Spinal Stenosis

Spinal Stenosis Overview

Spinal stenosis is a narrowing of the spinal canal, which pinches the nerves, causing pain in the leg and back. The condition commonly affects those over 50. That’s because with age, the ligaments (tissues that connect the spine and bones) become thicker and calcified, and the disks between vertebrae break down. Growths known as bone spurs may occur and enter the spinal canal. These conditions can reduce the size of the spinal canal.

Spinal stenosis affects one of three areas of the spine.

The canal in the center of the spinal column through which the spinal cord and nerve roots run.
The canals at the base or roots of nerves branching out from the spinal cord.
The openings between the vertebrae through which nerves leave the spine and go toward other parts of the body.

Symptoms

Spinal stenosis symptoms will vary depending on the source and location of the pressure. The actual narrowing of the spinal canal does not produce pain. Discomfort comes when the narrowing causes pressure on the spinal cord and other structures.

Common symptoms include numbness, weakness, cramping or general pain in the arms or legs. Sometimes these symptoms are relieved by bending forward, for example over a shopping cart.

If the pressure affects a nerve root, you may feel pain radiating down the leg or a burning pain in the legs or buttocks, which is known as sciatica. If it progresses it can also cause pain in the foot.

Other possible symptoms:

Foot drop, which is a feeling that the foot slaps the ground while walking.
A reduction in pain when sitting or leaning forward. That’s because sitting forward can open up the space for the nerves and relieve the pressure.
An increase in pain when standing up straight and walking.

Patients with a severe form of the condition known as cauda equina syndrome may experience loss of control of bowel, bladder or sexual function as well as pain, weakness or loss of feeling in one or both legs.

Risk Factors

Being 50 or older is the most significant risk factor for developing spinal stenosis. Other factors:

Osteoarthritis of the spine.
Certain bone diseases.
A defect or growth in the spine that was present from birth (congenital defect).
A herniated or slipped disk, which typically occurred in the past.
An injury that causes pressure on the nerve roots or the spinal cord.
A tumor of the spine.

Spinal Stenosis Prevention

You can’t prevent aging, which is the primary cause of spinal stenosis. But you can take steps to reduce your risk. And if you already have the condition, regular exercise and proper body mechanics may help reduce the chance of your spinal stenosis worsening.

Staying physically fit can improve endurance and strengthen the back muscles. Exercise can also help you maintain a healthy body weight; less weight means less pressure on the spine.

If you smoke, stop, as smoking can cause the spine to degenerate faster than the normal aging process.

If you’re new to exercise gradually build up your sessions until you feel comfortable. A general guideline is around 30 minutes on most days of the week. Your exercise program should ideally combine aerobic activities (such as walking or swimming) with resistance training (such as yoga or weight lifting). Stretching helps lengthen and warm up the spinal muscles.

Having good posture and practicing proper body mechanics are some of the best ways to prevent spinal stenosis from progressing and to ensure the health of your back. Use good posture all the time—whether you’re sitting, standing, lifting a heavy object or sleeping.

Your doctor can discuss the benefits of exercise and may recommend sessions with a Wellstar physical therapist who can show you safe, effective exercises and how to do them properly.

Spinal Stenosis Diagnosis

Your Wellstar neurologist will use a variety of means to diagnose or rule out spinal stenosis. A visit to the doctor will start with a thorough medical history and physical examination. The doctor will want to better understand the pain and determine the degree to which your movement is limited. A neurological examination will reveal any problems with sensation, muscle strength and reflexes in the arms and legs.

Tools and Tests

To confirm or rule out spinal stenosis, Wellstar physicians may recommend imaging and diagnostic tools including:

X-ray. X-rays are often done in advance of other tests. An x-ray produces a two-dimensional image and can reveal signs of an injury, tumor, calcification or other spinal problem.
MRI (magnetic resonance imaging). MRI uses a powerful magnet, a scanner and a computer to reveal soft tissues including the spinal discs. It can also show the condition of the spinal cord, nerve roots and surrounding spaces.
CT (computerized tomography). X-rays, a scanner and a computer produce cross-sectional images and/or 3D images of the spinal canal and nearby structures.
Myelogram. A contrasting dye is injected into the spinal column to indicate areas of pressure on the spinal cord or nerves from herniated disks, bone spurs or tumors.
Bone scan. This test involves injecting radioactive material, which attaches itself to bone to show a variety of spinal problems.

