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Spinal Stenosis

Overview

Doctor with tablet showing patient cat scan images of lumbar spine.

Living with spinal stenosis can be an extremely frustrating and, often, painful experience. Although spinal stenosis can occur amongst younger patients and athletes, it is typically a degenerative condition that affects older individuals. According to Medscape.com, spinal stenosis affects about 5 of every 1000 persons over the age of 50. Spinal stenosis can sometimes go undiagnosed, or even misdiagnosed, with its symptoms often dismissed as part of the aging process.

Most people suffering from this condition find it very difficult to live with because of the inconsistency of what sets it off. It can appear out of nowhere and can happen even while doing a normal routine you may have done countless times over.

One patient’s account of her experience started with her daily walk around the neighborhood. Everything was normal that day, she felt great… nothing out of the ordinary. About midway through her walk, a sudden jolt of pain shot down into her foot. She began to feel a tingling or burning sensation. This was quickly followed by what felt like pins and needles prickling at her lower extremity. Numbness began to settle in as the muscles in her leg began to weaken. The strength in her leg had all but disappeared, leaving her unable to put any pressure on it and impairing her ability to walk. She was grounded for a couple of days until she woke up one morning to find that she was completely fine, as if nothing had ever happened. The next day she was back, walking the neighborhood again. About six months later, it happened again. This time, she was at an out-of-town conference meeting. And again, it occurred in her kitchen just one month later. She was eventually referred to an orthopedic surgeon who diagnosed her with spinal stenosis.

These experiences can vary from person to person, but no matter the differences—it can happen at any moment, any place, without warning…and repeat itself time and time again. For some, symptoms can occur while walking or running. While others may experience them while standing or sitting in the same position for too long. Other times, symptoms can appear for no apparent reason at all. Spinal stenosis can affect many different parts of the body in different ways. This all depends upon which nerves of the spinal cord are being affected by the stenosis and to what level of severity.

A complete overview of spinal stenosis is discussed in greater detail below, including—symptoms, causes, diagnosis, and treatment options.

Click here to skip ahead to “What is a Spinal Stenosis?”>>

Structure of the Spinal Column

What is Spinal Stenosis?

Illustration of a healthy spinal canal vs a spinal canal effected by lumbar spinal stenosisSpinal stenosis is a condition that occurs when one or more openings of the vertebrae in the spine begin to narrow. These openings, also known as foramina, create a channel for the spinal cord to run down as well as serve as exit conducts for spinal nerves and roots. This narrowing of the foramina causes the nerves that run through them to become compressed or pinched. This can disrupt or distort signals being communicated to the brain by the affected nerve(s). The brain mistakenly perceives these impulses from the site of the stenosis as pain signals coming from parts of the body that are affected by the compressed nerve(s)—such as the leg, feet, arms, etc. This can spark a variety of symptoms such as:

Symptoms of Spinal Stenosis

  • Arm or leg pain, usually described as a sharp, shooting pain or burning sensation that may occur when moving into certain positions or when sneezing or coughing. In the neck, you will typically feel the most pain in your shoulder or arm. In the lower back, you will typically feel the most pain in your buttocks, thigh, and/or calf.
  • Stiffness, numbness, or tingling can be experienced at the stenosis site as well as parts of the body affected by the compressed nerve(s).
  • Weakness or loss of strength is normally experienced in the muscles that are affected by the compressed nerve(s).
  • Bladder or bowel control can be impaired by a pinched spinal cord or pinched nerves. Loss of bladder or bowel control could indicate a more serious matter and early surgery may be needed.
  • Loss of balance and coordination such as shuffling or tripping while walking.
  • Loss of sexual function may occur.

Spinal stenosis usually occurs in the neck (cervical stenosis) or in the lower back (lumbar stenosis) regions of the spine. Although spinal stenosis is far more common in the lower back, the cervical region is responsible for serious debilitating conditions such as severe body weakness and paralysis.

When spinal stenosis goes undiagnosed or untreated, symptoms may worsen and can occur more frequently—resulting in possible permanent nerve damage.

