Spinal stenosis is a disorder defined by the compression of the nerve roots due to a variety of pathologic reasons, resulting in symptoms such as pain, weakness, and numbness.
Every level of compression can result in a different set of symptoms depending on which region of the spine is being compressed. Some patients with spinal stenosis will not exhibit any symptoms.
Some people could feel discomfort, tingling, numbness, and muscle weakness. With time, symptoms may deteriorate. The wear-and-tear alterations in the spine brought on by arthritis are the most frequent cause of spinal stenosis. Those with severe spinal stenosis may require surgery.
Signs and Symptoms of Spinal Stenosis
While spinal stenosis can affect any part of the spine, it most frequently affects the neck (cervical spinal stenosis) and lower back (lumbar canal stenosis). Symptoms differ from each patient and can change over time.
A. Symptoms of Lower Back Spinal Stenosis
- Lower back pain can range in intensity from a dull ache or stiffness to an electric-like or scorching feeling.
- Sciatica is a pain that radiates from the buttocks to the leg or foot
- Numbness on the lower extremities of the body
- Weakness of leg and foot overtime
- Increasing pain when walking downhill or over a long period of standing
B. Symptoms of Neck Spinal Stenosis
- Neck pain
- Numbness below the point of the nerve compression
- Weakness of the arm, leg, hand, or foot
- Balance problems
- Difficulty in hand movements like writing
- In some severe cases, incontinence may be observed
Causes of Spinal Stenosis
Etiologies for spinal stenosis can be inherited or acquired. Congenital causes account for only 9% of instances.
A tiny spinal canal is a birth defect in some patients. However, the majority of spinal stenosis develops when the spine’s amount of open space is decreased.
Spinal stenosis can be brought on by various factors, such as:
- Bone spurs. The spine may develop additional bone due to wear-and-tear damage brought on by arthritis. These are known as bone spurs. Invasion of the spinal canal is possible. Moreover, Paget’s illness might lead to additional bone growth on the spine.
- Herniated disks. The soft cushions that serve as stress absorbers among the spinal bones are known as disks. The spinal cord or nerves may be pressed upon if soft interior material from the disk leaks out in some areas.
- Thick ligaments. The ligaments that keep the bones of the spine connected might stiffen and thicken. Thick ligaments may push into the spinal canal
- Tumors. Tumors may develop in the spinal canal on rare occasions.
- Spinal Injuries. Spinal bones can fracture or slide out of place as a result of trauma from car accidents and other incidents. After back surgery, localized tissue swelling can potentially impose pressure on the spinal cord or nerves.
Risk Factors to Spinal Stenosis
The majority of those who have spinal stenosis are over 50 years old. The risk of developing spinal stenosis may be increased if a person has scoliosis or other spinal issues. Moreover, women have a higher risk of developing spinal stenosis compared to men.
Complications of Spinal Stenosis
Without immediate treatment and a lifestyle change, spinal stenosis can lead to various complications which include:
- A slow and steady loss of leg strength
- Nerve compression
- Increased and persisting pain that comes and go
- Balance problems
- Incontinence
- Numbness
- Paralysis
Alongside this, it may increase the chance of developing other major medical conditions like Spondylolisthesis, Facet joint Syndrome, and Cauda equina syndrome.
Diagnosis of Spinal Stenosis
A physical exam may be requested by a healthcare professional and ask about the patient’s existing symptoms and medical history. Imaging tests may also be recommended to ensure the cause and location of spinal stenosis. These tests may include:
- X-rays. An X-ray of the back can detect bone abnormalities that might be reducing the space inside the spinal canal. Radiation exposure from each X-ray is minimal.
- Magnetic Resonance Imaging (MRI). A strong magnet and radio waves are used in an MRI to provide precise images of both hard and soft tissue. The examination can find ligament and disk problems. It may also reveal any tumors that are present.
- Computerized tomography (CT). This examination includes X-ray images obtained from numerous angles. A contrast dye is given during a CT myelogram to highlight the spinal cord and nerves. This may reveal tumors, bone spurs, and herniated disks.
