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Spinal Stenosis

Spinal stenosis occurs when the spaces in your spine narrow, whether from aging, injury, or a medical condition. You may have pain, weakness, or other symptoms if the spinal cord is compressed.

The spine provides stability and support to your upper body, enabling you to twist and turn.

The spinal cord is made up of spinal nerves, which conduct signals from your brain to the rest of your body. The surrounding bone and tissues usually protect the nerves. If the spinal nerves are damaged or impaired, it can affect your daily function.

Spinal stenosis is a condition in which the spaces in the spine narrow, compressing the spinal cord. This process is typically gradual. It can occur anywhere along the spine.

If the narrowing is minimal, no symptoms will occur. But too much narrowing can compress your nerves and cause problems.

There are multiple types of spinal stenosis. They include:

lumbar spinal stenosis, which affects the lower back

cervical spinal stenosis, which affects the neck

foraminal stenosis, which affects the openings in your bones where nerves or vessels pass (foramen)

tandem spinal stenosis, which affects at least two areas of the spine

The symptoms of spinal stenosis typically progress over time as nerves become more compressed.

If you have spinal stenosis, you might experience:

Sitting in a chair usually helps relieve these symptoms. However, the symptoms may return when you stand or walk.

Spinal stenosis can also cause problems with:

bowel control

bladder control

sexual function

The most common cause of spinal stenosis is aging. As you age, tissues in your spine may start to thicken, and bones may get bigger, compressing the nerves.

Certain health conditions may also contribute to spinal stenosis. They include:

Achondroplasia:Achondroplasia is a type of dwarfism that interferes with bone formation in the spine and other parts of the body.

Ankylosing spondylitis: Ankylosing spondylitis is a type of arthritis that causes chronic inflammation in the spine. It can lead to the growth of bone spurs.

Congenital spinal stenosis: Congenital spinal stenosis occurs when you're born with a naturally narrow spinal canal.

Ossification of the posterior longitudinal ligament (OPLL): In this condition, calcium deposits form on the ligament that runs through the spinal canal.

Osteoarthritis: In osteoarthritis, the cartilage that cushions your joints breaks down. The condition can affect the cartilage between vertebrae and cause bone spurs to grow in the spine.

Paget's disease of the bone: Paget's disease of the bone is a chronic condition that causes bones to get weaker and grow larger than usual.

Rheumatoid arthritis: Rheumatoid arthritis involves chronic inflammation, which can cause bone damage and the development of bone spurs.

Scoliosis: Scoliosis is an abnormal curving of the spine. It may result from certain genetic conditions, neurological abnormalities, or unknown causes.

Spinal injuries: Bone fractures may cause vertebrae or bone fragments to put pressure on the spinal nerves while slipped (herniated) discs can also put pressure on the spinal nerves.

Spinal tumors: These tissue growths may develop in the spinal canal, trigger inflammation, and cause changes in the surrounding bone.

If you have symptoms of spinal stenosis, a doctor typically starts by taking a medical history, performing a physical exam, and observing your movements.

The doctor may also order tests to check for signs of stenosis and other health conditions that may explain your symptoms. These tests may include:

Treatment for spinal stenosis can depend on the symptoms you are experiencing. Treatment can include:

nonsteroidal anti-inflammatory drugs (NSAIDs) to help ease pain

a short course of oral corticosteroids to reduce inflammation

injections of cortisone into your spine to help reduce swelling

physical therapy to help strengthen and stretch your muscles

other medications if you experience nerve pain

The doctor may recommend surgery if you have severe pain or weakness and other treatments have not worked. Most people will be able to manage their condition with nonsurgical treatments.

You may find some relief from your symptoms with one or more home remedies and complementary therapies such as:

heat therapy, in which you use a heating pad, warm towel, warm bath, or other heat sources to relax stiff muscles

cold therapy, in which you apply ice or a towel-wrapped cold pack to swollen areas to relieve swelling and pain

acupuncture

massage

yoga

Exercise can be a key component of spinal stenosis management. The exercise you perform on your own can complement physical therapy.

