Physiotherapy treatment for Recess Spinal Stenosis Pain Diagnosis Options

What Causes Spinal Stenosis?

Most of the time spinal stenosis is caused by the degenerative changes associated with aging. Other causes include:

Tumors, which press on the spinal cord and nerve roots. Most spinal tumors are found between the vertebrae and the spinal cord, but Tumors can occur anywhere in the spine. They are usually from cancers that have migrated from another part of the body.

Car accident Injury and other kinds of trauma pulls the spine out of alignment, putting pressure in abnormal places in the spine, including nervous tissue. In this case, the spinal cord and/or nerve roots can be affected.

Heredity, (including achondroplasia), or a small spinal canal present at birth will cause symptoms in younger people.

Paget's Disease, a bone disease in which bones enlarge and become deformed, can encroach on the spaces in the spine.

Flurosis, or an excess of fluoride in the body, can calcify spinal ligaments, which will compress and shorten the spine. This is not typically a cause of stenosis in the United States.

Ankylosing spondylitis - is a form of arthritis in which the joints of the spine and sacroiliac become chronically inflamed and stiffened. Eventually the spine can completely fuse, resulting in total loss of spinal mobility.

Ossification of the posterior longitudinal Ligament (OPLL) - Ossification is a bone formation in the ligament that can compress the spinal cord of the ligament between the vertebrae and the spinal dura.

Diffuse idiopathic skeletal hyperostosis (DISH) - also called Forestier's disease which is considered a form of degenerative arthritis.

Types of spinal fusion surgery options:

1. Posterolateral gutter fusion-the procedure is done through the back
2. Posterior lumbar interbody fusion (PLIF/TLIF))-the procedure is done from the back and includes removing the disc between two vertebrae and inserting bone into the space created between the two vertebral bodies
3. Anterior lumbar interbody fusion (ALIF)-the procedure is done from the front and includes removing the disc between two vertebrae and inserting bone into the space created between the two vertebral bodies
4. Anterior/posterior spinal fusion-the procedure is done from the front and the back

The most common surgery in the lumbar spine is:

• Decompressive laminectomy in which the laminae (roof) of the vertebrae are removed to create more space for the nerves.

A surgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disc.

Various devices (like screws or rods) may be used to enhance fusion and support unstable areas of the spine.

Types of surgery to treat stenosis include the following:

1. Laminotomy - when only a small portion of the lamina is removed to relieve pressure on the nerve roots;
2. Foraminotomy - when the foramin (the area where the nerve roots exit the spinal canal) is removed to increase space over a nerve canal. This surgery can be done alone or along with a laminotomy;
3. Medial Facetectomy - when part of the facet (a bony structure in the spinal canal) is removed to increase the space;
4. Anterior Cervical Discectomy and Fusion - the cervical spine is reached through a small incision in the front of the neck. The intervertebral disc is removed and replaced with a small plug of bone, which in time will fuse the vertebrae.
5. Cervical Corpectomy - when a portion of the vertebra and adjacent intervertebral discs are removed for decompression of the cervical spinal cord and spinal nerves. A bone graft, and in some cases a metal plate and screws, is used to stabilize the spine.
6. Laminoplasty - a posterior approach in which the cervical spine is reached from the back of the neck and involves the surgical reconstruction of the posterior elements of the cervical spine to make more room for the spinal canal.

What does a Physiotherapist do?

Most of them work to help others prevent back pain with Physiotherapy. They assist patients with movement disorders and pain management are just some of the problems addressed by physiotherapists, along with assisting the patient in overcoming immobility.

A friend of mine was diagnosed when she went to the doctor after experiencing discomfort in her lower back, she said ever since she was pregnant she had been dealing with a shooting pain down her legs. The doctor told her that the lateral recess is an area of the spine in the lower back, the nerves exiting the spine put pressure on her spinal canal.

Confused at why her pain had continued for several years when her co-workers said that when they dealt with sciatica the pain subsided after their babies were born.

The doctor mentioned that the sciatica she was experiencing was a result of recess spinal stenosis and that she had a bulging disc causing the discomfort. In order to fix the disc and relive the pressure on the nerves surgery would be necessary.

Medical Imaging used to diagnose spinal stenosis

The different types of medical imaging can be used to diagnose spinal stenosis such as:

• X-rays
• MRI, or magnetic resonance imaging
• CRT scans, or computerized axial tomography,
• myelogram or bone scan.

Spinal Surgery Options:

Spinal Fusion Surgery this type of surgery is designed to stop the motion at a painful vertebral segment, which is supposed to decrease pain generated from the joint.

Some of the many approaches to lumbar spinal fusion surgery involve adding bone graft to an area of the spine to set up a biological response that causes the bone graft to grow between the two vertebral elements and create a fusion, thereby stopping the motion at that segment.

Research Sources:

Effectiveness of balneotherapy in chronic low back pain -- a randomized single-blind controlled follow-up study. by Balogh Z, Ordogh J, Gasz A, Nemet L, Bender T.

Physical Therapy - Improvement in automatic postural coordination following alexander technique lessons in a person with low back pain. By Cacciatore TW, Horak FB, Henry SM.

Treatment of low back pain exacerbations with willow bark extract: a randomized double-blind study. By Chrubasik S, Eisenberg E, Balan E, Weinberger T, Luzzati R, Conradt C.

Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. By Santilli V, Beghi E, Finucci S. (Spine Journal)

Internal Medicine: Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. By Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA.

Trunk-strengthening exercises for chronic low back pain: a systematic review. J Manipulative Physiol Therapy. By Slade SC, Ther MM, Keating JL. Steidl L, Ditmar R, Dostal A.

Serum magnesium and calcium in patients with dorsalgias. By Magnes Res Journal Articles

Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain. Health Technol Assess. By Thomas KJ, MacPherson H, Ratcliffe J, Thorpe L, Brazier J, Campbell M, Fitter M, Roman M, Walters S, Nicholl JP.