Treatment for Spinal Stenosis
Treatment options for stenosis vary on the nature of the disease, where it is located, and how severe the symptoms are. The healthcare professional might first advise using some self-care remedies if the symptoms are minor. The healthcare professional may advise physical therapy, medication, and ultimately surgery if the alternatives do not help and as symptoms develop.
Self-help remedies typically include:
- Heat application
- Cold compress
- Exercise
Non-surgical treatments include:
- Medications. Before administration of such medication, consult a professional and ask about the side effects and long-term problems of taking these.
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Antidepressants
- Anti-seizure drugs
- Opioids
- Physical Therapy. Physical therapists will work with the patient to develop a back-healthy exercise program to help them gain strength and improve balance, flexibility, and spine stability. Strengthening the back and abdominal muscles will make the spine more resilient. Physical therapists can teach the patient how to walk in a way that opens up the spinal canal, which can help ease pressure on the nerves.
- Steroid injections. Injections of corticosteroids can aid in reducing swelling, discomfort, and irritation in the location of the spine’s area where nerve roots are being compressed or where worn-out bone areas rub against one another. However, as corticosteroids tend to weaken adjacent tissue and bones over time, only a few injections are typically administered.
- Decompression procedure. Percutaneous image-guided lumbar decompression (PILD) is used to treat lumbar spinal stenosis, which is brought on by the thickening of a ligament (ligamentum flavum) near the base of the spinal column. No general anesthetic or stitches are required because it is done through a very small incision. An X-ray and a contrast chemical that is injected during the surgery serve as guides. A portion of the thickened ligament is cut out by the surgeon using specialized equipment, which creates more room inside the spinal canal and relieves pressure on the nerve roots.
The following surgical procedures could be performed to widen the spinal canal:
- Laminectomy. The afflicted spinal bone’s lamina is removed during surgery. This lessens the pressure by creating more room around the nerves. In some circumstances, a bone transplant and metal hardware may be required to connect that bone to surrounding spinal bones.
- Laminotomy. The lamina is partially removed with this procedure. The surgeon creates a hole that is just large enough to release pressure in a particular area.
- Laminoplasty. Only the neck’s spinal bones are subjected to this procedure. It creates a hinge on the lamina, expanding the space inside the spinal canal. The spine’s opened part is connected by metal hardware.
Nursing Care Diagnosis for Spinal Stenosis
Spinal Stenosis Nursing Care Plan 1
Nursing Diagnosis: Impaired Physical Mobility related to neuromuscular impairment secondary to spinal stenosis as evidenced by the inability to move, muscle atrophy, and contractures.
Desired Outcome: The patient will be able to maintain his or her position of function as evidenced by the absence of contracture and the patient will increase his or her strength of unaffected body parts.
Spinal Stenosis Nursing Interventions
Assess and monitor the patient’s motor function by instructing the patient to perform actions including shrugging shoulders, spreading of fingers, squeezing, and releasing the examiner’s hands. Assessing and monitoring the patient’s motor function helps to evaluate the status of the individual’s situation for a specific level of injury that would affect the type and choice in formulating intervention.
Assist and instruct the patient to perform range of motion (ROM) exercises on all of his or her extremities and joints, and instruct the patient to perform ROM in a slow, and smooth movement. Performing range of motion exercises will help in enhancing the patient’s circulation, and it also helps restore and maintain the patient’s muscle tone and joint mobility.
Develop and plan activities that would provide the patient with an uninterrupted rest period. Planning activities will help to prevent fatigue and will allow an opportunity for the patient’s maximal effort and participation.
Spinal Stenosis Nursing Care Plan 2
Nursing Diagnosis: Acute Pain related to traction apparatus secondary to spinal stenosis as evidenced by burning pain below the level of the patient’s injury, and muscle spasms.
Desired Outcome: The patient will be able to report relief of pain and discomfort and the patient will be able to identify ways that would help manage pain.
