Spinal Stenosis

Causes of spinal stenosis

Degenerative arthritis (osteoarthritis) is the most common cause of spinal stenosis. The natural wear and tear on the bones in the spine can prompt bone spur formation in the spinal canal.

Other causes of spinal stenosis include:

• Herniated discs
• Tumors — abnormal growths within the spinal cord can cause spinal stenosis
• Spinal injuries — accidents and trauma can cause fractures or dislocations in the spine, which may damage the spinal canal contents
• Thickened ligaments — the cords that hold the bones in the spine together can thicken over time and swell into the spinal canal

Risk factors for spinal stenosis

• Age — people over the age of 50 are more likely to develop spinal stenosis, the disease worsens by age.
• Smokers — the ingredients in cigarettes can constrict the blood vessels.
• Genetics — certain people are more vulnerable to develop spinal stenosis.
• Obesity — people who are overweight carry excess body weight, which puts more stress on the spine.
• Medical history — patients who have had a spinal injury before are more likely to be affected again.

Symptoms of spinal stenosis

Symptoms of spinal stenosis depend on where the spinal stenosis is located.

Myelopathy (compression of the spinal cord)

Symptoms of spinal stenosis caused by myelopathy include:

• Loss of bladder or bowel control
• Difficulty performing day-to-day activities such as picking up coins
• Balance that progressively worsens

Radiculopathy (compression of the nerves)

Symptoms of spinal stenosis are caused by radiculopathy include:

• Pain
• Tingling
• Numbness
• Weakness in the area where the nerve is compressed

Cervical (neck) spinal stenosis

Symptoms of cervical spinal stenosis include:

• Numbness
• Tingling
• Cramping in the arms and hands
• Weakness in the hands or arms

Lumbar (lower back) spinal stenosis

Symptoms of lumbar spinal stenosis include:

• Pain
• Tingling
• Numbness
• Weakness in the legs and feet which relieve when resting but made worse when walking or running

Diagnosis of spinal stenosis

Spinal stenosis can be diagnosed with a full medical history and physical exam. In the medical history, your physician will ask questions to determine what caused the injury, what your symptoms are, what makes the symptoms worse and where the symptoms are most prevalent.

The physician may order an x-ray, MRI or CT scan to pinpoint the exact location and extent of the injury.

• X-ray — an x-ray can show bony changes, such as a bone spur, that could be narrowing the space inside the spinal canal.
• MRI — an MRI can detect damage to the ligaments and discs in the spine, as well as indicate where the nerves in the spine are being pressured.
• CT scan — if you are not a candidate for a MRI, your physician may recommend a CT scan. A CT scan can reveal herniated discs, bone spurs or tumors.

Treatments for spinal stenosis

Treatment for spinal stenosis will depend on the location and severity of your case. Some patients can self-treat their condition with over-the-counter pain relievers and self-care tips provided by the physician.

Nonsurgical treatment

Nonsurgical treatment options for spinal stenosis include:

• Medications — medications such as pain relievers, antidepressants, anti-seizure drugs and opioids.
• Physical therapy or rehabilitation — can help you build strength and endurance, maintain flexibility and stability, and improve balance.
• Steroid injection — can reduce inflammation and relieve pain caused by spinal stenosis.

Surgical treatment

Surgical treatment options for spinal stenosis include:

• Surgical decompression — part of the ligament in the back of the spinal column is removed to increase space in the spinal canal through percutaneous image-guided lumbar decompression (PILD).
• Lumbar laminectomy — opens more space in the spinal cord and relieves pressure on the nerves by removing the lamina (back) of the affected vertebra.
• Laminotomy — only a portion of the lamina is removed to relieve pressure in a specific spot.
• Laminoplasty — will open the space within the spinal canal by creating a hinge on the lamina; performed on the cervical spine (neck vertebrae).

Recovery from spinal stenosis surgery

Although approximately 80-90% of patients will be able to relieve their pain associated with spinal stenosis with surgery, recovery from spinal stenosis surgery is a lengthy process.

You may be on pain medications for up to four weeks following surgery and will have instructions on the activity level you should keep. Your doctor will recommend minimizing activities that move your spine too much.

Your provider will also work with you to help you develop healthy lifestyle habits including:

• Sitting and standing properly
• Learning to lift correctly
• Exercising regularly
• Using proper sports equipment
• Maintaining a healthy body weight
• Avoiding excessive alcohol use
• Quitting smoking
• Eating healthy foods