Start saving regularly

If you have followed up on our wealth building tips sofar, you'll have:

1. reined in your overspending
2. balanced your outgoings and expenses
3. insured yourself against the worst
4. thinking of started to save in a Cash ISA

Once you have an income that’s enough to cover your ‘basics’ you need to start developing a proactive and regular long-term savings plan.

Saving becomes easy if you remove the necessity for willpower and 'pay yourself first'. In your wealth building plan under your savings goals, you should already have decided how much you can save in a year and therefore you know the monthly amount.

Open a separate savings account such as a high interest cash ISA, and direct the appropriate amount of money into it, via a standing order. Let the transfer take place the next day your salary is paid into your current account. The money you’re saving is ‘gone’ before you ever see it.

By doing it like this, you are taking the stress out of saving. You know you've already put away your savings 'quota', so, if you wish, you can spend every penny of what's left over with a clear conscience. And because ‘you never actually see’ the money you're saving, going without it doesn't feel like major deprivation.

Factor in pensions and RRSPs

This brings us to the thorny issue of pensions. You may be fortunate enough, if you’re a public servant or work in the right industry, to be the recipient of a defined benefit pension. If so, you can simply contact your employer’s human resources department to find out the size of the monthly retirement cheque you can expect.

If that amount is enough to bridge the gap between government stipends and your retirement needs, then congratulations—your retirement planning is largely done. You may still want to contribute to an RRSP to finance luxuries, to provide you with a buffer against inflation, and to guard against the possibility that your employer will go bust and renege on its pension promises, but, in all probability, those contributions will simply increase your security, not determine your retirement lifestyle.

Most of us, though, aren’t in that position. Maybe you don’t have a pension plan. Or perhaps your employer’s pension plan is a defined contribution plan that only promises how much your employer will contribute each year you work, but leaves the actual investing up to you. Or maybe your employer’s defined benefit payouts aren’t enough to bridge the gap between government pensions and what you need. In any of those cases, you’re going to have to deal with uncertainty.

Surgical treatment of the Spinal stenosis

When there are signs that pressure is building on the spinal cord, surgery may be required, sometimes right away. Surgeries used to treat spinal stenosis include

• laminectomy
• anterior cervical discectomy and fusion
• corpectomy and strut graft

Laminectomy

The lamina is the covering layer of the bony ring of the spinal canal. It forms a roof-like structure over the back of the spinal cord. When bone spurs or disc contents have pushed into the spinal canal, a laminectomy is done to take off the lamina bone in order to release pressure on the spinal cord.

Some surgeons completely remove the entire lamina bone, called total laminectomy. Others prefer to keep the lamina in place by forming a hinge on one edge of the bone. This hinge is formed by cutting partially through the lamina on one side. A second cut is made all the way through the lamina on the other side. This edge is then lifted away from the spinal cord, and the other edge acts like a hinge. The hinged side eventually forms a bone union, which holds the opposite side open and keeps pressure off the spinal cord.

Anterior Cervical Discectomy and Fusion

A fusion surgery joins two or more bones into one solid bone. Fusion of the neck bones is most often done through the front of the neck. The surgeon takes out the intervertebral disc (discectomy) between two vertebrae. A layer of bone is shaved off the flat surfaces of the two vertebrae to be fused. This causes the surfaces to bleed and stimulates the bone to heal. (This is similar to the way two sides of a fractured bone begin to heal.) A section of bone is grafted from the top part of the pelvis bone and inserted into the space where the disc was taken out. This separates the two vertebra bones, taking pressure off the spinal cord. As the bone graft heals in place, the vertebral bones fuse together into one solid bone.

Corpectomy and Strut Graft

A corpectomy relieves pressure over a large part of the spinal cord. In this procedure, the surgeon takes off the front part of the spinal column and removes several vertebral bodies. The spaces are then filled with bone graft material. Metal plates and screws are generally used to hold the spine in place while it heals. A corpectomy is used in cases of severe spinal stenosis.

Causes of Cervical spinal stenosis

The bony spinal canal normally has more than enough room for the spinal cord. Typically, the canal is 17 to 18 millimeters around, slightly less than the size of a penny. Spinal stenosis occurs when the canal narrows to 13 millimeters or less. When the size drops to 10 millimeters, severe symptoms of myelopathy occur. Myelopathy is a term for any condition that affects the spinal cord. The symptoms of myelopathy result from pressure against the spinal cord and reduced blood supply in the spinal cord as a result of the pressure.

Spinal stenosis may develop for any number of reasons. Some of the more common causes of spinal stenosis include

• congenital stenosis
• degeneration
• spinal instability
• disc herniation
• constriction of the blood supply to the spinal cord

Congenital Stenosis

Some people are born with a spinal canal that is narrower than normal. This is called congenital stenosis. They may not feel problems early in life, but having a narrow canal to begin with places them at risk for stenosis. Even a minor neck injury can set them up to have pressure against the spinal cord. People born with a narrow spinal canal often have problems later in life, because the canal tends to become narrower due to the affects of aging. These degenerative changes often involve the formation of bone spurs (small bony projections) that point into the spinal canal and put pressure on the spinal cord.

Degeneration

Degeneration is the most common cause of spinal stenosis. Wear and tear on the spine from aging and from repeated stress and strain can cause many problems in the cervical spine. The intervertebral disc can begin to collapse, shrinking the space between vertebrae. Bone spurs may form that protrude into the spinal canal and reduce the space available to the spinal cord. The ligaments that hold the vertebrae together may become thicker and can also push into the spinal canal. All of these conditions narrow the spinal canal.

