What Is Spinal Stenosis?
Spinal stenosis is a narrowing of the spinal canal. It is a common cause of lower back, leg, neck and arm pain.
The spinal canal is the space within the vertebrae through which the spinal cord runs. In a healthy spine, the spinal cord has enough space in the spinal canal. However, often due to age and arthritis this space can narrow–spinal stenosis.
If the narrowing is slight, there may be no symptoms. A very narrow spinal canal may pinch the spinal cord or nerve roots branching from it, resulting in pain, tingling, numbness, weakness or other symptoms.
Spinal stenosis most often occurs in the lumbar spine (lower back), but it can also occur in the cervical spine (neck) or, rarely, in the thoracic spine (upper back).
Causes and Risk Factors
Osteoarthritis and degenerative disc disease are the two main causes of spinal stenosis. Osteoarthritis is the most common form of arthritis and is often known as “wear and tear” arthritis. In the spine, osteoarthritis affects the connections between vertebrae called facet joints.
When enough cartilage in the facet joints wears away, the vertebrae rub together. Sometimes this bone-on-bone contact causes bone spurs, which encroaches upon the spinal canal and causes it to narrow.
Degenerative disc disease is an age-related condition in which the intervertebral discs–which sit between vertebrae and act as shock absorbers–dry out and weaken. This makes them susceptible to herniation, where some of the inner portion of a disc punches through the outer portion. This bulge can jut out into the spinal canal and compress the spinal cord or nerve roots.
Other causes of spinal stenosis can include:
- Birth defect (known as congenital spinal stenosis)
- Spinal tumors
- Thickened ligaments
- Trauma to the spine
Symptoms
Pain that radiates to other areas of the body is the most common symptom of spinal stenosis. Where that pain is felt depends on where the narrowing occurs in the spine. Spinal stenosis in the lower back will be felt in the legs, hips and buttocks, while cervical spinal stenosis will affect the arms.
Other symptoms can include:
- Back or neck pain
- Numbness or tingling in the arms, legs, hands or feet
- Problems with balance
- Urinary or bowel incontinence
- Weakness in the arms, legs, hands or feet
Diagnosis
Diagnosing spinal stenosis usually starts with a medical history and physical exam, looking for evidence of nerve compression. Imaging tests are often used to confirm the diagnosis and can include:
- X-rays–X-rays can reveal any bone spurs compression the spinal cord or nerve roots, as well as rule out other causes of back pain such as compression fractures. X-rays do not show soft tissue such as intervertebral discs.
- Magnetic resonance imaging (MRI) scans–MRIs use powerful magnets and radio waves to produce images of the body. Unlike X-rays, MRI scans can depict soft tissue such as disc herniations, thickened ligaments or spinal tumors.
- Computed tomography (CT) scans–The magnets in MRIs prevent some patients with certain conditions or implanted medical devices such as pacemakers from having these scans. In such cases, a CT scan, which uses X-rays from multiple angles and sometimes a contrast dye, can be a substitution.
Treatment
Spinal stenosis has no cure, but symptoms can be managed both conservatively and surgically. Doctors usually recommend a nonoperative treatment plan first.
Exercise and physical therapy can help ease symptoms by strengthening and stretching affected muscles and improving balance. Over-the-counter anti-inflammatory medication can cut down on the swelling that’s causing a structure to compress nerve roots. Corticosteroid injections are a step up from anti-inflammatories.
Spinal Stenosis Surgery
If conservative management has proven unsuccessful, surgery may be an option. There are two main types of surgery used to treat spinal stenosis, and they are often used together.
A laminectomy is a procedure that removes the back of a vertebra, called the lamina. This opens up the spinal canal, potentially removing the source of nerve root compression.
A spinal fusion creates an environment where two or more vertebrae grow together and become one bone. This is accomplished by inserting a bone graft, which acts as a scaffold for the body to build new bone tissue and connect the vertebrae. A spinal fusion reduces movement, which can cut down on pain and other symptoms.
If you have back pain, request an appointment at Edison Spine Center. Our expert surgeons will diagnose the source of your pain and craft a treatment plan that’s right for you.