Spinal Stenosis Nursing Interventions
Assess and evaluate the presence of spinal pain and help the patient identify the quality, location, type, and intensity of pain using a scale of 0-10. It is important to assess the quality, location, type, and intensity of pain because patients with spinal stenosis usually report pain above the level of injury including the chest and back and the patient may experience headaches due to the stabilizer apparatus.
Provide and promote comfort measures such as position change, massage, ROM activities, and warm or cold packs as needed. Providing alternative measures that will reduce pain is desirable to provide emotional benefit and to reduce pain medication needs.
Encourage and instruct the patient to perform and use relaxation techniques and provide the patient with diversional activities to reduce pain as needed. Relaxation techniques and diversional activities refocus the patient’s attention and will help enhance the patient’s coping abilities.
Spinal Stenosis Nursing Care Plan 3
Nursing Diagnosis: Situational Low Self-esteem related to situational crisis secondary to spinal stenosis as evidenced by verbalization of forced change in lifestyle and feelings of helplessness and hopelessness.
Desired Outcome: The patient will be able to verbalize acceptance of self in a situation and the patient will be able to recognize changes in self-concept accurately without negating self-esteem.
Spinal Stenosis Nursing Interventions
Acknowledge and identify difficulty in determining the degree of functional incapacity and the chance of the patient for functional improvement. Acknowledging and identifying the patient’s ability is important to help the patient integrate the situation into self-concept because self-concept may be delayed during the acute phase of spinal stenosis.
Encourage open communication and listen actively to the patient’s comments and responses to the situation. This intervention will provide clues to the patient’s view of self and changes due to spinal stenosis.
Include the patient and his or her significant others in self-care activities as possible. This will help the patient to recognize his or her responsibility for own life and this intervention will provide a sense of control over his or her situation.
Spinal Stenosis Nursing Care Plan 4
Nursing Diagnosis: Impaired Urinary Elimination related to disruption in bladder innervation secondary to spinal stenosis as evidenced by bladder distention and incontinence.
Desired Outcome: The patient will be able to verbalize understanding about his or her condition and the patient will demonstrate behaviors that would prevent retention.
Spinal Stenosis Nursing Interventions
Assess and evaluate the patient’s voiding pattern including frequency and amount. The patient’s voiding pattern should be assessed and evaluated to identify the characteristics of bladder function and to evaluate the effectiveness of bladder emptying, renal function, and fluid balance.
Instruct and encourage the patient to increase fluid intake by up to 2 to 4 L a day including acid ash juices. Increasing fluid intake will help maintain the patient’s renal function and will help in preventing infection and the formation of urinary stones.
Assess then cleanse the patient’s perineal area and observe for the presence of infection and keep it dry. Cleansing the patient’s perineal area decreases the risk of skin irritation and skin breakdown and will also decrease the development of ascending infection.
Observe and monitor for cloudy, bloody, and foul odor urine and use dipstick urine as indicated. If a patient shows signs of urinary tract infection or kidney infection that can increase the risk of sepsis. The dipstick urine helps in determining pH, nitrite, and leukocyte esterase that would indicate the presence of infection.
Spinal Stenosis Nursing Care Plan 5
Nursing Diagnosis: Deficient Knowledge related to misinterpretation of information secondary to spinal stenosis as evidenced by inappropriate and exaggerated behaviors and the development of complications that can be prevented.
Desired Outcome: The patient will be able to understand his or her condition, treatment, and prognosis, and he or she will correctly perform necessary procedures.
Spinal Stenosis Nursing Interventions
Instruct and teach the patient about the injury process, current prognosis, and future expectations about spinal stenosis. Providing common and accurate knowledge about the condition can help the patient in making informed choices and commitment to the spinal stenosis therapeutic regimen.
Instruct and teach the patient and the significant others about the positioning, and use of pillows, supports, and splints. Proper positioning and use of supports, pillows, and splint will help promote circulation and reduces tissue pressure, and will reduce the risk of infection.
Instruct and encourage the patient to continue participation in daily exercises and conditioning programs. Encouraging the patient about daily activities and conditioning program increases the patient’s mobility and muscle strength.
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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