Try to build an exercise routine around activities that improve your balance and flexibility or strengthen your spine and core.

Speak with a doctor or physical therapist first to ensure your at-home exercise routine is safe and appropriate. A physical therapist can typically provide a home exercise program to follow during and after physical therapy.

Possible activities include:

short stints of walking

swimming

using a stationary bike

certain yoga moves, like child's pose or cat-cow

modified versions of the moves you've learned in physical therapy

People with severe pain and weakness that doesn't respond to other treatments may require surgery. A doctor may also prescribe surgery if the condition is affecting your ability to:

walk

control your bowel or bladder

perform other daily activities

Several types of surgery are used to treat spinal stenosis.

Laminectomy: Laminectomy is the most common type of spinal stenosis surgery. A surgeon removes part of the vertebrae to provide more room for the nerves.

Foraminotomy: Foraminotomy is used to widen the foramen, the parts of the spine where the nerves exit.

Spinal fusion: Spinal fusion is typically performed in more severe cases, especially when multiple levels of the spine are involved. The surgeon uses bone grafts or metal implants to attach the affected bones of the spine together.

How serious is spinal stenosis?

Spinal stenosis can vary in severity, depending on if the nerve is compressed and how much of the spine is affected. Spinal stenosis may also get worse over time.

What are the 4 stages of spinal stenosis?

The four stages of degenerative disc disease include:

Stage 1: Dysfunction stage, in which the spine loses protection from shock, and you may have mild pain

Stage 2: Dehydration stage, in which you continue to lose function and may experience moderate pain

Stage 3: Stabilization stage, during which spinal stenosis occurs, and you may feel severe pain

Stage 4: Collapsing stage, in which the spinal discs may collapse, and you may experience severe pain

What are the severe symptoms of spinal stenosis?

If the spinal cord is compressed due to spinal stenosis, you may experience pain, numbness, or other symptoms. In severe cases, it can lead to a loss of bowel or bladder control and limited mobility.

What is the most common treatment for spinal stenosis?

The most common treatment for spinal stenosis typically involves medication to reduce swelling and physical therapy to strengthen the surrounding muscles. Physical therapy may include mobility and strengthening exercises to help reduce pain and other symptoms.

What is spinal stenosis pain like?

Spinal stenosis pain can feel like pain, stiffness, tingling, or numbness. The pain may feel burning or aching pain that is worse while walking, sitting, or standing. These symptoms can radiate down the leg, arm, or buttocks, depending on which part of the spine is affected.

Many people with spinal stenosis lead full and active lives. However, you may need to adjust your exercise routine or other day-to-day activities to help manage your symptoms.

A doctor may prescribe medications, physical therapy, or surgical treatments to relieve pain and other symptoms. You may experience residual pain after treatments, even surgical ones.

Talk with a doctor to learn more about your treatment options and outlook.

Medications And Their Potential To Cause Increase In 'Congenital Hypertrophic Pyloric Stenosis'

List of Drugs that may cause 'Congenital hypertrophic pyloric stenosis'

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Updated on August 25, 2023 This page features an assortment of drug(s) that could potentially trigger 'Congenital hypertrophic pyloric stenosis' as a Side-effect or adverse response. It is not uncommon for medications to have some tolerable mild side effects. Do remember that these listed medication(s) only represents individual medications that could be part of a larger combination therapy. Please keep in mind that this list of drug(s) is intended to serve as an information resource and should not be a substitute to professional medical advice. If you have concerns about 'Congenital hypertrophic pyloric stenosis', we advise that you speak with a healthcare professional. Similar to 'Congenital hypertrophic pyloric stenosis,' there are other symptoms or signs that might more accurately describe your side effect. They are detailed below for your convenience. If any of these additional symptom(s) align more closely with your experience, you can choose them to determine potential medications that could be responsible.

