Spinal stenosis
Spinal stenosis is a condition in which the openings of the spinal canal or spinal nerve narrow (stenosis means “narrowing”). This narrowing puts pressure on the nerves, disrupting their function and causing pain.
Depending on where the narrowing occurs, pain may be felt in the lower back, legs, neck, shoulders or arms.
Symptoms of spinal stenosis
Symptoms of spinal stenosis depend on where the narrowing occurs. They may include:
- Arm, back, neck and leg pain (neurogenic claudication). Often, this pain radiates from the spine to the arms or legs, and it ranges from a dull ache to a burning or shock-like pain.
- Balance problems or frequent falls.
- Cramping in one or both legs, especially after long periods of standing.
- Loss of bladder or bowel control. This is a symptom of cauda equina syndrome, in which spinal stenosis leads to pressure on the nerve leading to the lower part of the body.
- Numbness or tingling in the limbs.
- Trouble walking.
- Weakness in the limbs.
If you notice any of the above symptoms, talk with your healthcare provider. These symptoms may also be signs of other health conditions, like a heart attack.
If your symptoms are sudden onset and severe, accompanied by pain in the jaw or chest, or involve loss of bowel or bladder control, call 911.
Causes of spinal stenosis
Spinal stenosis has multiple causes. Many of them are related to wear-and-tear aging on the spine. Among the causes of spinal stenosis:
Bulging or herniated disks. The discs between your vertebrae can bulge or rupture and put pressure on the nerves coming from your spinal cord, leading to pain.
Congenital stenosis. Congenital disorders are disorders that you’re born with. Congenital disorders that can cause stenosis include scoliosis, or the abnormal curving of the spine. In other cases, people are born with abnormally small spinal canals. Congenital stenosis may be hereditary, meaning it can pass from parent to child over generations.
Degenerative disk disease. This disorder leads to the slow breakdown of the discs in your spine. This is usually a result of sports and strenuous activity or as part of aging. It can put pressure on spinal nerves and cause neck pain.
Osteoarthritis. Osteoarthritis is a degenerative joint disease in which the slippery cartilage that protects the ends of your bones wears away. Small growths of bones called bone spurs may develop over time as well. Osteoarthritis happens because of wear and tear, and it can lead to spinal nerve compression.
Spinal tumor. Tumors are growths of abnormal cells. When they develop within or along the spine, they can put pressure on the nerves. Tumors may be cancerous, which means they have the potential to spread to other parts of the body. Spinal tumors are serious and require medical attention or surgery.
Thickening ligaments. Over time, the connective tissue (ligaments) that hold the facet joints of your spine together can become thick and hard, encroaching on the spinal nerves or spinal cord.
Trauma or injury. If you are in a car accident or another traumatic event, your vertebrae may be fractured, misaligned or bone fragments may be displaced. The surrounding tissue may also swell and impinge on nerves.
How is spinal stenosis diagnosed?
If you are experiencing symptoms of a spinal stenosis, talk to your healthcare provider. They will ask you about your medical history, current symptoms, and your hobbies or work. These can give clues about the cause of your symptoms. Your provider may also conduct a physical exam and test the strength of your limbs.
In addition, you may undergo one of the following imaging exams:
- X-ray. An x-ray uses high-energy beams to create a picture of your bones. Your doctor can examine these pictures for evidence of fractures or arthritis. However, X-rays don’t show soft tissues like muscles or tendons.
- CT scan. A CT scanner takes multiple X-ray images to create a cross-sectional view of the body. This can help your doctor see soft tissue damage, fractures, bone spurs or other causes of spinal stenosis. Your doctor may also inject you with a contrast dye that will better outline the spine and spinal nerves. This is called a CT myelogram.
- MRI. Like an X-ray, an MRI creates a picture of your bones. It can also show soft tissue (muscles, tendons, ligaments) and can help your provider pinpoint things like inflammation, tumors or ruptured discs. It can also show where nerves are being compressed.
Spinal stenosis: conservative treatments
Your healthcare team will first try conservative, or non-invasive, treatments to help with your spinal stenosis.