Causes of Spinal Stenosis

There are many factors that can cause spinal stenosis. However, arthritis remains the leading cause of most cases. Other factors can include:

  • Naturally narrow spinal canal (congenital disorder).
  • Osteoarthritis can cause the formation of bone spurs which can lead to narrowing of the spinal canal.
  • Spinal tumors can form within the spine causing pressure on the spinal cord.
  • Degenerative disorders such as spondylolysis and spondylolisthesis.
  • Paget’s disease causes bones to become misshapen and fragile which can lead to stenosis of the spine.
  • Injuries or trauma to the spine. A displaced bone or new bone growth caused by the healing of subtle fractures can put pressure on the spinal cord.
  • Herniated discs bulge into the spinal column compressing spinal nerves.

Diagnosis of Spinal Stenosis

Spinal stenosis can be diagnosed by a physician after discussing a patient’s symptoms, reviewing medical history, and performing a physical examination. The examination will usually involve a neurological exam to help determine if there is muscle weakness or loss of sensation.

The most common and preferred imaging for this condition is a magnetic resonance imaging (MRI) scan. This type of diagnostic test can produce 3-D images of the body structure surrounding the affected area. This includes soft tissue—such as the intervertebral discs—the spinal cord, nerve roots, and other key structures. An MRI can detect degeneration, tumors, and other anomalies which can cause similar symptoms. If an MRI is not available, a computerized tomography (CT) scan or a myelogram may be ordered instead.

Treatment Options for Spinal Stenosis

Conservative Treatments

Non-surgical treatment may be used to help alleviate symptoms and restore function and mobility. These methods will not stop or reduce the narrowing of the spinal canal; however, it has been reported that these types of treatments can help relieve symptoms and improve overall quality of life.

Non-surgical treatment may include:

  • Proper posture and body mechanics- Keeping your spine in the proper alignment while sitting, standing, lifting, etc., can help prevent further injury and help improve symptoms and mobility when executed properly.
  • Maintaining healthy body weight- Keeping a healthy body weight appropriate to height and body frame can help slow down the progression of stenosis.
  • Medications- The use of nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen or naproxen, can help to relieve pain.
  • Physical therapy- Specific exercise regimens can be used to strengthen the muscles that help support the lower back and spine.
  • Epidural steroid injection- An injection of a steroid medicine into the space around the affected nerve root has been shown to successfully relieve pain in many patients who have not seen improvement following six weeks or more of other non-surgical care.

Surgical Treatments

In many cases, spinal stenosis symptoms can be relieved without the need for surgery. However, a patient should speak with their physician about surgery if:

  • The patient has progressive loss of nerve function.
  • Symptoms have not improved with non-surgical treatment.
  • The patient’s level of pain is severe.
  • The patient is having trouble standing or walking.
  • The patient is unable to control their bowels or bladder.
  • The patient has trouble with coordination of fine motor skills.

Surgical treatments for spinal stenosis include:

  • Laminectomy/laminotomy- This procedure is used to remove some or all of the portion of the vertebra called the lamina. This allows access to the spinal canal and relieves pressure on the nerve root.
  • Laminoplasty- This procedure is used for stenosis in the cervical (neck) region of the spine. Incisions are made on the left and right sides of the lamina, creating a “hinge”. The lamina is then moved to the “open” position, increasing space around the spinal cord and relieving pressure. A spacer is then inserted to keep the spinal cord in the “open” position.
  • Spinal Fusion- This procedure involves fusing the two vertebrae on either side to help stabilize the spine and reduce movement of the bones preventing more pain from occurring. This may be combined with laminectomy surgery.

If you are experiencing any of the above symptoms, be sure to schedule an appointment to talk to your doctor. Our team of experienced and certified orthopaedic surgeons can offer individualized treatment plans that utilize the best combination of methods to help optimize your recovery, reduce pain, and improve your quality of life. Let us help to get you on the road to recovery.

Physicians Who Treat This Condition