Vertebral stenosis is a narrowing of one or more areas of the vertebral canal, formed by the overlapping of the thirty-three vertebrae that make up our spine. Since delicate nerve structures are contained within this canal, which give rise to the bone marrow, it is generally a rather annoying pathology. In addition to the medulla, the stenosis can also compress the spinal nerves, which emerge from it at the vertebral foramina.
Stenosis, which electively affects the cervical and / or lumbar spine, can manifest itself through symptoms such as cramps, pain, numbness of the lower limbs, back, neck, shoulders or arms; signs of spinal cord distress include bladder or bowel dysfunction.
Causes and risk factors
Fortunately, vertebral stenosis is a not very common disease, which recognizes causes of congenital origin (when it is present from birth), acquired or mixed. Congenital or constitutional forms, such as achondrodysplasia, are extremely rare, as are the developmental ones, which arise during development in subjects suffering from various forms of dwarfism.
In its secondary form, vertebral stenosis appears more frequently after middle age and electively affects the male sex. The acquired forms are in fact by far the most common and recognize their main causal factor in degenerative joint disease. This term, synonymous with osteoarthritis, designates a pathological picture caused by the progressive wear of the articular cartilage; in response to this cartilage degeneration, a series of changes arise in the underlying bone tissue, which increases in size and takes on an irregular appearance. Specifically, these alterations can also affect one or more vertebrae, which increase in size and take on an irregular shape, thus narrowing the spinal canal.
Also degenerative disc disease (herniated disc), spondylolysis and spondylolisthesis, ligamentous hypertrophy, the after-effects of spinal trauma (such as vertebral fractures) or infections and surgery to the spine - as well as tumor and systemic diseases of the "bone (Piaget's disease and gout) - can reduce the caliber of the spinal canal.
Among athletes, spinal stenosis mainly affects former wrestlers and former weightlifters, who for years have borne heavy loads on their backs and in particular in the lumbar area.
Among the risk factors, in addition to advanced age and the execution of demanding work, burdensome for the spine, we remember fluorosis (a disease caused by the "accumulation of fluoride in the" organism, due to an "excessive introduction of the mineral with Foods).
Symptoms
The narrowing of the spinal canal does not always cause significant problems, which appear instead when it compresses the spinal cord or nerve roots, causing a series of symptoms distributed in the regions innervated by them. The mechanical compressive effects can also affect blood vessels and cause a decrease in local blood flow, contributing to the onset of symptoms.
Lumbar vertebral stenosis is clinically manifested by pseudo-claudication (intermittent claudication spinalis). The painful symptoms are in fact produced by standing or walking, while they improve within a few minutes when one assumes a sitting or lying position (only to reappear after another physical effort).
In other cases the symptoms are more nuanced and may include asthenia (muscle weakness), numbness or paresthesia (tingling) of the lower limbs, always aggravated by walking. Often, and particularly when it is caused by a "herniated disc, spinal stenosis causes moderate low back pain (localized pain in the lower back), more or less accompanied by sciatica (pain that radiates into the back of the thigh and leg). o cruralgia (pain that radiates to the front of the thigh).
The posture of flexion of the waist (for example, bending forward on the shopping cart) is often useful for relieving painful symptoms, while the transition from this position to the extension of the spine tends to exacerbate it. This explains why patients suffering from stenosis of the vertebral canal prefer to proceed with a forward inclined posture and feel more discomfort in the uphill sections and more relief in the downhill ones (unlike the subjects affected by intermittent claudication of vascular origin).
When the stenosis affects the cervical tract, the patient may experience pain radiating to the neck, shoulder and upper limbs, more or less associated with an annoying sense of vertigo and loss of balance.
In severe cases, severe disorders may arise, such as impotence, impaired sexual functions, bladder dysfunction and defecation control (paralytic syndrome involving the cauda equina).
DIAGNOSIS: a good evaluation of the amplitude of the vertebral canal can be obtained with the traditional radiological examination, but also and above all with the CT and magnetic resonance imaging.
Treatment
Treatment of spinal stenosis pain begins with NSAIDs, over-the-counter drugs widely used for their anti-inflammatory and analgesic properties. Since their use can cause important side effects, such as gastric ulcer, NSAIDs should still be used under medical supervision. If the pain is severe and does not subside, they are replaced with more powerful analgesics, such as paracetamol.
Only in exceptional cases, such as in the presence of positive neurological tests for myelopathy (bone marrow suffering, acute loss of bladder or intestinal continence), surgery is indicated to remove the cause that gave rise to the stenosis. In all others In cases, we proceed with conservative treatment, which can make use, according to medical indications, of one or more physiotherapeutic and non-physiotherapeutic treatments (ultrasounds, electrostimulation, massages, manipulations, acupuncture, etc.).
In the presence of a narrowing of the lumbar spinal canal, exercises aimed at strengthening the abdominal muscles, combined with other stretching exercises, may be useful; on the other hand, exercises that result in hyperextension of the spine should be avoided.
The acquisition of a correct technique for lifting loads is also very important (straight back and bent knees, not the other way around). These behavioral rules are also very useful in the preventive field. The most suitable exercises in the presence of a vertebral stenosis will in any case be established. after a careful postural examination, in collaboration with the doctor and other specialists.
