SPINAL STENOSIS

Spinal stenosis (or narrowing) is a common condition that occurs when the small spinal canal that contains the nerve roots and spinal cord becomes restricted. This narrowing can squeeze the nerves and the spinal cord causing lower back and leg pain. In general, spinal narrowing is caused by osteoarthritis, or “wear and tear” arthritis, of the spinal column. This results in a “pinching” of the spinal cord and/or nerve roots.

People suffering from spinal stenosis have trouble walking any significant distance, and frequently must sit or lean over forward on a grocery cart, countertop or assistive device such as a walker. While there are no cures, there are many therapies available.

Fast Facts
Spinal stenosis is typically the result of osteoarthritis causing a pinching of the spinal cord.

There are no cures for spinal stenosis, but therapies can assist in regaining mobility and comfort.

Exercise is of paramount importance in the treatment of spinal stenosis.

What is spinal stenosis

The image at right shows the narrowing of the spinal canal.

Spinal stenosis is a narrowing of one or more areas of the spine. This narrowing, which occurs most often in lumbar region (lower back) can put pressure on the spinal cord or nerves branching out from the compressed areas.

Typically, a person with spinal stenosis complains about developing tremendous pain in the legs or calves and lower back after walking. Pain comes on more quickly when walking up hills. This is usually very reproducible and immediately relieved by sitting down, or leaning over. When the spine is bent forward, more space is available for the spinal cord, causing a reduction in symptoms.

Although symptoms may arise from narrowing of the spinal canal, not all patients with narrowing develop symptoms. Why some patients develop symptomatic stenosis and others do not remains unknown. Therefore, the term spinal stenosis refers not to the finding of spinal canal narrowing, but rather to manifestation of lower extremity pain caused by compression on the affected nerves.

What causes it?
Unless the individual is born with a small spinal canal (congenital stenosis), spinal narrowing most commonly results from progressive degenerative changes. This “acquired spinal stenosis” can occur from the narrowing of the space around the spinal cord due to bony overgrowth from osteoarthritis combined with thickening of one of the ligaments in the back, and a bulge of the intervertebral discs.

Who gets it?
The risk of developing spinal stenosis increases in those who:
Are born with a narrow spinal canal

Are female

Are 50 years of age or older

Have had previous injury or surgery of the spine

Conditions that can cause spinal stenosis include:

Osteoarthritis and osteophytes (bony spurs) associated with aging

Inflammatory spondyloarthritis

Spinal tumors

Trauma

Paget's disease of the bone

Previous surgery

How is it diagnosed?
Your doctor will ask about your symptoms and medical history, and perform a physical exam if spinal stenosis is suspected. Your symptoms may include: numbness, weakness, cramping, or pain in the legs and thighs; radiating pain down the leg; abnormal bowel and/or bladder function; decreased sensation in the feet causing difficulty placing the feet when walking; loss of sexual function; and/or partial or complete leg paralysis.

Additional tests conducted to confirm and assess the diagnosis may include:

An X-ray of the spine to check for abnormalities in the bones of the back including osteoarthritis, bone spurs and obvious narrowing of the spinal canal.

A computed tomography (CT) scan to take images of the bony architecture of the back. This helps to evaluate the spinal canal.

A magnetic resonance imaging (MRI) scan of the spine to make pictures of soft tissues such as the spinal cord and the spinal nerves inside the back.

An EMG which may show active and chronic neurological changes.

How is it treated?
Although there is no cure for spinal stenosis, various therapies are available, one of the most important being exercise. Keeping the hip adductors and abductors, quadriceps and hamstrings from developing atrophy helps increase stability and the ability to walk.

Medications such as nonsteroidal anti-inflammatories (NSAIDs) also may be appropriate and helpful in pain relief. Cortisone injections into the epidural space, the area around the spinal cord, can afford tremendous temporary or permanent relief to people suffering this disorder.

Under severe circumstances, surgery to correct this disorder may be appropriate. However, adequate decompression of the neural elements and maintenance of bony stability are necessary for a good surgical outcome for patients with spinal stenosis. Decompression laminectomy, which is the removal of a build-up of bony spurs or increased bone mass in the spinal canal, can free space for the nerves and the spinal cord.

Spinal fusion to fuse two vertebrae together to provide stronger support for the spine almost always follows a decompression laminectomy.

Several studies report that surgical treatment produces better outcomes than non-surgical treatment in the short term. However, results tend to deteriorate with time. Lumbar decompressive surgery can be complicated by epidural hematoma, deep venous thrombosis, dural tear, infection, nerve root injury and recurrence of symptoms
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