Spinal stenosis has been called “baby boomer back” by such medical groups as The American Academy of Orthopedic Surgeons because it is most commonly found among patients who are 50+ years old. This condition involves a narrowing of the spaces within the patient’s spine, which can put pressure on the nerves that travel through the spine. Spinal stenosis can occur in the lower back and the neck.
Until recently, it was thought to be caused by wear-and-tear changes in the spine related to osteoarthritis, and in many cases, there were few, if any, symptoms until the pain began. However, recently published research has shed some light on the causes of this painful condition, and they may be genetically based.
The new study published in the Journal of Orthopaedic Research suggests that “certain genetic changes are linked with an increased risk of developing lumbar spinal stenosis that can lead to pain in the legs when individuals walk.”
The results of this groundbreaking study among 469 individuals (ages 18-55) provide insights into the potential causes of spinal stenosis. Senior author Dr. Dino Samartzis said, “With a better understanding of the condition and the identification of genetic markers, individuals who are at increased risk can be identified early and preventative measures can be initiated. The information may also help investigators develop more novel and precision-based management options for affected patients.”
Dr. Rey Bosita, a spine surgeon in the Dallas-Fort Worth area and a member of the referral line of Texas Health Spine & Orthopedic Center, has treated many patients with spinal stenosis. He offered insights about the current treatment and the ramifications of having genetic markers for this condition.
Where Spinal Stenosis can Occur
Spinal stenosis affects 8 to 11 percent of the population according to the Centers for Disease Control and Prevention (CDC). It is in a group of several conditions, such as osteoarthritis, cognitive impairment and hormonal deficiencies that affect older patients.
“Most of the patients that I treat for this condition are 50 years and older,” Dr. Bosita said. “Although x-rays can show arthritis of the spine or even instability, most cases will require an MRI or CT scan to diagnose spinal stenosis accurately.
“Spinal stenosis can occur in the neck or low back. Cervical stenosis is a narrowing of the spinal canal in the neck area. Lumbar stenosis–the most common location for spinal stenosis–is found in the lower back. Unfortunately, it is possible for patients to experience stenosis in both their neck and low back at the same time.
The Symptoms of Stenosis
The symptoms for spinal stenosis vary depending on the location, and, once they begin, they typically worsen over time.
“A patient with stenosis in the neck area can experience several symptoms,” Dr. Bosita said. “These include numbness or tingling or weakness in the hands and arms, problems with walking and balance, neck pain, and–in severe cases–bowel or bladder dysfunction (urinary and/or bowel incontinence).
“Those with stenosis of the lower back area can experience numbness, tingling or weakness in the legs or feet, pain or cramping in one or both legs when they stand or walk (which usually eases when the patient bends forward or sits), and even severe back pain.”
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The Causes of Stenosis
Before the release of this study on the genetic markers for this condition, spinal stenosis was thought to be caused by age- and activity-related wear and tear, injuries to the spine, and even compression from nerves in an unstable spine.
Dr. Bosita noted, “The current medical literature on spinal stenosis highlights the following causes:
- Overgrowth of bone. The wear and tear damage from osteoarthritis on a patient’s spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal and compress spinal nerves.
- Herniated disks. The soft cushions that act as “shock absorbers” between vertebrae tend to dry out with age. Cracks in a disk’s exterior may allow some of the soft inner material to escape and compress the spinal cord or nerves.
- Thickened ligaments. The ligaments that help hold the bones of the spine together can become stiff and thickened over time. These can bulge into the spinal canal and narrow it further.
- Spinal injuries. Car accidents and other trauma can cause dislocations or fractures of one or more vertebrae. Displaced bone from a spinal fracture may narrow the spinal canal and damage the spinal cord and spinal nerves
- Instability. Many people with spondylolisthesis or spinal instability will develop symptoms of spinal stenosis as nerves are trapped in an unstable spine.
- Tumors. Abnormal masses can form inside the spinal cord, within the membranes that cover the spinal cord, or in the space between the spinal cord and vertebrae to compress spinal nerves.
“Assuming this research holds up to further analysis, we will need to add genetic markers to this list for the onset of lumbar stenosis.”
What Does This Research Mean for Treatment?
The results of this study have the potential for changing the way spinal stenosis is diagnosed and treated.
“In this study, the researchers were trying to identify possible single nucleotide polymorphisms (SNPs) that are associated with developmental spinal stenosis,” Dr. Bosita said. “Using genomic statistical analyses of the 469 participants they accomplished this.
Why is this genetic research so important?
“With a better understanding of the spinal stenosis phenotype and genetic markers, patients at-risk for spinal stenosis can be identified earlier, whether they are exhibiting symptoms or not,” he said. “This would allow patients to initiate preventative measures, including lifestyle and activity modifications and improving core strengthening and range of motion. In the future gene therapy, vaccines, and other completely non-invasive treatments could be developed specifically for patients with a genetic predisposition to develop spinal stenosis so they never ever have to feel pain or weakness from stenosis–now that would be a huge game-changer!
Are you concerned about spinal stenosis? Contact the Texas Health Spine & Orthopedic Center referral line for an appointment.