About Spinal Stenosis
Spinal stenosis is a narrowing of the spinal canal, the bony structure that encloses the spinal cord and the nerve roots. Typically spinal stenosis is caused by age related spinal degeneration, and is most common in people 50 years and older. Most cases occur in the lumbar spine (lower back), but can also occur in the cervical spine (neck) and rarely occurs in the thoracic spine (mid/upper back).
Other causes of spinal stenosis include thickening of spinal ligaments, degeneration, herniation or bulging of intervertebral discs, and formation of synovial cysts. Fractures, tumors, infections, bone diseases, and conditions present at birth can also cause the spinal canal to narrow, but these cases do not fall under the term spinal stenosis.
Common Symptoms of Spinal Stenosis
When nerve roots or the spinal cord are compressed symptoms tend to appear. Symptoms vary based on the location and severity of the stenosis. Symptoms of cervical spinal stenosis:
- Numbness/clumsiness of hands
- Coordination problems
- Weakness/incoordination of arms and hands
- Difficulty with fine motor skills of hands (buttoning, tying, writing, typing)
- Difficulty with bladder/bowel control
Symptoms of lumbar spinal stenosis:
- Lower back pain
- Pain, tingling or weakness in the legs (symptoms usually relieved when sitting or leaning forward) – referred to as neurogenic claudication
- Weakness/numbness/pain that radiates to the buttocks and legs – symptoms of radiculopathy
Diagnosis for Spinal Stenosis
A complete medical history and physical examination are the first steps of diagnosing spinal stenosis. A neurological exam will review a patient’s strength, sensations, and reflexes in order to determine if the spinal cord or nerve root has been compressed. The following imaging tests may be ordered in addition to help with the diagnosis.
- X-ray – produces images of bones and shows an overall assessment of bone anatomy and the curvature/alignment of the spine. Spinal dislocation or slippage, spinal balance, and bony abnormalities can also be assessed with X-rays.
- Magnetic resonance (MR) imaging – provides detailed images of soft tissues and are very helpful in determining the location and severity of the stenosis. MRIs can also identify any spinal cord or nerve root compression.
- Computed tomography scan (CT scan) – uses X-rays and a computer to provide more detailed images than X-rays.
- Myelogram – X-rays and CT scans taken after a dye is injected into the spinal canal, usually helpful in patients with other conditions or who have had previous surgeries.
Treatment Options for Spinal Stenosis
Nonoperative treatments are usually considered first when treating spinal stenosis. Some of these options include anti inflammatory medications, physical therapy, weight control, or epidural spinal injections. Exercise programs or instruction on proper posture may also be suggested.
If nonoperative treatments are not successful surgery typically provides relief. One type of surgery is a decompressive lumbar laminectomy, which removes a section of the vertebral bone, making more room for the spinal cord and nerve roots. This procedure is recommended for patients with neurogenic claudication. Other procedures may be recommended to remove parts of joints, discs, or ligaments that are compressing the spine or nerves.