Spine is a major organ of locomotion and posture maintenance. The spine consists of 33 vertebrae (bones). There are cushion-like structures called discs between each of the vertebra that act like pads or shock absorbers. Each disc is made up of a tire-like outer band called the annulus fibrosus and a gel-like inner substance called the nucleus pulposus. Together, the vertebrae and the discs provide a protective tunnel (the spinal canal) to house the spinal cord and spinal nerves. These nerves run down the center of the vertebrae and exit to various parts of the body.

• Spinal stenosis means Narrowing of space for nerves in the spine due to compression.
• When the disc or cushion bulges and degeneration (wear and tear) of facet joints (joints in the spine) protrude into the spinal canal causing compression of the nerve then its called Spinal Stenosis.

Lumbar Canal Stenosis, Lumbar Spinal Stenosis:

Degeneration of joints and disc bulge into the canal of nerves results in reduced space for nerves into the canal of nerves resulting in a spinal stenosis. Compression of nerve results in back pain, buttock pain, leg pain, leg numbness or buttock pain traveling down the leg and patients complains of pain in leg with numbness and difficulty in walking. This pain in legs with numbness in leg and heaviness in leg increase during walking and is called claudication.

Spinal stenosis is a condition where the space for nerve roots in the spinal column gets narrow – narrowing of the spine means spinal stenosis. Spinal stenosis leads to narrowing of channels where the spinal cord and nerve roots travel resulting in the spinal cord and nerve roots getting squeezed also known as “compression of nerve roots.”

Spinal stenosis can lead to pain in the lower back, leg pain, sciatica, neck, arms, or hands depending on the exact location of the stenosis. Spinal stenosis most commonly happens in the low back (lumbar spine) or in the neck (cervical spine and so is called lumbar spinal stenosis or cervical spinal stenosis.

• Spinal stenosis is of two types – Primary spinal stenosis or developmental spinal stenosis present since birth although the symptoms appear in the latter part of the life. This is a form of inherited stenosis.
• the Second form of spinal stenosis category is common – Acquired spinal stenosis which results from wear and tear of the spine –disc and facet joints – called degeneration, where the cartilage that cushions joints starts to degenerate wear out due to age.
• Spinal Stenosis also happens in the severe yet chronic bulge of disc /bulge disc. Slip disc or bulge disc or herniated disc protrudes into the spinal canal and pinches over the nerve. Risk factors for both degeneration and lumbar spinal stenosis in the spine include aging, poor posture, high impact sports, and being overweight.
• Dr. Vishal Kundnani is an expert in Spinal Stenosis and is the Best spine specialist in Mumbai for Spinal stenosis. Dr. Vishal Kundnani is the best spinal surgeon who performs minimally invasive spinal surgery for spinal stenosis. Available for consultation in spine clinic and various hospital attachments in Mumbai.

• Back Pain, Leg pain, buttock pain, pain in legs, Numbness in legs, Heaviness in legs, Imbalance in walking, Difficulty in walking, Weakness in legs, Calf cramps are the common symptoms of spinal stenosis in the lumbar spine. All these symptoms increase with walking and are called as CLAUDICATION .
• Spinal stenosis in the low back (lumbar spine) can cause pain or cramp in legs during standing or during a walk for a smaller distance.
• In severe cases of lumbar spinal stenosis, nerves to the bladder or bowel may be compressed, which can lead to partial or complete incontinence. The earliest symptom of this may be increased frequency of urination or urgency of urination and may progress to complete incontinence/inability to control urine. This is a surgical emergency and may need surgery at earliest

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• Spinal stenosis in the neck -cervical spine compression the main nerve – spinal cord is called spinal stenosis of the cervical spine and can cause neck pain, shoulders pain, vertigo, giddiness, arm pain, pain in nape of the neck, forearm pain. However in advanced cases, the symptoms may be difficulty in walking, imbalance during walking, numbness in hands, change in fine functions of the hand, difficulty in holding a glass, change of signature, etc. weakness of hands and grip.
• Imbalance during walking, clumsiness of gait, difficulty in walking and difficulty in fine functions of the hand are the commoner presentations of cervical stenosis.

