SPINAL STENOSIS

Spinal stenosis refers to a condition where the spaces within your spine become narrower, resulting in pressure on your spinal cord and the surrounding nerves, leading to discomfort and other issues.

Think of your spinal cord as a vital link between your brain and body, housed within the spinal canal formed by the hollow spaces within each vertebra — the bony building blocks of your spine. The narrowing can occur within the spinal canal itself, between the vertebrae, or where nerves branch out from the spine to other body parts.

As these spaces diminish, they can compress the spinal cord or adjacent nerves, causing sensations like pain, tingling, or numbness in your legs, arms, or torso.

Spinal stenosis can stem from injuries or conditions like arthritis and tends to be more prevalent in individuals aged 50 and above. While there’s no outright cure, various nonsurgical treatments and exercises exist to alleviate discomfort and manage symptoms effectively.

Causes

The spinal column is a stack of bones extending from the skull to the tailbone, providing protection to the spinal cord within the spinal canal.

While some individuals are born with a naturally smaller spinal canal, most cases of spinal stenosis occur due to factors that reduce the available space within the spine. These causes include:

Bone Spurs: Arthritis-related wear-and-tear can prompt the growth of additional bone, known as bone spurs, which may intrude into the spinal canal. Paget’s disease can also contribute to excess bone growth on the spine.
Herniated Disks: Disks, which serve as shock absorbers between spinal bones, can herniate, causing their soft inner material to press against the spinal cord or nerves.
Thick Ligaments: Over time, the ligaments that support spinal bones can become stiff and thick, potentially encroaching upon the spinal canal.
Tumors: While rare, tumors can develop inside the spinal canal, further narrowing the available space.
Spinal Injuries: Traumatic events like car accidents or other injuries can result in spinal bone fractures or displacement. Additionally, swelling of nearby tissue following back surgery may exert pressure on the spinal cord or nerves.

Types of Spinal Stenosis

Spinal stenosis manifests in two primary forms, depending on its location along the spine:

Cervical Spinal Stenosis: This occurs when the spinal canal in the neck region becomes narrowed.
Lumbar Spinal Stenosis: In this type, narrowing of the spinal canal is observed in the lower back, which is the most prevalent form.

Individuals may experience one or both types of spinal stenosis. Although less common, spinal stenosis can also affect the middle back.

Spinal Stenosis and Arthritis

For many individuals, stenosis arises from spinal wear and tear associated with arthritis. Osteoarthritis prompts the breakdown of cartilage between joints, leading to vertebrae rubbing against each other and stimulating the formation of bone spurs. These bone spurs contribute to the narrowing of the spinal canal. Moreover, arthritis can cause thickening of the ligaments in the spine, further reducing the canal’s space.

Stages of Spinal Stenosis

Imaging tests such as MRI can provide insights into the severity of spinal stenosis. Based on the MRI results, your doctor may categorize your condition into different stages:

Stage 0: No narrowing of the spinal cord is observed.
Stage I: Mild stenosis is present.
Stage II: Moderate stenosis is detected.
Stage III: Severe stenosis is evident.

Spinal stenosis symptoms

Spinal stenosis often manifests without symptoms initially. However, when symptoms arise, they typically develop gradually and worsen over time, depending on which part of the spine is affected.

Lower Back Symptoms

When spinal stenosis occurs in the lower back, it may lead to pain or cramping in one or both legs, particularly after standing for extended periods or during walking. These symptoms often improve when bending forward or sitting. Additionally, some individuals may also experience back pain in conjunction with leg discomfort.

Neck Symptoms

In cases where spinal stenosis affects the neck, individuals may experience:

Numbness
Tingling or weakness in a hand, leg, foot, or arm
Difficulties with walking and maintaining balance
Neck pain
Issues with bowel or bladder control

Risk Factors of spinal stenosis

The primary risk factor for spinal stenosis is age, particularly being over 50. Additionally, women and individuals who have undergone spinal surgery are at an elevated risk.