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Aortic Stenosis: Effects Of Heart Valve Narrowing

Medically reviewed by Anisha Shah, MD

Aortic stenosis is a condition that causes the heart's aortic valve to narrow. The aortic valve connects the heart's main pumping chamber (left ventricle) to the aorta. Aortic stenosis can occur due to a congenitally abnormal aortic valve or due to degeneration of the valve.

It's a fairly common condition, particularly in adults over age 65 years. You may not have any symptoms early on, but your healthcare provider may be able to hear a heart murmur. In later stages, when symptoms are present, valve replacement is necessary.

This article will discuss the stages of aortic stenosis and treatment options.

FG Trade Latin / Getty Images

Why Does Aortic Stenosis Happen?

Narrowing of the aortic valve can happen for several reasons. Some more common causes include degenerative valve disease, congenital valve disease, and rheumatic heart disease. The most common type of aortic stenosis is degenerative aortic stenosis due to wear and tear on the valve over many years. Usually, this doesn't happen until around 60 years old, with symptoms appearing between 70 and 80 years old.

Congenital (present at birth) malformations of the aortic valve are actually quite common, with up to an estimated 2% of people born with a bicuspid valve that has just two cusps (flaps) instead of the normal three cusps. Over time, increased stress on the valve leads to calcification and narrowing. People with congenital aortic valve narrowing may begin to have symptoms as soon as 30 years old.

Lastly, rheumatic heart disease can cause aortic stenosis. Rheumatic heart disease happens years after rheumatic fever, a condition related to untreated strep infections. While it is rare in the United States, in other parts of the world it's a common cause of heart valve disease. Rheumatic heart disease typically affects the mitral valve, but the aortic valve can also be affected.

Classification of Aortic Stenosis

According to the American Heart Association/American College of Cardiology, valvular heart disease is classified based on echocardiogram (heart ultrasound) findings and presence or absence of symptoms. Aortic stenosis starts as mild but becomes more severe and causes symptoms over time.

Progressive Aortic Stenosis

Progressive aortic stenosis is a term that includes mild and moderate aortic stenosis. There is some narrowing of the valve, but the valve is still able to allow enough blood to pass from the heart to the body without causing symptoms. A murmur is heard on physical examination, but progressive aortic stenosis can be monitored over time and does not require immediate treatment.

Severe Aortic Stenosis

Severe aortic stenosis, on the other hand, is when the valve becomes so narrow that blood flow out of the heart is significantly impaired. This typically leads to symptoms like exercise intolerance (the body's inability to exercise), shortness of breath, chest pain, light-headedness or even fainting.

Often, people with severe aortic stenosis have symptoms. Sometimes, when someone with severe aortic stenosis does not notice symptoms, it is because they have decreased their activity levels without realizing it. If you have severe aortic stenosis but no symptoms, a cardiologist can perform a treadmill stress test, during which exertion can bring out any unnoticed symptoms.

It's important to pay attention to any symptoms, because once symptoms are present, it's time to get the valve fixed. In some cases the valve should be fixed sooner, and this depends on the severity based on echocardiogram measurements as well as any other heart surgeries that may be needed.

Receiving an Aortic Stenosis Diagnosis

The murmur of aortic stenosis is very specific, so the condition is usually first suspected with physical examination. However, the details of the valve and the severity of aortic stenosis require an echocardiogram, or heart ultrasound, for further characterization.

If you have been diagnosed with aortic stenosis, it's important to follow up with a cardiologist for regular screening and/or treatment. For progressive aortic stenosis, your cardiologist will perform echocardiograms every so often (every year or three to five years, depending on how narrow the valve is) to monitor progression and heart function. Pay attention to any of the following symptoms and report them to your heart team. Note that it's not the severity of symptoms but the presence of any symptoms, even if mild, that is important. Symptoms may include:

A heart valve replacement is needed if aortic stenosis becomes very severe or if symptoms develop.

Aortic Stenosis Progression and Effect on Life Expectancy

Progression of aortic stenosis varies based on the type of aortic stenosis and the severity at diagnosis. Those with severely narrowed valves experience the most rapid progression. Once aortic stenosis is severe, the two-year survival rate is 30% to 50% without valve replacement.

