Spinal Stenosis

What Is Spinal Stenosis?

Spinal stenosis is a condition, mostly in adults 50 and older, in which your spinal canal starts to narrow. This can cause pain and other problems.

Your spine is made up of a series of connected bones (or vertebrae) and shock- absorbing discs. It protects your spinal cord, a key part of the central nervous system that connects your brain to your body. The cord rests in the canal formed by your vertebrae.

There are two different types of spinal stenosis. The type you have depends on where on your spine the condition is.

• Cervical stenosis is when the neck area of your spine is narrow.
• Lumbar stenosis is when the lower back area of your spine is narrow.

You can have one or both types of spinal stenosis. Lumbar stenosis is the most common.

For most people, stenosis results from changes caused by arthritis. As the spinal canal narrows, the open spaces between your vertebrae start to get smaller. The tightness can pinch the spinal cord or the nerves around it, causing pain, tingling, or numbness in your legs, arms, or torso.

There’s no cure, but there are a variety of nonsurgical treatments and exercises to keep the pain at bay. Most people with spinal stenosis live normal lives.

Spinal Stenosis Symptoms

Spinal stenosis usually affects your neck or lower back. Not everyone has symptoms, but if you do, they tend to be the same: stiffness, numbness, and back pain.

More specific symptoms include:

• Sciatica. These shooting pains down your leg start as an ache in the lower back or buttocks.
• Foot drop. Painful leg weakness may cause you to “slap” your foot on the ground.
• A hard time standing or walking. When you’re upright, it tends to compress the vertebrae, causing pain.
• Loss of bladder or bowel control. In extreme cases, it weakens the nerves to the bladder or bowel.
• Radicular pain. Pain that radiates, or shoots out from your spine into your arms and legs.
• Radiculopathy. Spinal stenosis that presses on the root of your spinal nerves can cause numbness, tingling, or weakness in your arms and legs.
• Myelopathy. When spinal stenosis squeezes your spinal cord, you may feel numbness, tingling, or weakness in your arms and legs. It can affect other parts of your body, like your bladder and bowel.
• Cauda equina syndrome. This is the section of nerves at the bottom of your spinal cord. If spinal stenosis compresses this part, you might lose feeling in your pelvic area, or have problems with incontinence. This can cause permanent nerve damage if you don’t treat it. This is a medical emergency.

If you’re having symptoms, talk them over with your doctor. If you’re having a loss of bladder or bowel control, call your doctor at once.

Spinal Stenosis Causes and Risk Factors

The leading reason for spinal stenosis is arthritis, a condition caused by the breakdown of cartilage -- the cushiony material between your bones -- and the growth of bone tissue.

Osteoarthritis can lead to disc changes, a thickening of the ligaments of the spine, and bone spurs. This can put pressure on your spinal cord and spinal nerves.

Other causes include:

• Herniated discs. If these cushions are cracked, material can seep out and press on your spinal cord or nerves.
• Injuries. An accident may fracture or inflame part of your spine.
• Tumors. If cancerous growths touch the spinal cord, you may get stenosis.
• Paget’s disease. With this condition, your bones grow abnormally large and brittle. The result is a narrowing of the spinal canal and nerve problems.
• Thickened ligaments. When the cords that hold your bones together get stiff and thick, they can bulge into your spinal canal.

Some people are born with spinal stenosis or diseases that lead to it. For them, the condition usually starts to cause problems between the ages of 30 and 50.

Risks for spinal stenosis vary with age. For example:

• Wear and tear damage to the spine in adults over 50.
• Trauma, scoliosis, or genetic diseases in younger adults.

Spinal Stenosis Diagnosis and Tests

The doctor will ask questions about your medical history. After that, they might order at least one of the following tests to figure out whether you have the condition:

• Medical history review. Your doctor will ask about your health history and risk factors.
• X-rays. These can show how the shape of your vertebrae has changed.
• Magnetic resonance imaging (MRI). By using radio waves, an MRI creates a 3-D image of your spine. It can show tumors, growths, and even damage to discs and ligaments.
• Computerized tomography (CT scan). A CT scan uses X-rays to create a 3-D image. With the help of a dye injected into your body, it can show damage to soft tissue as well as issues with your bones.

Spinal Stenosis Treatment

The treatment you need for your spinal stenosis depends on where the stenosis is and how severe your symptoms are. You might need:

Medication

You might take:

• Over the counter pain treatment: Common pain remedies such as aspirin, acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen can offer short-term relief. All are available in low doses without a prescription.
• Antidepressants: Taking tricyclic antidepressants, such as amitriptyline, can help ease chronic pain.
• Opioids: For short-term pain relief, your doctor might prescribe drugs with codeine, such as oxycodone (Oxycontin, Roxicodone) and hydrocodone (Norco, Vicodin). These drugs can be habit-forming and have serious side effects.
• Muscle relaxants: These can help control muscle spasms.
• Anti-seizure medication: You can take these to ease pain from damaged nerves.
• Corticosteroid injections: Your doctor will inject a steroid such as prednisone into your back or neck. Steroids make inflammation go down. However, because of side effects, they are used sparingly.
• Anesthetics: Used with precision, an injection of a “nerve block” can stop pain for a time.

Surgery

If you have a severe case of spinal stenosis, you might struggle to walk or have issues with your bladder and bowels. Your doctor may recommend a type of surgery to create space between the bones so inflammation can go down. You might get:

• Laminectomy. This procedure removes the back part of the affected vertebrae.
• Laminoplasty. Your doctor puts metal hardware in your neck vertebrae to form a bridge in the open section of your spine.
• Laminotomy. The doctor removes a part of your vertebrae to relieve pressure.
• Minimally invasive surgery. This type of surgery helps avoid spinal fusion by removing bone in a way that reduces damage to nearby healthy tissue.
• Decompression procedure. The doctor uses needle-like instruments to remove part of the thickened ligaments in your spinal column. You only get this procedure if you have lumbar spinal stenosis caused by thickened ligaments.

Surgery carries its own risks. Talk to your doctor about how much it can help, recovery time, and more before taking that step.

Assistive Devices

You might get braces, a corset, or a walker to help you move about.

Spinal Stenosis Home Remedies

Some things you can do to help ease symptoms of spinal stenosis include:

• Exercise. Think about moderation. Just take a 30-minute walk every other day. Talk over any new exercise plan with your doctor.
• Apply heat and cold. Heat loosens up your muscles. Cold helps heal inflammation. Use one or the other on your neck or lower back. Hot showers are also good.
• Practice good posture.Stand up straight, sit on a supportive chair, and sleep on a firm mattress. And when you lift heavy objects, bend from your knees, not your back.
• Lose weight.Extra pounds put added pressure on your back.

Many patients also try nontraditional therapies, including chiropractic, acupuncture, and massage therapy. Again, be sure your doctor knows if you’re trying a nontraditional approach.

Complications

If you don’t treat your spinal stenosis, it can get worse over time. Certain symptoms may even become permanent, including:

• Numbness
• Weakness
• Problems with balance
• Loss of bladder and bowel control
• Paralysis

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