Spinal instability

Spinal instability can cause spinal stenosis. Spinal instability means there is extra movement among the bones of the spine. Instability in the cervical spine can happen if the supporting ligaments have been stretched or torn from a severe injury to the head or neck. People with diseases that loosen their connective tissues may also have spinal instability. For example, rheumatoid arthritis can cause the ligaments in the upper bones of the neck to loosen, allowing the topmost neck bones to shift and close off the spinal canal. Whatever the cause, extra movement in the bones of the spine can lead to spinal stenosis and myelopathy.

Disc herniation

Spinal stenosis can occur when a disc in the neck herniates. Normally, the shock-absorbing disc is able to handle the downward pressure of gravity and the strain from daily activities. However, if the pressure on the disc is too strong, such as from a blow to the head or neck, the nucleus inside the disc may rupture through the outer annulus and squeeze out of the disc. This is called a disc herniation. If an intervertebral disc herniates straight backward, it can press against the spinal cord and cause symptoms of spinal stenosis.

Constriction of the blood supply to the spinal cord

The changes that happen with degeneration and disc herniation can choke off the blood supply that goes to the spinal cord. The sections of the spinal cord that don't get blood have less oxygen and don't function normally, leading to symptoms of myelopathy.

Outlook (Prognosis) of Spinal stenosis

Many people with spinal stenosis are able to be active for many years with the condition, although they may need to make some changes in their activities or work.

Spine surgery will often partly or fully relieve symptoms. However, people who had long-term back pain before their surgery are still likely to have some pain afterward. Spinal fusion probably will not take away all of the pain and other symptoms.

Spine problems are possible after spine surgery. The area of the spinal column above and below a spinal fusion are more likely to be stressed when the spine moves. Also, if you needed more than one kind of back surgery (such as laminectomy and spinal fusion), you may be more likely to have future problems.

What Are Some Nonsurgical Treatments for Spinal Stenosis?

In the absence of severe or progressive nerve involvement, a doctor may prescribe one or more of the following conservative treatments:

• Nonsteroidal anti–inflammatory drugs (NSAIDs), such as aspirin, naproxen, ibuprofen, or indomethacin, to reduce inflammation and relieve pain.1
• Analgesics, such as acetaminophen, to relieve pain.
• Corticosteroid injections into the outermost of the membranes covering the spinal cord and nerve roots to reduce inflammation and treat acute pain that radiates to the hips or down a leg.
• Anesthetic injections, known as nerve blocks, near the affected nerve to temporarily relieve pain.
• Restricted activity (varies depending on extent of nerve involvement).
• Prescribed exercises and/or physical therapy to maintain motion of the spine, strengthen abdominal and back muscles, and build endurance, all of which help stabilize the spine. Some patients may be encouraged to try slowly progressive aerobic activity such as swimming or using exercise bicycles.
• A lumbar brace or corset to provide some support and help the patient regain mobility. This approach is sometimes used for patients with weak abdominal muscles or older patients with degeneration at several levels of the spine.

1Warning: NSAIDs can cause stomach irritation or, less often, they can affect kidney function. The longer a person uses NSAIDs, the more likely he or she is to have side effects, ranging from mild to serious. Many other drugs cannot be taken when a patient is being treated with NSAIDs because NSAIDs alter the way the body uses or eliminates these other drugs. Check with your health care provider or pharmacist before you take NSAIDs. Also, NSAIDs sometimes are associated with serious gastrointestinal problems, including ulcers, bleeding, and perforation of the stomach or intestine. People age 65 and older, as well as those with any history of ulcers or gastrointestinal bleeding, should use NSAIDs with caution.

Causes, incidence, and risk factors of Herniated disk

The bones (vertebrae) of the spinal column protect nerves that come out of the brain and travel down your back to form the spinal cord. Nerve roots are large nerves that branch out from the spinal cord and leave your spinal column between each vertebrae.

The spinal bones are separated by disks. These disks cushion the spinal column and put space between your vertebrae. The disks allow movement between the vertebrae, which lets you bend and reach.

• These disks may move out of place (herniate) or break open (rupture) from injury or strain. When this happens, there may be pressure on the spinal nerves. This can lead to pain, numbness, or weakness.
• The lower back (lumbar area) of the spine is the most common area for a slipped disk. The neck (cervical) disks are affected a small percentage of the time. The upper-to-mid-back (thoracic) disks are rarely involved.

Radiculopathy is any disease that affects the spinal nerve roots. A herniated disk is one cause of radiculopathy.

Slipped disks occur more often in middle-aged and older men, usually after strenuous activity. Other risk factors include conditions present at birth (congenital) that affect the size of the lumbar spinal canal.

Symptoms of Herniated disk

Low back or neck pain can feel very different. It may feel like a mild tingling, dull ache, or a burning or pulsating pain. In some cases, the pain is severe enough that you are unable to move. You may also have numbness.

The pain most often occurs on one side of the body.

• With a slipped disk in your lower back, you may have sharp pain in one part of the leg, hip, or buttocks and numbness in other parts. You may also feel pain or numbness on the back of the calf or sole of the foot. The same leg may also feel weak.
• With a slipped disk in your neck, you may have pain when moving your neck, deep pain near or over the shoulder blade, or pain that moves to the upper arm, forearm, or (rarely) fingers. You can also have numbness along your shoulder, elbow, forearm, and fingers.

The pain often starts slowly. It may get worse:

• After standing or sitting
• At night
• When sneezing, coughing, or laughing
• When bending backwards or walking more than a few yards
• You may also have weakness in certain muscles. Sometimes, you may not notice it until your doctor examines you. In other cases, you will notice that you have a hard time lifting your leg or arm, standing on your toes on one side, squeezing tightly with one of your hands, or other problems.

The pain, numbness, or weakness will often go away or improve a lot over a period of weeks to months.