Spinal Stenosis

The spine is a column of bones. It provides stability and support for the upper body. It enables us to turn and twist. Spinal nerves run through openings in the vertebrae and conduct signals from the brain to rest of the body. These nerves are protected by the surrounding bone and tissues. If they are damaged or impaired in any way, it can affect functions such as walking, balance, and sensation.

Spinal stenosis is a condition in which the spinal column narrows and starts compressing the spinal cord. This process is typically gradual. If the narrowing is minimal, no symptoms will occur. However, too much narrowing can compress the nerves and cause problems.

Stenosis can occur anywhere along the spine. How much of the spine is affected can vary.

Spinal stenosis is also called:

• pseudo-claudication
• central spinal stenosis
• foraminal spinal stenosis

The most common cause of spinal stenosis is aging. Degenerative processes occur throughout the body as it ages. Tissues in the spine may start to thicken and bones may get bigger, compressing the nerves. Osteoarthritis and rheumatoid arthritis may also contribute to spinal stenosis. The inflammation they cause can put pressure on the cord.

Other conditions that can cause stenosis include:

• spine defects present at birth
• a naturally narrow spinal cord
• scoliosis, or spinal curvature
• Paget’s disease of the bone, which causes abnormal bone destruction and regrowth
• bone tumors
• achondroplasia, a type of dwarfism

Symptoms typically progress over time, as nerves become more compressed. You might experience:

• leg or arm weakness
• lower back pain with standing or walking
• numbness in your legs or buttocks
• balance problems

Sitting in a chair usually helps relieve these symptoms. However, they will return with periods of standing or walking.

If you experience symptoms of spinal stenosis, your doctor will start by taking a medical history, performing a physical exam, and observing your movements. Tests can be used to confirm a suspected diagnosis. They may include:

• spinal imaging, using X-ray, MRI, or CT scan
• electromyelogram (EMG), to check the health of spinal nerves
• bone scan to look for damage or growths in the spine

First-Line Treatments

Medical treatment is typically tried first. The goal is to relieve your pain. Cortisone injections into the spinal column can reduce swelling. Nonsteroidal anti-inflammatory drugs (NSAIDs) can also help with pain.

Physical therapy may be an option. It can strengthen back muscles and gently stretch your body.

Surgery

Surgery may be needed for severe pain. It can relieve pressure permanently. Several types of surgery are used to treat spinal stenosis:

• Laminectomy is the most common type of surgery. Part of the vertebrae is removed to provide more room for the nerves.
• Foraminotomy widens the part of the vertebrae where the nerves exit.
• Spinal fusion is typically performed in more severe cases. Bone grafts or metal implants are used to attach the affected bones of the spine together.

Options other than surgery may be able to ease the pain of spinal stenosis. These include:

• heat packs or ice
• acupuncture
• massage

Back pain can have a serious impact on your quality of life. Cognitive behavioral therapy may be able to help you manage your pain by providing education and coping mechanisms.

Many people with spinal stenosis lead full lives and remain active. However, they may need to make modifications to their physical activity. In addition, even after surgery, many people do have residual pain after treatment.