Spine specialist may examine you clinically and may ask for investigations like X-Ray and MRI SCAN OR CT SCAN to diagnose the presence of Spinal Stenosis / Lumbar Canal stenosis / Lumbar spinal stenosis in presence of symptoms . MRI scan can show various grades of Spinal Stenosis / Lumbar Canal stenosis / Lumbar spinal stenosis and may also suggest if surgery is really needed in view of ongoing compression of nerves in the spinal canal.

For diagnosis of the spinal problem meet the specialist in your locality. Dr. Vishal Kundnani is available in Mumbai, Goregaon, Bandra, Kandivali on appointment. Dr. Vishal Kundnani is the best spine specialist in Mumbai. Dr. Vishal Kundnani is Best spinal specialist in Mumbai , Goregaon , Malad and Kandiwali

• No. Surgery is not the only option of treatment in a spinal stenosis. Surgery is required in a select group of patients with severe symptoms affecting daily living. Nonsurgical treatment helps in most patients significantly .
• Non-surgical treatment options to treat Slip Disc include physiotherapy, exercises, medication and injection in spine. Meet your spine specialist to decide on which is the best treatment option for you. The best spine specialist in India is Dr. Vishal Kundnani, Mumbai who manages these problems with a scientific approach.
• These options of non-surgical management of slip disc are available at Spine Clinic Mumbai –best spine clinic in Mumbai for treatment of slip disc. Dr. Vishal Kundnani is the best spine consultant in Mumbai and is available on appointment in Mumbai on appointment for spine specialist.

• No. Surgery is required in select group of patients with severe symptoms affetcing daily living .Non surgical treatment helps in most patinets significantly.
• The non surgical treatment option is decided based on the duration and dseverity of symptoms in consultation with your spine surgeon/spinal surgeon the options available for slip disc treatment are –
  • Medicines – NSAIDS/ Muscle relaxant / Pregabalin / TCA,S /non opiod analgesics
  • Hot fomentation
  • Cold sponging
  • Physical therapy
  • TENS
  • SWD
  • However before one resorts to any option one should have advise of Spine Surgeon

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These options of non-surgical management of slip disc are available at Spine Clinic Mumbai – best spine clinic in Mumbai for treatment of slip disc. Dr. Vishal Kundnani is the best spine consultant in Mumbai and is available on appointment in Mumbai on appointment for spine specialist. Dr. Vishal Kundnani is the best spine speclaist in mumbai and best spinal consultantin Goregaon, Kandiwali and Malad.

• Physiotherapy has a major role in spinal stenosis treatment and recovery. It teaches how to condition your body to prevent further injury and help in the recovery of the painful episode. There are a variety of physical therapy techniques. Passive and active treatments.
• Passive treatments relax your body and include deep tissue massage, hot and cold therapy, electrical stimulation (TENS), and hydrotherapy. Active treatment involves active stretching and strengthening exercises trunk stability, core strengthening.

What are Passive Treatments / Exercise for slip disc / spinal stenosis ?

