Spinal stenosis occurs when the spinal column narrows. As a result, the spinal nerves become compressed, causing pain. Although the pain usually occurs in the legs, it may be present in the neck, lower back or even the arms.
The condition typically develops very slowly as we get older, usually occurring after the age of 50. It has been estimated that as many as one in every 10 Americans suffers from spinal stenosis. Sometimes curvature of the spine (scoliosis) or congenital factors may lead to spinal stenosis in younger individuals.
How Does Spinal Stenosis Develop?
The most common cause of spinal stenosis is osteoarthritis. This occurs when the soft cartilage between the vertebrae breaks down. This causes the ligaments in the spine begin to thicken. Bone spurs (little outgrowths of bone) may develop. As a result, the spinal column narrows and puts pressure on the spinal cord and spinal nerves.
Although arthritis is the most common contributor to spinal stenosis, it can also develop as a result of:
- Herniated discs. When the soft centers of the discs that separate and cushion the back bones begin to seep out, they can press on the spinal cord or nerves.
- Spondylolisthesis is the slippage and misalignment of the vertebrae. It can cause spinal stenosis.
- Injuries or trauma that result in spinal fractures or spinal inflammation.
- Tumors or cysts may develop and press on the spinal cord and surrounding nerves.
- Paget’s disease causes bones to be abnormally large and brittle. It may lead to a narrowing of the spinal canal.
Who is at risk of developing Spinal Stenosis?
Those who are over the age of 50 are at greatest risk for spinal stenosis (absent any other pre-existing conditions). Arthritis is a common condition that develops as we age and is the biggest contributing factor to spinal stenosis.
Symptoms of Spinal Stenosis
The majority of cases of spinal stenosis occur in the lower (or lumbar) spine. It can also occur in the cervical (neck) spine.
The location and severity of lumbar spinal stenosis determines the type of symptoms you may develop and how it is treated. Common symptoms include:
- Cramping or aching in the calves that impairs walking, often confused with a circulation problems.
- Tingling, numbness, or pain that radiates from the low back into the buttocks and legs
- Difficulty walking and standing
- Drop foot
- Low back pain
Cervical spinal stenosis involves the narrowing of the spinal column in the neck. Symptoms of cervical spinal stenosis include:
- Numbness, tingling or weakness in the hands, arms, feet or legs
- Pain with walking
- Balance issues
- Neck pain
- In severe cases, urinary and bowel urgency and incontinence
How Spinal Stenosis is Diagnosed
An experienced pain management doctor can diagnose spinal stenosis. He or she can distinguish it from other conditions or disorders that may cause similar symptoms. To make an accurate diagnosis, your pain specialist will:
- Conduct a thorough clinical evaluation. This may involve asking you to try to walk. Your physician will assess the level of pain and difficulty you have and may also look for signs of a foot drop (slapping your foot on the ground when you walk.)
- Compile your complete medical history, including a record of any injuries you may have had or other chronic conditions.
- Order imaging exams, including:
- X-rays that will reveal if your vertebrae have changed.
- MRI (magnetic resonance imaging) that creates a 3-D image of the soft tissues in your spine and may reveal tumors, cysts or changes in your discs and ligaments.
- CT scans (computerized tomography) provide images of both the soft tissues and bones in your spine to pinpoint the source of pain.
Treating Spinal Stenosis
As is often the case, your physician will begin with the most conservative therapies at first. These may include:
- Heat/Ice therapy: Cold can reduce inflammation that may be contributing to the narrowing of your spinal column. Heat can reduce muscle tension and tightness.
- Exercise: Whether under the direction of a physical therapist or simply trying to increase the number of steps you take each day, exercise can strengthen the muscles around your spine and improve your flexibility. Low impact exercise, such as swimming, can help you lose weight. This will put less pressure on your spine.
- Lifestyle changes: Don’t underestimate the impact of a firm mattress, good posture and proper lifting techniques.
- Alternative therapies: Some patients may get some pain relief by working with a chiropractor or by trying acupuncture or biofeedback.
- Medication: Over-the-counter medications such as non-steroidal anti-inflammatories (Motrin, Advil) or naproxen (Aleve) may provide short-term relief. In some cases, your physician may also prescribe stronger prescription medications such as muscle relaxants.
Minimally Invasive Treatment Options
If these measures fail to resolve your pain, there are a number of minimally invasive interventions you can try. Each of these procedures is performed on an out-patient basis. There are no major incisions. Recovery times are a fraction of those associated with traditional open spinal surgery.
- Epidural Nerve Block; Using x-ray guidance, your doctor can administer an epidural nerve block of corticosteroid medication to decrease pain and inflammation caused by spinal stenosis. Up to three injections may be given within a six-month time frame. Usually, the injections are performed two to three weeks apart. A set of three injections is the norm. You may, however, gain considerable relief after the first or second injection. In that instance, further injections may not be necessary.
- MILD (Minimally Invasive Lumbar Decompression) Procedure: MILD requires only a small incision under local anesthesia and takes less than an hour. Using fluoroscopic (x-ray) guidance, your physician will locate and remove small pieces of bone and excess ligament tissue. This restores space in the spinal canal and decrease the compression on nerves that cause pain.
- Spinal Cord Stimulation: An implanted device transmits mild electrical impulses to the spinal cord to interrupt the feeling of pain. It substitutes it with a more pleasing sensation called paresthesia. This feeling can differ from patient to patient, but is often described as a pleasant tingling. Although the degree of pain relief varies from person to person, studies show that 85 to 90 percent of those who have undergone spinal cord stimulation report a 50 to 70 percent reduction in overall pain.
- Radiofrequency Neurotomy: Also known as radiofrequency ablation, this procedure interrupts pain signals by using heat to deaden the nerves. A local skin anesthetic is applied. Then the physician uses x-ray guidance to place needles with electrical tips alongside the nerves that supply the inflamed area. After testing to ensure that the needle is in the correct position, thermal (heat) energy is applied to deaden the nerve. Successful neurotomy typically provides relief for six to 12 months. Some enjoy relief for up to two years and beyond.
Surgery as a Last Resort
For those patients who do not obtain relief from these procedures, a laminectomy may be the last resort. This is major surgery and presents different risks and a much longer recovery time. Most physicians recommend their patients exhaust their other treatment options before considering back surgery.