Spinal Stenosis Treatment

Patients with spinal stenosis often benefit from nonsurgical treatments including exercise and injections. In more severe cases surgery may be an option.

Nonsurgical Treatment

If symptoms are not severe and there are no neurological complications your doctor may recommend non-surgical treatments. While they are not considered a cure for spinal stenosis, these treatments help many patients manage symptoms.

Prescribed exercises and physical therapy to maintain motion of the spine and strengthen abdominal and back muscles.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen or naproxen to reduce inflammation and relieve pain. Discuss the use of all medications, including NSAIDs, with your doctor, as there are risks and complications.
Activity modification. The idea is to avoid activities that cause symptoms and doing things that relieve symptoms. Examples are walking while bending forward (such as over a walker or a shopping cart) rather than walking upright, and riding a stationary bike while leaning forward over the handlebars.
Epidural injections. An injection of cortisone can temporarily relieve symptoms for many patients. Your Wellstar neurologist will talk with you about the benefits of injections. Many patients whose symptoms are improved by an injection will have a good outcome if they later choose surgery.

Surgical Options

If a patient is no longer able to walk or care for themself, or if neurologic problems are present, lumbar spinal stenosis surgery may be the best choice. Surgery often helps relieve pain associated with severe spinal stenosis, but improvement may be limited if nerves have been damaged in the past. Your Wellstar neurologist will answer your questions about surgery and help you decide if this is the best option.

The purpose of surgery is to relieve pressure on the spinal cord or nerves and restore alignment and strength of the spine. Depending on the causes and location of your spinal stenosis, your Wellstar neurosurgeon will remove, trim or adjust parts that are causing the pressure. There are two primary types of surgery:

Decompression. Also known as laminectomy, this surgery involves removing the bone and soft tissues of the spine that are pinching the nerves. The procedure can be done as traditional open surgery, or using a minimally invasive method, which typically reduces recovery time.
Spinal fusion. This surgery involves permanently fusing two or more vertebrae together in order to eliminate the motion between vertebrae. The fusion is usually accomplished using a piece of bone, often from the patient’s hip. In some cases rods and screws are used to hold the spine in place while the bones fuse.
Interspinous spacers (devices). In this minimally invasive surgery, spacers are placed between the vertebrae to keep the space for the nerves open.

If you’re considering surgery for spinal stenosis you will want to talk with your physician at length. about the options and risks, which are generally quite low. You’ll also want to learn more about the procedure itself, recovery time and when you can resume work and other activities.

Alternative Therapies

Alternative (or complementary) therapies include a variety of practices and approaches. While not considered part of conventional medicine, they are known to help some patients.

Chiropractic treatment. Chiropractic treatment is based on the principle that restricted motion in the spine reduces function and can cause pain. Doctors of chiropractic (DC) manipulate or adjust the spine to restore normal movement, and use other techniques.
Acupuncture. Acupuncturists stimulate places on the skin, usually by manipulating thin, solid needles that penetrate the skin. Back pain is one area found to improve with use of acupuncture.
Supplements. Some patients report a reduction in pain with supplements including glucosamine and chondroitin. Discuss any supplements or other alternative treatments with your Wellstar physician.

Ongoing Care for Spinal Stenosis

Anyone over 50 is at risk for developing spinal stenosis. But you can help by exercising regularly to keep your spine in motion. Be sure to avoid any activities that cause the pain to worsen. See your Wellstar neurologist to help make a diagnosis and develop a treatment plan that works for you. Our doctors and therapists want to help get you out of pain and back into life.