Spinal Stenosis Risk Factors in Younger Adults

While spinal stenosis commonly affects older individuals, certain factors can predispose younger adults to the condition. These include:

Congenital Conditions: Some individuals are born with spinal stenosis or conditions like scoliosis, which can lead to it. Symptoms typically emerge between the ages of 30 and 50 in such cases.
Spinal Injuries: Traumatic injuries to the spine can also increase the risk of developing stenosis at a younger age.

Diagnosis

When you consult a healthcare provider for symptoms related to spinal stenosis, they’ll likely begin by inquiring about your symptoms and medical history. A physical examination may also be conducted. Additionally, your healthcare provider may recommend imaging tests to pinpoint the issue accurately.

Imaging Tests

These tests may include:

X-rays: X-rays of the back can reveal bone changes that contribute to a narrowing of the spinal canal. Each X-ray procedure involves a small dose of radiation.
Magnetic Resonance Imaging (MRI): MRI utilizes a potent magnet and radio waves to generate detailed images of both hard and soft tissues. This test is effective in identifying damage to disks and ligaments, as well as detecting the presence of tumors.
Computerized Tomography (CT): In cases where an MRI is not feasible, a CT scan may be recommended. This imaging method combines X-ray images captured from various angles. In a CT myelogram, a contrast dye is injected to highlight the spinal cord and nerves, enabling visualization of herniated disks, bone spurs, and tumors.

Your healthcare provider may inquire about:

The location and nature of your pain
Whether any positions alleviate or exacerbate the pain
Any weakness, numbness, or tingling
Changes in coordination
Difficulties controlling bowel or bladder function
Previous treatments attempted for these issues

Treatment

While there’s no cure for spinal stenosis, various treatments can help manage symptoms, depending on the severity and location of the condition.

Observations without treatment may suffice for mild cases, with regular monitoring by your doctor.

Pain Management

Medications are commonly used to alleviate pain associated with spinal stenosis:

Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Aspirin, acetaminophen, ibuprofen, and naproxen can offer short-term relief from pain and inflammation.
Antidepressants: Tricyclic antidepressants like amitriptyline can help manage long-lasting pain.
Corticosteroid Injections: Steroids injected into the back or neck can reduce inflammation, but are used sparingly due to potential side effects. However, they may not always be the best option due to possible side effects like bone weakening.
Opioids: Prescription opioids such as oxycodone or hydrocodone may be prescribed for short-term pain relief, but their use is limited due to potential habit-forming properties and serious side effects.
Nerve Blocks: Precision injections of anesthetic can provide temporary pain relief.
Muscle Relaxants: These medications help control muscle spasms.
Anti-Seizure Medications: Certain medications like gabapentin are used to reduce pain stemming from nerve damage.

Surgery

For severe cases of spinal stenosis, surgery may be necessary:

Laminectomy: Removal of the back part of affected vertebrae to create space.
Laminoplasty: Placement of metal hardware in the neck vertebrae to widen the spinal canal.
Laminotomy: Partial removal of vertebrae to relieve pressure.
Minimally Invasive Surgery: Removes bone tissue with minimal damage to nearby healthy tissue, avoiding spinal fusion.
Decompression Procedure: Removes part of thickened ligaments in the spinal column.
Spinal Fusion: Fuses two vertebrae together, considered a last resort due to its impact on mobility.

Physical Therapy

A physical therapist can design exercises to:

Enhance strength and endurance
Maintain flexibility and stability of the spine
Improve balance

Needle Procedure for Thickened Ligaments

In cases where the ligament at the back of the lumbar spine thickens, a minimally invasive procedure involving needle-like tools may be performed to remove excess ligament tissue, thus relieving pressure on nerve roots.