• Deep Tissue Massage: Deep tissue massage relieves deep muscle tension and spasms, which develop to prevent muscle motion at the affected area.
• Hot and Cold Therapy: Both hot and cold therapies offer their own set of benefits, and your physical therapist may alternate between them to get the best results. This reduces inflammation, muscle spasms and pain.
• Hydrotherapy: gently relieves pain and relaxes muscles.
• TENS (transcutaneous electrical nerve stimulation): uses electrical current to stimulate your muscles and reduces muscle spasms and is generally believed to trigger the release of endorphins, which are your body’s natural pain killers. TENS machine stimulates your muscles through variable (but safe) intensities of electrical current. TENS may increase your body’s production of endorphins, your natural pain killers. The TENS equipment your physical therapist uses is larger than the “at home” use machine.
• ultrasound: By increasing blood circulation, an ultrasound helps reduce muscle cramping, swelling, stiffness, and pain. It does this by sending sound waves deep into your muscle tissues, creating a gentle heat that enhances circulation and healing.
• Traction: reduce the effects of gravity on the spine. the intent is to reduce the disc herniation and is usually performed in the cervical or lumbar spine.
• The McKenzie Method is a system of evaluating and treating spinal disorders, including spinal stenosis. McKenzie Method does not actively treat spinal stenosis. It is a non-responding condition to mechanical therapy, so the typical techniques used in the McKenzie Method will not help the pain from spinal stenosis.McKenzie Method involves patient education and active patient involvement. For spinal stenosis, a clinician will help you learn how to avoid sustained extension positions because the extension can increase pain if you have spinal stenosis. And helps you on flexed positions when pain is less with bending forward. The protocol involves you to learn abdominal flexors.

These options of non-surgical management of slip disc are available at Spine Clinic Mumbai –best spine clinic in Mumbai for treatment of slip disc. Dr. Vishal Kundnani is the best spine consultant in Mumbai and is available on appointment in Mumbai on appointment for spine specialist. Dr. Vishal Kundnani is the best spine specialist in Mumbai and best spinal consultant in Goregaon, Kandivali and Malad.
What are Active physiotherapy Treatments / Exercise for slip disc / spinal stenosis?
Help to reduce recurrent pain but will also benefit your overall health.

• Core stability: Many people don’t realize how important a strong core is to their spinal health. Your core (abdominal) muscles help your back muscles support your spine. When your core muscles are weak, it puts extra pressure on your back muscles. Your physical therapist may teach you to core stabilizing exercises to strengthen your back.
• Flexibility: Learning proper stretching and flexibility techniques will prepare you for aerobic and strength exercises. Flexibility helps your body move easier by warding off stiffness.
• Muscle strengthening: Strong muscles are a great support system for your spine and better handle pain. and strengthening of muscles which can cause your back stretches and strengthen along with pelvic tilt, which helps you find a neutral spine position

Surgery for Spinal stenosis or lumbar spinal stenosis involves decompression – freeing the nerves of the compression from disc or facet joints in the spine. it involves partial removal of the compressive elements which are causing spine compression and are the cause of symptoms.

Various options of spine surgery include conventional open spine surgery and Minimal Invasive Spine Surgery or MIS surgery for spinal stenosis. These options of surgical management of Slip Disc and spinal stenosis are available at Spine Clinic Mumbai – Best Spine Clinic in Mumbai for treatment of Slip Disc and spinal stenosis. Dr. Vishal Kundnani is the best spine consultant in Mumbai and is available on appointment in Mumbai on appointment for spine specialist. Dr. Vishal Kundnani is the best spine specialist in Mumbai and best spinal consultant in Goregaon, Kandivali and Malad.

Most patients with lumbar spinal stenosis respond well to non-surgical treatments (such as medication)

1. Indications for spinal surgery in spinal stenosis are:
   • No response / partial response to non-surgical treatments
   • Progressive radiculopathy, – pain, numbness, and tingling in the arms or legs.
   • Loss of power sensation in your arms or legs.
   • lost bowel or bladder control.
2. Goal of stenosis surgery is to free up area for your spinal cord and/or the nerve roots. That’s called spinal decompression.
3. Two surgical techniques for spinal stenosis surgery:
   • Decompression: Tissue pressing against a nerve structure is trimmed, which makes more room in the spinal canal (for the spinal cord) or in the foramen (for the nerve roots)
   • Stabilization: to limit motion between vertebrae when instability is the cause of problem giving rise to pain and numbness / weakness

Various options of spine surgery include conventional open spine surgery and minimally invasive spine surgery or MIS surgery for spinal stenosis. These options of surgical management of Slip Disc and spinal stenosis are available at Spine Clinic Mumbai – Best Spine Clinic in Mumbai for treatment of Slip Disc and spinal stenosis. Dr. Vishal Kundnani is the best spine consultant in Mumbai and is available on appointment in Mumbai on appointment for spine specialist. Dr. Vishal Kundnani is the best spine specialist in Mumbai and best spinal consultant in Goregaon, Kandivali, and Malad