Medication
Pain relief medications can help manage pain-related symptoms. Common medications include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen help fight inflammation and block pain. Many are available over-the-counter, and stronger versions can be obtained with a doctor’s prescription
- Antidepressants like duloxetine and amitriptyline have also been shown to be effective against back pain. These medications can have other side effects and may not be safe for elderly patients, so be sure to talk with your healthcare provider about them.
- Cortisone injections. If you experience pain that radiates down your legs, your doctor may recommend corticosteroid injections. Corticosteroids are strong anti-inflammatory drugs that are injected near the space of your spine. They provide back pain relief for one to two months.
Therapy
- Physical therapy. Physical therapy is sometimes prescribed to help treat pinched nerves. Your physical therapist can help you learn exercises and movement patterns that relieve pressure on your nerves and strengthen surrounding muscles to prevent future pain. They can also teach you new movement patterns to avoid aggravating a nerve altogether.
- Chiropractic therapy. This therapy system helps treat and prevent disorders affecting the musculoskeletal system muscles, joints, bones and connective tissues. It often involves gentle spinal manipulation to re-align the vertebrae and correct posture. While chiropractic therapy cannot cure spinal stenosis, it can help relieve symptoms in mild cases caused by structural misalignment. However, you should talk to your doctor first.
Decompression procedure
If you have lumbar spinal stenosis caused by thickened ligaments, you may be eligible for percutaneous image-guided lumbar decompression (PILD). This procedure involves using a thin needle, guided by an x-ray machine, to remove sections of thickened ligaments, reducing the pressure placed on nerves coming from the lumbar spine.
PILD has many advantages: it does not involve stitches or anesthesia and does not disrupt the rest of the spine.
Spinal stenosis: surgical treatments
In some spinal stenosis cases, conservative treatments are not enough. You may benefit from spinal surgery if your symptoms are severe and debilitating, if you experience a loss of bowel or bladder control, or if your symptoms don’t respond to other treatments.
The exact type of surgery will depend on the underlying cause and location of your spinal stenosis.
Laminectomy (decompression surgery). This involves removing the bony back part (the lamina) of a vertebra to relieve pressure on the nerves. Sometimes, the vertebra has to be stabilized via spinal fusion, which involves using a bone graft and screws to attach it to a neighboring vertebra. A laminectomy is the most common form of spinal stenosis surgery.
Laminotomy or foraminotomy. This involves removing only part of the lamina or foramen (the space where a nerve root emerges from a vertebra).
Laminoplasty. If you have debilitating cervical stenosis, your doctor may recommend a laminoplasty. The goal of this procedure is to enlarge the spinal canal and make more room for the spinal cord. Your surgeon will use hardware to create a hinge on one side of the lamina and will wedge the other side open a bit. This leads to a larger canal.
Bone spur or disc removal. Bone spurs and damaged discs are removed. The vertebrae are stabilized via spinal fusion, which involves using a bone graft and screws to attach it to a neighboring vertebra.
The outlook for spinal stenosis patients
Is spinal stenosis a permanent disability?
Usually, if spinal stenosis is treated, it is not a permanent disability. With proper, targeted conservative or surgical treatment, you should be able to return to work or your daily activities.
During physical therapy, your care team can also work with you to help minimize pain and maximize your flexibility and strength.
Note that if severe spinal stenosis is not treated, it can cause permanent nerve damage and potentially paralysis. So if you experience any symptoms, be sure to reach out to your primary care provider so you can start getting the help you need.
References
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Spinal Stenosis (https://www.niams.nih.gov/health-topics/spinal-stenosis)
MedlinePlus: National Library of Medicine. Spinal Stenosis (https://medlineplus.gov/spinalstenosis.html)
American Association of Neurological Surgeons (AANS). Lumbar Spinal Stenosis (https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Lumbar-Spinal-Stenosis)
Orthoinfo: American Academy of Orthopaedic Surgeons. Lumbar Spinal Stenosis (https://orthoinfo.aaos.org/en/diseases–conditions/lumbar-spinal-stenosis/)