenosis is important to assist with pain relief, improve flexibility and strength, and to ensure an optimal outcome. This may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • mobilization
  • traction
  • dry needling
  • education
  • activity modification advice
  • prescription of walking aids
  • clinical Pilates
  • hydrotherapy
  • exercises to improve flexibility, strength and core stability
Other intervention for spinal canal stenosis
Despite appropriate physicl therapy management, some patients with this condition continue to deteriorate. When this occurs, other intervention may be required. This may include pharmaceutical intervention, investigations such as an X-ray, CT scan or MRI, corticosteroid injection or assessment from a specialist. The treating physical therapist can advise on appropriate management and can refer to the appropriate medical authority if it is warranted clinically. In more severe cases of spinal canal stenosis surgery may be required to relieve the pressure on the spinal cord.