New Treatment Options

Interspinous Spacer Placement: A minimally invasive procedure involving the placement of a spacing device between vertebrae to alleviate pressure.
Total Posterior Arthroplasty System (TOPS): A joint replacement operation that stabilizes the spine without restricting movement like spinal fusion.
Stem Cell Therapy: Involves injecting stem cells into the damaged area to generate healthy tissue. While promising, further research is needed.

Alternative Medicine

Integrative and alternative therapies can complement conventional treatments to manage spinal stenosis pain, such as:

Massage Therapy
Chiropractic Treatment
Acupuncture

Home Care tips

Your healthcare provider might recommend:

Pain Relievers: Over-the-counter medications like aspirin, ibuprofen, naproxen sodium, and acetaminophen can help alleviate pain and inflammation.
Weight Loss: Shedding excess weight can reduce stress on the lower back, thereby reducing pain.
Exercise: Engaging in stretching and strengthening exercises can help alleviate symptoms. Consult with your healthcare team to determine safe exercises to perform at home.
Walking Aids: Canes and walkers not only provide stability but also relieve pain by allowing you to lean forward while walking.

Complications of Spinal Stenosis

Without treatment, spinal stenosis can progressively worsen over time, potentially leading to permanent symptoms, such as:

Numbness: Persistent loss of sensation in affected areas.
Weakness: Gradual weakening of muscles due to nerve compression.
Balance Issues: Difficulty maintaining balance, which can increase the risk of falls.
Loss of Bladder and Bowel Control: In severe cases, spinal stenosis can impair the ability to control bladder and bowel functions.
Paralysis: In rare but severe instances, untreated spinal stenosis may lead to paralysis due to severe nerve compression.

Precautions for Cervical Spinal Stenosis

To minimize pain and reduce the risk of further injury, it’s advisable to avoid or modify certain activities if you have cervical spinal stenosis. These include:

Lifting Heavy Items: Refrain from lifting heavy objects, as this can strain the neck and exacerbate symptoms.
High-Impact Activities: Avoid activities such as running or jumping, which can jar the spine and worsen discomfort.
Contact Sports: Participation in contact sports should be avoided to prevent potential injury to the neck.
Maintain Good Posture: Practice good posture to alleviate strain on the neck and spine.
Limit Repetitive Movements: Minimize repetitive activities like texting or typing for extended periods without taking breaks, as these can aggravate symptoms.
Quit Smoking: If you smoke, consider quitting, as smoking can exacerbate symptoms. Consult your doctor for assistance with smoking cessation if needed.

Sources

Here are the sources for the information provided:

American College of Rheumatology
Mayo Clinic
Arthritis Foundation
Weill Cornell Brain and Spine Center
Altair Health
Spine and Pain Clinics of North America
Premia Spine
International Journal of Spine Surgery: “Stem Cells and Intervertebral Disc Regeneration Overview—What They Can and Can’t Do.”
Cleveland Clinic: “Spinal Stenosis,” “Can Lifestyle Changes Help You Manage Spinal Stenosis?”
National Institute of Arthritis and Musculoskeletal and Skin Diseases: “What Is Back Pain? Fast Facts: An Easy-to-Read Series of Publications for the Public,” “Spinal Stenosis.”
Johns Hopkins Medicine: “Lumbar Spinal Stenosis.”
Stamford Health: “A New Treatment Option For Back Pain.”
FDA: “TOPS System – P220002.”
Kaiser Permanente: “Lumbar Stenosis: What You Can Do.”
American Association of Neurological Surgeons: “Lumbar Spinal Stenosis.”
Asian Spine Journal: “Lumbar Spinal Canal Stenosis Classification Criteria: A New Tool.”
American Family Physician: “Lumbar Spinal Canal Stenosis: A Common Cause of Back and Leg Pain.”
American Academy of Orthopaedic Surgeons: “Lumbar Spinal Stenosis,” “Spine Basics,” “Effects of Aging,” “About Us.”
Neuroscience Online, McGovern Medical School at the University of Texas Health Science Center Houston: “Chapter 3: Anatomy of the Spinal Cord.”

Spinal Stenosis