Surgery for spinal stenosis is safe and simple. To remove the tissue that’s pressing on a nerve, the spine surgeon may perform one of the following:

1. Foraminotomy: If part of the disc or a bone spur (osteophyte) is pressing on a nerve root in its path (an exit called the foramen), a foraminotomy – widening of the path for nerve root- may be done. Ostomy means “to make an opening.” So a foraminotomy is making the opening of the foramen larger, so the nerve can exit without being compressed.
2. Laminotomy: laminotomy makes a larger opening, this time in bony plate protecting the spinal canal and spinal cord. The lamina bony sheath over the nerves along with the nerve roots  may be pressing on your nerve,  which is removed  to  make more room for the nerves using a laminotomy.
3. Laminectomy: Sometimes, in severe cases and multilevel cases small opening in the bone may not be And what is needed is to remove all or part of the lamina, and this procedure is called a laminectomy.  This can often be done at many levels without any harmful effects.
4. Indirect decompression is a variation of decompression surgery where pressure is relieved by spreading the bones apart instead of removing the bone. This can be done with different techniques and various instrumentation some examples are distraction laminoplasty with or without implants like interspinous process devices or interbody cages. Even artificial discs can accomplish some indirect decompression by restoring the height between adjacent vertebrae.

Various options of spine surgery include conventional open spine surgery and Minimal Invasive Spine Surgery or MIS surgery for spinal stenosis. These options of surgical management of Slip Disc and spinal stenosis are available at Spine Clinic Mumbai – Best Spine Clinic in Mumbai for treatment of Slip Disc and spinal stenosis. Dr. Vishal Kundnani is the best spine consultant in Mumbai and is available on appointment in Mumbai on appointment for spine specialist. Dr. Vishal Kundnani is the best spine specialist in Mumbai and best spinal consultant in Goregaon, Kandivali, and Malad

• Surgery for lumbar spinal stenosis is safe and simple. Spinal fusion for spinal stenosis is rarely required. Spinal fusion is not required in all cases of spinal stenosis. Spinal fusion is required in patients when there is instability –painful mobility between the vertebrae bones and the surgery is aimed at reducing the mobility at that segment. It’s especially helpful in cases where one or more vertebrae have slipped forward – SPONDYLOLISTHESIS – slipping of one vertebra forward in relation to other, which makes spine unstable and painful due to pinch of nerves causing pain.
• Spinal fusion may also be required if instability although not present today is imminent after the surgery for spinal stenosis. Henceforth the fusion is added to decompression in anticipation of instability. Spinal fusion surgery requires putting/inserting Spinal implant (Pedicle screw and plates and cages ) in the spine after decompression surgery. The spinal implants are an extremely safe procedure .
• Spinal fusion can be done in open conventional technique. However Minimal invasive spinal fusion surgery is extremely safe and simple and most efficient. The best technique to do spinal fusion is Minimal Invasive Spinal Fusion. Minimal invasive spinal fusion also called as minimal invasive transforaminal interbody fusion or MIS-TLIF or MIS TLIF is a extremely safe procedure with plenty of benefits of less pain , less blood loss , less infection , smaller incisions , early return to work , early discharge from hospital , no need of bed rest after surgery .

Various options of spine surgery include conventional open spine surgery and minimally invasive spine surgery or MIS surgery for spinal stenosis. These options of surgical management of slip disc and spinal stenosis are available at Spine Clinic Mumbai – Best Spine Clinic in Mumbai for treatment of slip disc and spinal stenosis. Dr. Vishal Kundnani is the best spine consultant in Mumbai and is available on appointment in Mumbai on appointment for spine specialist. Dr. Vishal Kundnani is the best spine specialist in Mumbai and best spinal consultant in Goregaon, Kandivali and Malad