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.
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.
- The space at the center of the spine
- The canals where nerves branch out from the spine
- The space between vertebrae (the bones of the spine).
This narrowing puts pressure on the spinal cord and nerves and can cause pain.
- 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).
- 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.
- Tumors of the spine
- 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.
- Pain in the neck or back
- Numbness, weakness, cramping, or pain in the arms or legs
- Pain going down the leg
- Foot problems.
- 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.
- 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.
- 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.
- 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.
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.
- 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.
- Physical therapy. Mayo Clinic physical therapists work with you to strengthen your back and stomach muscles and to increase your spine’s flexibility.
- 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.
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.
- 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.