Back pain is one of the world’s leading causes of disability and absenteeism from work. There are a plethora of reasons for back pain, ranging from poor posture and injury to obesity and the natural process of aging. One such age-related condition that results in back pain is spinal stenosis.
“Spinal canal stenosis is basically the narrowing of the spinal canal, which impacts the spine,” says Dr Suad Trebinjac, Medical Director of the Dubai Physiotherapy and Rehabilitation Centre.
“The condition is most common in the lower back, followed by the neck and it’s much rarer in the thoracic [middle] part of the back.
There are different aetiology factors but the most common are age-related causes.
“The lumbar canal of the back should measure between 15 and 27mm. If the width is less than 12mm, it is considered as spinal canal stenosis. For the cervical part of the back, the average width should be between 17 and 18mm and in the lower part of the back, the width should be between 12 and 14mm.”
Causes and risk factors
The most common reason people develop spinal stenosis is the natural degeneration that occurs as a result of aging. “There are different aetiology factors but the most common are age-related causes,” says Dr Trebinjac. “Spinal stenosis most commonly affects people over the age of 50 as when the bone system ages, it can become deformed. Bone spurs or osteophytes form [boney projections that develop on the bone edges] and enter the spinal canal, narrowing the spinal canal.
“Other reasons for spinal stenosis are diseases such as rheumatoid arthritis. The condition can also be caused by trauma. It can also occur as result of movements between the vertebrae called spondylolysis, where there isn’t proper alignment of the vertebrae.
“Another cause can be ligamentum flavum, which is a thickening of ligaments that usually happens as a result of aging and causes pressure on the spinal canal. Spinal deformities such as scoliosis can also cause a narrowing of the spinal canal in severe cases.”
One of the difficulties in diagnosing and treating the condition is that it can develop gradually, with few signs and symptoms.
“Initially, spinal stenosis is symptomless and it gradually develops as a person ages. When people have an X-ray or an MRI, you can see the signs of stenosis but the patient may not have any signs or symptoms. But, as the condition develops, symptoms start to present themselves.
“The most common symptom is pain in the standing position. When the patient is standing, they will feel some pain or discomfort in the lower back.
“As the stenosis continues to develop, the patient will feel pain in the legs or if it is affecting the neck area, pain will develop in the shoulders and down to the arms.”
Fixing the issue
For patients visiting a DHA clinic, in most cases staff will carry out a clinical examination to check for medical signs and symptoms of stenosis. “If we suspect the patient has the condition, the first radiological procedure is to conduct an X-ray, but most of the time we need to carry out an MRI, to check all structures such as the ligaments, the tissues and the position of the discs,” explains Dr Trebinjac.
“If we suspect the patient’s nerves are damaged, we can do an EMG (electromyography) test.
“In more severe cases and if therapy doesn’t help, then the patient usually requires surgery. The treatment depends on each patient’s individual case but the most common procedure is a laminectomy, where you cut the lamina [of the back] to relieve the pressure on the spinal canal. Another common procedure is when the ligaments are thick and you need to cut the ligaments to relieve the pressure and decompress the nerves. We can also carry out a fusion of the spine when required.”
In addition to physical treatment, Dr Trebinjac says that educating the patient about how to manage the condition is also important.
“People with spinal stenosis feel better when they bend forward and sleeping and lying down is usually pain-free. It is only painful when the patient is standing or walking around, so it is important to educate the patient about, what the aggravating factors are and how to manage them.”