What is spinal stenosis?
The spine is composed of several interconnected bones called vertebrae, which are surrounded by ligaments, tendons, muscles and nerves. Each vertebra has an opening in the middle through which the spinal cord passes. Together, these openings form what’s known as the spinal canal. The nerves that pass through the spinal canal help control and interpret movements, reflexes and sensations in your entire body.
In spinal stenosis, the spinal canal becomes narrow and begins to “close in” around the nerves, putting pressure on them and causing pain in the arms or, most commonly, the legs. Spinal stenosis can occur in both the low back (lumbar stenosis) or upper back and neck (cervical stenosis).
What causes spinal stenosis?
The most common cause of spinal stenosis is aging. Years of wear and tear on the spine can cause several changes in the spine:
- the connective tissues surrounding the vertebrae can thicken, taking up more space in the canal;
- tiny bone spurs can form and press against the nerves;
- “settling” and compression of the discs can occur as discs become less “spongy” with age;
- arthritis may develop, resulting in bony overgrowth around the joints in the spine; this overgrowth can take up additional space in the spinal column.
In some people, spinal stenosis occurs as a result of trauma or injury to the spine that causes tiny bone fragments to be released into the canal. Tumors in or near the spine can result in increased pressure on the nerves as the tumor grows. And some patients experience spinal stenosis as a “side effect” of a condition called spondylolisthesis, a condition that occurs when one vertebra slips forward over another, resulting in a misalignment and narrowing of the spinal canal.
What are the symptoms of spinal stenosis?
Spinal stenosis can cause a variety of symptoms, including:
- back pain (or neck pain in the case of cervical stenosis)
- burning or aching pain that radiates through the buttocks or legs and may extend to the foot (also referred to as sciatica); in cervical stenosis, pain may radiate into the arms and hands
- numbness, “pins and needles” or tingling in the buttocks or legs or arms
- weakness in the legs or arms, sometimes resulting in falling or “clumsiness”
- loss of sensation in the legs or arms
- abnormal reflexes in the legs or arms
Some studies have shown the symptoms of lumbar spinal stenosis can be alleviated by leaning forward, especially when sitting, since this can widen the canal space. If you have pain that’s alleviated by leaning forward, there’s a good chance it could be spinal stenosis.
How is spinal stenosis treated?
Non-steroidal anti-inflammatory drugs (NSAIDs) – both over-the-counter and prescription-strength – are typically the first line of treatment for spinal stenosis. These medications can sometimes provide enough relief for pain and inflammation to cause symptoms to subside. When these medications don’t provide relief, steroid injections into the area surrounding the spine are often effective. Physical therapy is often used in conjunction with medication to improve flexibility and strength.
Some patients indicate chiropractic adjustment can provide relief; however, the use of chiropractic techniques should be used only with extreme caution, since they may exacerbate some conditions and even cause them to become much worse.
When non-surgical approaches to spinal stenosis don’t provide relief, surgery may be recommended to stabilize the spine and the canal space. Surgery is typically reserved for patients who have significant impairment of motion or pain that affects their quality of life. The two primary surgical approaches are laminectomy, which removes a portion of the vertebrae to expand the canal space, and spinal fusion, a procedure that fuses the vertebrae together to reduce friction and stabilize the canal space.
Left untreated, back pain can cause a significant reduction in motion and an increase in pain and other symptoms. If you’re experiencing back pain, don’t ignore it; find a doctor that’s right for you.