The central portion of the spine has a canal where spinal cord is located. The cord itself ends at around L1 level (below the middle portion of the spine). Below this level, the canal is occupied entirely by bunch of roots (This portion looks like Cauda Equina-“Horse tail’). Stenosis means narrowing and spinal canal stenosis literally means that this canal, housing the cord or the nerves, is narrowed. This gradual narrowing happens as a result of the degeneration of both the facet joints and the intervertebral discs. The osteophytes, which develop in the degenerative disc disease, encroach inside the spinal canal or the root canal. These are called respectively as canal stenosis and lateral recess/ foraminal stenosis. When we stand or walk, our legs need more nerve impulses flowing through the spinal roots. This, in turn increases the need for blood supply to the area inside the spinal canal. Whenever there is increased need of oxygen and sugar for the Cauda-equina (nerve roots), normally blood vessels in the spinal canal distend to allow more blood flow. In canal stenosis, these vessels can not distend due to lack of space. The nerve roots, resultantly, suffer form the lack of oxygen & glucose and start to dysfunction. This is when the symptoms like pain, numbness or weakness appear in one or both the legs. As soon as the person stops walking/ Running etc, the need for the oxygen & glucose goes down and the symptoms slowly subside. The person can then again walk for sometime. So, to summarize the symptoms, usually, there are no symptoms when a person starts walking, running etc. After a certain distance, there is one or more of the following numbness, weakness, heaviness, tingling pain in one or both the lower limbs. The person has to stop walking and rest. The symptoms subside and he can walk without a symptom is called ‘Claudication’ distance. As the stenosis progress, this distance reduces. Finally, a stage comes when the person can barely walk for 2 to 3 minutes. Any position, which increases the diameter of the spinal canal, reduces the symptoms. Flexion (Bending Forward) of the spine alleviates the symptoms, as it increases the diameter of the spinal canal. (e.g. Person who can hardly walk for 5 minutes can ride a bicycle in bending forwards posture for half an hour.) I have known a senior police officer who had symptoms even on standing. When on duty, he had to bend down on pretext of tying shoe laces. This bending down would then relieve his pain. Treatment In initial stages, exercises to strengthen the flexor muscles of the lower spine (Mainly Iliopsoas and abdominals) are useful. Doing only stretching exercise like yogasanas without strengthening muscle exercise is the commonest mistake seen especially in India. As the disease advances Neuro Surgical decompression of the affected area is essential. This should be done in the disease which is progressively increasing and has reached moderate severity. On ocarinas, when there is instability, instrumental fixation may be required. Delaying surgery when it is necessary can have adverse effects on the nerve roots. (Alternative medicine treatments should be attempted logically and intelligently. Not fanatically. Very few of them are, actually, really proven by modern scientific methodology.)
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