Spinal Stenosis

What Is It?

Spinal stenosis is an abnormal narrowing of the spinal canal, the location of the spinal cord. While the spinal cord usually has ample room around it, surrounded by fluid and then the bony and soft tissue structures of the spine, with stenosis this room is reduced. Varying from mild to severe, stenosis can cause symptoms as it gets progressively worse and causes compression of the nervous system structures within, including the spinal cord and the nerves exiting the cord.

Spinal stenosis generally occurs as a part of degenerative spine disease. With aging and wear and tear of the spine over years, the spine undergoes many changes. Ligaments and other soft tissue can both become lax and also become over-grown, impinging on areas they should not be. The intervertebral discs can bulge and even herniate, adding to the impingement of the spinal canal. Likewise, the bone and joints can have degenerative changes that include over-growth of bone called osteophytes.

All of these changes that occur in the spine can slowly reduce the diameter of parts of the spinal canal. At some point, the stenosis can become symptomatic. Stenosis occurs most frequently in either the cervical or lumbar spine.

Another form of stenosis in the spine is foraminal stenosis, which is narrowing of the small holes through which nerves pass in and out of the spinal column. It can occur alone or concurrently with spinal stenosis.

What Types of Symptoms Are Typical?

The symptoms caused by stenosis vary considerably from patient to patient depending on its severity and location.

Cervical stenosis, in the area of the neck, often presents with neurological symptoms in the arms, including but not limited to arm pain, numbness, tingling and occasionally weakness. Very severe stenosis can compress the spinal cord itself, leading to spasticity, difficulty walking, clumsiness and even problems with the normal control of bowel and bladder function.

Lumbar stenosis, in the area of the lower back, can cause low back pain and leg pain as well as possible numbness, tingling and weakness or clumsiness of the legs. It can cause urinary and bowel dysfunction as well. The pain and weakness in the legs often gets worse with prolonged activity. This is sometimes termed neurogenic claudication.

Spinal stenosis generally causes symptoms on both sides of the body, although occasionally it can be unilateral. This is in contrast to a herniated disc, for example, which most often only impinges on a nerve to one side or the other.

How Is The Diagnosis Typically Made?

A patient with typical symptoms generally undergoes a thorough neurological examination followed by some type of imaging study. Most commonly, an MRI scan of the neck or low back is performed to evaluate for degenerative spine disease, including stenosis. The MRI is generally effective in demonstrating the degree of narrowing of the spinal canal and which levels of the spine are involved. Other studies such as nerve conduction studies may be performed in some patients to evaluate which levels and areas are most affected.

What Are Some Common Treatments?

For milder cases, rest, physical therapy, anti-inflammatory drugs and/or epidural spinal injections are often recommended. For patients who do not improve or for more severe cases, surgical treatment is considered for some patients. The goal of surgery is generally to remove some of the tissues and bone that are narrowing the spinal canal so that the nerves and/or spinal cord are no longer compressed. In the lumbar region this usually involves a laminectomy with or without foramenotomy.

A laminectomy is a procedure that removes part of the back part of the vertebra, the lamina. This helps to open up the spinal canal so that it can expand posteriorly.

In the case of cervical spinal stenosis, either a posterior laminectomy or an anterior procedure through the neck can be performed. The choice depends on several factors, including the specific anatomy of the stenosis and whether most of the compression is from the front or the back.

Occasionally, large laminectomies will require concurrent or subsequent spinal fusion.

Every case is different, so each patient should consult their own physician about what the best treatment plan is for them.

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Important Note: This site is not intended to offer medical advice. Every patient is different, and only your personal physician can help to counsel you about what is best for your situation. What we offer is general reference information about various disorders and treatments for your education.

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