Spinal Stenosis

Stenosis means narrowing.

In spinal stenosis, the spinal canal, which contains and protects the spinal cord and nerve roots, narrows and pinches or irritates the spinal cord and/or nerves that enter or leaves the spinal cord. This narrowing can be caused by bulging or herniated disc in the spinal column. The result is low back pain.

You can also experience pain or numbness in the legs, muscle weakness or changes in leg reflexes.

 Spinal stenosis affects both men and women and is most common between the ages of 50 and 70. It also may occur in younger people who are born with a narrowing of the spinal canal or who experience an injury to the spine.

Causes of Spinal Stenosis

There are many causes of spinal stenosis, including:

  • Aging. As you get older, the ligaments (tough connective tissues between the bones in the spine) can thicken. Spurs (small growths) from degenerative arthritis may develop on the bones and into the spinal canal. In addition, the cushioning disks between the veterbrae may begin to deteriorate and lose their ability to serve as shock absorbers. The facet joints (flat surfaces on each veterbrae that form the spinal column) also may begin to break down

  • Heredity. If the spinal canal is too small at birth, symptoms may show up early in a relatively young person

  • Changes in blood flow to the lumbar spine

Symptoms of Spinal Stenosis

Spinal stenosis can occur along any area of the spine (cervical, thoracic, lumbar), but is most common in the lower back. If the stenosis is located on the lower part of the spinal cord it is called lumbar spinal stenosis. Stenosis in the neck part of the spine is called cervical spinal stenosis.

  • Dull to severe pain in the lower back or buttocks when walking or standing, which can be relieved by sitting, lying down or bending forward at the waist

  • Weakness or tired feeling in the legs, aggravated by activity

  • Numbness, tingling, hot or cold feelings in the legs

  • Clumsiness, frequent falling or a foot-slapping gait

Diagnosing Spinal Stenosis

These symptoms can be caused by many other conditions, which may make spinal stenosis difficult to diagnose.

There is usually no history of back problems or any recent injury. Often, unusual leg symptoms are a clue to the presence of spinal stenosis.

If simple treatments, such as postural changes, nonsteroidal anti-inflammatory drugs or physical therapy do not relieve the problem, your orthopaedic surgeon may request special imaging studies to determine the cause of the problem. An MRI (Magnetic Resonance Image) provide details about the bones, tissues and narrowing of the spinal canal. A CT (Computed Tomography) scan with intrathecal contrast may be done if the patient cannot undergo MRI because of implanted devices such as a pacemaker. A myelogram (an X-ray taken after a special fluid is injected into the spine) may also be arranged.

Treatment

Conservative treatment options include:

  • Changes in posture. People with spinal stenosis may find that flexing the spine by leaning forward while walking relieves the symptoms. Lying with the knees drawn up to the chest also can offer some relief. These positions enlarge the space available to the nerves and may make it easier for stenosis sufferers to walk longer distances

  • Medications. Sometimes the pressure on the nerves is caused by the inflammatory swelling. Nonsteroidal anti-inflammatory medication such as aspirin or ibuprofen may help relieve symptoms

  • Rest, followed by gradual resumption of activity, also can help. Aerobic activity such as bicycling is often recommended

  • Losing weight can also relieve some of the load on the spine

When stenosis causes severe nerve root compression, these treatments may not be enough. Back and leg pain may return again and again. Because many stenosis sufferers are unable to walk even short distances or have difficulty standing they often confine themsleves to home.

If conservative treatment does not relieve the pain, your orthopaedic surgeon may recommend surgery to relieve the pressure on affected berves. In properly selected cases, the results are quite satisfactory, and patients are able to resume a normal lifestyle.