Those with mild aortic stenosis may take years to progress to severe disease or require a valve replacement. That is why echocardiograms to monitor progression can be spaced out every three to five years for those with mild aortic stenosis.

Treatment of Aortic Stenosis

Aortic stenosis historically required open heart surgery to correct. However, over the past several decades, a less invasive procedure called transcatheter aortic valve replacement (TAVR) has become a preferred treatment option for many people. The type of valve replacement you receive depends on several factors, including your age and whether or not there is other valve disease present.

There are two types of prosthetic heart valves that may be used: mechanical (artificial) or bioprosthetic. Mechanical valves last longer, but they require open heart surgery. People with these valves need to take lifelong anticoagulant (blood-thinning) medication.

Bioprosthetic valves are made from either porcine (pig) or bovine (cow) tissue and can be surgically implanted with TAVR. These valves do not require long-term medication, but it may be recommended short-term after implantation.

Surgical Aortic Valve Replacement

Surgical aortic valve replacement requires open heart surgery to implant a new valve. A heart surgeon can place a mechanical or bioprosthetic valve, the choice of which depends on individual patient factors.

Surgical valve replacement may be preferred over TAVR for younger patients because mechanical valves are known to last longer, and mechanical valves cannot be placed with TAVR. However, open heart surgery is more invasive than TAVR, and the recovery period is longer.

TAVR

In TAVR, a bioprosthetic aortic valve is implanted using a catheter-based technique. A catheter is typically placed through an artery in the groin but in some cases may be placed through arteries in the neck or upper chest.

Once in the proper position in the aortic valve, a balloon is inflated, pushing the old valve aside and leaving the new valve in place. TAVR is a great option for people with aortic stenosis who have frailty or other medical conditions. TAVR is often preferred in people older who are 65 years old or older.

Postoperative Care

Postoperative care differs based on the type of procedure. If a surgical aortic valve was implanted through open heart surgery, recovery is longer and can take about four to eight weeks. In either case, you may benefit from cardiac rehab, a supervised exercise program for people with heart disease or recovering from heart surgery.

Speak with your heart team about any exercise, driving, or other activities restrictions. You will also receive instructions on how to care for any surgical wounds.

Lifestyle and Medical Management

No medications or treatments have been shown to slow the progression of aortic stenosis. However, it's recommended that people with heart disease follow a heart-healthy lifestyle, which includes:

Eating heart-healthy diet high in fruits, vegetables, legumes, whole grains, and low in salt and processed foods

Getting regular physical exercise

Quitting smoking and avoiding secondhand smoke

Avoiding alcohol or drinking alcohol in moderation

Keeping cholesterol, blood pressure, and blood sugar controlled

How to Find a Cardiologist You Trust

It can be intimidating to receive a diagnosis of aortic stenosis, and finding a cardiologist and heart team that you trust with your care is important. Cardiologists are physicians who have completed internal medicine residency training and three years of additional fellowship training in cardiovascular disease. Interventional cardiologists who perform TAVRs have one to two years of additional procedural training.

Many health centers have specialized valve teams with expertise and experience managing complex valvular heart disease. Cardiologists and heart surgeons work together to determine the best course of action regarding valve replacement. Look for a care team that is experienced in managing aortic stenosis and who takes the time to explain your condition and answer your questions.

Summary

Aortic stenosis is narrowing of the heart valve that allows blood to exit the heart to supply the body with blood and oxygen. Severe narrowing of this valve causes symptoms including exercise intolerance, chest pain, shortness of breath, and light-headedness. Once aortic stenosis is severe and causing symptoms, life expectancy is reduced and replacement of the valve is necessary.

Valve replacement can be performed through open heart surgery or a less invasive technique called transcatheter aortic valve replacement (TAVR). A specialized heart team will determine the best treatment plan for individual patients.

Read the original article on Verywell Health.

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