Spinal stenosis is the narrowing in one or more areas of the spinal canal as a result of injury or deterioration of the discs, joints or bones of the spine. Most cases of spinal stenosis develop as a result of the degenerative changes that occur during aging. Osteoarthritis is the main cause of spinal stenosis, since this condition causes deterioration of cartilage in the area that leads to the bones rubbing against each other. As bones make repeated abnormal contact, bone spurs form, narrowing the spinal canal.
Other causes of spinal stenosis are traumatic injury, herniated disc, ligament thickening and, in rare cases, spinal tumors, any of which can damage the alignment of the vertebrae. A subtype of spinal stenosis is foraminal stenosis. This condition is caused by a narrowing of the foramen, the opening within each of the spinal bones that allows nerve roots to pass through.
Patients with spinal stenosis may experience a number of troubling symptoms. These may include:
- Pain in the back, neck, shoulders or extremities
- Muscle cramping
- Loss of sensation in affected areas
- Loss of balance
- Bladder or bowel dysfunction
The loss of bladder or bowel control is a rare, but particularly distressing symptom, for which surgery is most often necessary.
In order to diagnose spinal stenosis, a medical history and a physical examination are always necessary. The condition is often difficult to diagnose, not only because its symptoms may resemble the symptoms of other conditions, but because they may only occur intermittently. A diagnosis of spinal stenosis is usually achieved only after ruling out other disease conditions. Typically, imaging exams such as a spinal X-rays, MRI, CT or bone scans are administered to definitively diagnose the condition and to pinpoint the spinal region affected. An electromyography (EMG) may also be administered to measure electrical impulses in the affected skeletal muscles.
Most cases of spinal stenosis can be effectively treated through conservative methods such as physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), rest and a supportive back brace or cervical collar. In some situations, corticosteroid injections may provide relief.
For more severe cases, surgical procedures such as a decompressive laminectomy, laminotomy or spinal fusion may be required to relieve pressure on the nerves. When the patient is diagnosed with foraminal stenosis, a surgical procedure known as a foraminotomy may be performed. This operation widens the area where the spinal nerve roots project from the spine.
Whiplash is a common neck condition that occurs as a result of a sudden backwards-forwards motion of the head, often associated with car accidents. This type of injury can stretch the muscles and ligaments as the neck moves out of its normal range of motion. Women are more likely to experience whiplash than men, presumably because men's necks are usually stronger.
In addition to resulting from vehicular accidents, most commonly rear-end collisions, whiplash can occur from injuries suffered during:
- Roller coaster rides
- Contact sports
- Physical abuse
Any activity in which the neck area is moved suddenly or violently may result in whiplash. Being punched or tackled puts an individual at risk for the injury, as does being shaken. One of the injuries suffered in shaken baby syndrome is whiplash.
Patients with whiplash usually develop some symptoms within 24 hours of the injury. It is not unusual, however, for other symptoms to appear, or for symptoms to worsen, weeks after the original injury. Physical injuries after whiplash may include:
- Neck pain and stiffness
- Headaches, especially at the base of skull
- Blurred vision
- Ringing or buzzing in the ears
A wide range of cognitive or emotional symptoms may also result from whiplash. These include:
- Concentration difficulties
- Memory problems
- Sleep disturbances
- Depression, anxiety, irritability
Because whiplash may occur with other serious injuries, such as disc or ligament injury, or concussion, it is important for patients to report severe or worsening symptoms to their physicians, particularly if their pain spreads to their shoulders or arms, if they experience weakness, numbness or tingling in their arms, or if moving the head becomes painful.
Most patients recover from whiplash injuries within 4 to 6 weeks through the help of conservative treatments, such as applying ice to the area and taking over-the-counter anti-inflammatory medication. More severe cases of whiplash may require corticosteroid injections or the use of a cervical collar for several hours during the day to immobilize the neck. It is important to wear a cervical collar for limited periods of time and only under medical guidance.
Patients with whiplash should be carefully evaluated by their physicians before engaging in any physical therapy for the condition. While gentle massage, chiropractic care, electrical stimulation or ultrasound can provide significant relief, exercise, even mild exercise, may be contraindicated if the patient has also suffered a concussion.