Spinal Stenosis

Alternative names: Lumbar Spinal Stenosis, Lumbar Stenosis, Cervical Stenosis, Cervical Spinal Stenosis

The term 'stenosis' describes an abnormal narrowing of a passage or opening in the body.  For the spine, this means a narrowing of the spinal canal caused by bone overgrowth, deformed discs, thickened ligaments, tumors or injury.  Narrowing of the spinal canal can put pressure on the spinal cord and nerves, thus causing symptoms in parts of the body that are served by the affected nerves.

Spinal Stenosis can occur in three areas: the spinal canal, the smaller canals where the nerve roots branch out from the spinal cord, and the openings between vertebrae through which the nerves exit the spine.

Incidence; Causes and Development

Spinal Stenosis occurs most often in the lower back (Lumbar Stenosis) and the neck (Cervical Stenosis).  Most cases occur in those aged over 50.

The most common cause of Spinal Stenosis is osteoarthritis-related wear-and-tear on the spinal vertebrae.  Other possible causes:

• Herniated discs can leak material from the soft inner nucleus into the spinal canal
• Bulging discs can bulge into the spinal canal
• Spinal injury/trauma due to an accident or surgery can cause displaced bone or swollen tissue to impinge upon the spinal cord or nerves
• Spinal ligaments can stiffen or thicken over time due to wear and tear, and bulge into the spinal canal
• Spinal tumors can form inside the spinal canal, spinal cord, or on the vertebrae
• Paget's disease causes enlarged and abnormal bones, including sometimes in the spine

• Congenital spinal deformity

  • Being born with a narrow spinal canal
  • Scoliosis

Signs and Symptoms

Some patients with Spinal Stenosis show no symptoms at all, while others have pain, tingling, numbness and muscle weakness.  When symptoms do occur, they often start gradually and become worse over time.  The locations of symptoms depend on the location of the stenosis, and the nerves that are being affected.

Cervical Stenosis symptoms:

• neck pain
• numbness, tingling, cramping and/or weakness in hand(s), arm(s), foot/feet or leg(s)
• walking difficulty

Lumbar Stenosis symptoms:

• back pain
• numbness, tingling and/or weakness in foot/feet or leg(s)
• pain or cramping in leg(s) when walking or standing for long periods of time

In severe cases of either cervical or lumbar stenosis, urinary and/or fecal incontinence, sexual dysfunction, or paralysis may occur.

Diagnosis and Tests

Diagnosis usually starts by going through the patient's symptoms and discussing their medical history to look for possible causes.  A physical examination is then used to determine more precisely the location and nature of the problem.

Once Spinal Stenosis is suspected, imaging studies may be ordered, including X-rays (good for showing up bone spurs or other abnormalities), MRI (can detect nerve compression, disc or ligament damage, and tumors), and/or a CT or myelogram (if an MRI is not possible).

Treatment and Prevention

In mild cases, watchful waiting may be the best course of action, alongside massage therapy, Chiropractic treatments, acupuncture, behavior modifications, a lumbar brace or corset to provide support, and various exercises to improve strength, endurance, balance, and spine health.

Medications cannot treat the condition, only relieve pain.  Medications used to treat the pain include pain relievers, opioids, seizure medications, antidepressants, and steroid injections which also reduce inflammation.

In severe cases, surgery is used to widen the spinal canal and create sufficient space for the spinal cord and/or nerves.  Types of surgical intervention include decompression, laminectomy, laminotomy, and laminoplasty.  Surgery is not always successful.

Prognosis; Complications

Removing the obstruction causing the stenosis usually provides symptom relief.  However, if the nerves were damaged before (or during) surgery, some or all symptoms may persist.

Unfortunately, any degenerative process involved in the stenosis will likely continue, possibly leading to recurrence of symptoms.

Untreated Spinal Stenosis can eventually lead to permanent nerve damage and therefore numbness, weakness, difficulty walking, incontinence and even paralysis.