Spinal Stenosis – Causes, Symptoms and Treatment

What Is Spinal Stenosis?

Spinal stenosis is a narrowing of one or more areas in your spine — most often in your neck or lower back. This narrowing can put pressure on the spinal cord or spinal nerves at the level of compression.

Depending on which nerves are affected, spinal stenosis can cause pain or numbness in your legs, back, neck, shoulders or arms; limb weakness and incoordination; loss of sensation in your extremities; and problems with bladder or bowel function. Pain is not always present, particularly if you have spinal stenosis in your neck.

Spinal stenosis is commonly caused by age-related changes in the spine. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves.

The spine, a row of 26 bones in your back, allows you to stand up straight and bend over. The spine also protects your spinal cord from being hurt.

In people with spinal stenosis, the spine is narrowed in one or more of three parts:

1. The space at the center of the spine
2. The canals where nerves branch out from the spine
3. The space between vertebrae (the bones of the spine).

This narrowing puts pressure on the spinal cord and nerves and can cause pain.

Who Gets Spinal Stenosis?

Spinal stenosis is most common in men and women over 50 years old. Younger people who were born with a narrow spinal canal or who hurt their spines may also get spinal stenosis.

What Causes Spinal Stenosis?

Aging

Changes that occur in the spine as people get older are the most common cause of spinal stenosis. As people get older:

• The bands of tissue that support the spine may get thick and hard.
• Bones and joints may get bigger.
• Surfaces of the bones may bulge out (these are called bone spurs).

Arthritis

In some cases arthritis, a degenerative (gets worse over time) condition can cause spinal stenosis. Two forms of arthritis may affect the spine: osteoarthritis and rheumatoid arthritis.

Osteoarthritis:

• The most common form of arthritis
• Most often occurs in middle-aged and older people
• Doesn’t go away
• May involve many joints in the body
• Wears away the tough tissue (cartilage) that keeps the joints in place
• Causes bone spurs and problems with joints.

Rheumatoid Arthritis:

• Affects most people at a younger age than osteoarthritis
• Causes the soft tissues of the joints to swell and can affect the internal organs and systems
• Is not a common cause of spinal stenosis
• Can cause severe damage, especially to joints.

Inherited Conditions

Some people are born with conditions that cause spinal stenosis. For instance, some people are born with a small spinal canal. Others are born with a curved spine (scoliosis).

Other Causes

Other causes of spinal stenosis are:

• Tumors of the spine
• Injuries
• Paget’s disease (a disease that affects the bones)
• Too much fluoride in the body
• Calcium deposits on the ligaments that run along the spine.

What Are the Symptoms of Spinal Stenosis?

There may be no symptoms of spinal stenosis, or symptoms may appear slowly and get worse over time. Signs of spinal stenosis include:

• Pain in the neck or back
• Numbness, weakness, cramping, or pain in the arms or legs
• Pain going down the leg
• Foot problems.

One type of spinal stenosis, cauda equine syndrome, is very serious. This type occurs when there is pressure on nerves in the lower back. Symptoms may include:

• Loss of control of the bowel or bladder
• Problems having sex
• Pain, weakness, or loss of feeling in one or both legs.

If you have any of these symptoms, you should call your doctor right away.

How Is Spinal Stenosis Diagnosed?

To diagnose spinal stenosis, your doctor will ask about your medical history and conduct a physical exam. Your doctor may also order one or more tests, such as:

• X rays
• Magnetic resonance imaging (MRI) – a test that uses radio waves to look at your spine
• Computerized axial tomography (CAT) – a series of x rays that give your doctor a detailed image of your spine
• Myelogram – a test in which the doctor injects liquid dye into your spinal column
• Bone scan – a test in which you are given a shot of radioactive substance that shows where bone is breaking down or being formed.

Who Treats Spinal Stenosis?

Because spinal stenosis has many causes and symptoms, you may require treatment from doctors who specialize in certain aspects of the condition. Based on your symptoms, your doctor may refer you to:

• Rheumatologists (doctors who treat arthritis and related disorders)
• Neurologists and neurosurgeons (doctors who treat diseases of the nervous system)
• Orthopedic surgeons (doctors who treat problems with the bones, joints, and ligaments)
• Physical therapists.

What Are Some Nonsurgical Treatments for Spinal Stenosis?

There are many nonsurgical treatments for spinal stenosis. Your doctor may prescribe:

• Medicines to reduce swelling
• Medicines to relieve pain
• Limits on your activity
• Exercises and/or physical therapy
• A brace for your lower back.

When Should Surgery Be Considered?

Your doctor will likely suggest nonsurgical treatment first unless you have:

• Symptoms that get in the way of walking
• Problems with bowel or bladder function
• Problems with your nervous system.

Your doctor will take many factors into account in deciding if surgery is right for you. These include:

• The success of nonsurgical treatments
• The extent of the pain
• Your preferences.

What Are Some Alternative Treatments for Spinal Stenosis?

Alternative treatments are those that are not part of standard treatment. For spinal stenosis, such treatments include chiropractic treatment and acupuncture. More research is needed on the value of these treatments. Your doctor may suggest alternative treatments in addition to standard treatments.

What Research Is Being Done on Spinal Stenosis?

Questions about spinal stenosis that scientists are trying to answer include:

• Which is more effective in treating spinal stenosis, surgery or other treatments?
• Can MRIs identify who should have surgery?

These studies are still ongoing, but results so far indicate that surgery is generally more effective than nonsurgical treatments. Nonsurgical treatments. however, were shown to improve patient function to some extent.

Spinal Stenosis Treatment

The following is the recommendations of the Mayo Clinic for spinal stenosis:

If your spinal stenosis is mild, specialists may recommend:

• Physical therapy. Mayo Clinic physical therapists work with you to strengthen your back and stomach muscles and to increase your spine’s flexibility.
• Acupuncture.
• Therapeutic massage.
• Medication. Ibuprofen and acetaminophen can reduce pain and swelling. Cortisone injected next to your spine can reduce swelling of the spinal nerves and nerve roots. Relief is usually temporary, so you may need steroid injections more than once a year.

Surgery

Specialists may recommend surgery if your spinal stenosis is severe or hasn’t responded to other treatments. Some people are candidates for minimally invasive surgery, which can result in less pain and quicker recovery than traditional surgery.

Many specialists perform these surgeries for spinal stenosis:

• Laminectomy (decompression). The back part of the affected vertebrae (lamina) is removed, creating more room in your spinal canal and restoring normal blood flow to the nerves. Some decompression surgery can be done in two hours, and you can go home the same day.
• Laminoplasty. Similar to laminectomy, this procedure requires less bone removal and preserves the spine’s range of movement.
• Spinal fusion. Two or more vertebrae are connected.

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