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Spinal Stenosis

What Is Spinal Stenosis?

Spinal stenosis is a narrowing of the spinal column, the tubular structure in the back that contains the vertebrae, spinal cord, spinal discs and nerves. Pinched nerves and compression of the spinal cord can result, leading to pain.

The upper and lower spine are more prone to stenosis because they are fairly mobile and therefore suffer more wear and tear. But other diseases involving the spine — such as osteoporosis, degenerative disc disease, arthritis and ankylosing spondylitis — can contribute to spinal stenosis.

What Are Causes of Spinal Stenosis?

Among the causes of spinal stenosis are:

  • Trauma

  • Inflammation

  • Tissue degeneration

  • Tumors

Adults age 50 and older comprise the majority of those affected by spinal stenosis, but the condition can occur in younger adults who have had a spinal injury or were born with narrow spinal canals.

Types of Spinal Stenosis

Spinal stenosis develops when the normal wear and tear of aging causes the spaces within the spine to narrow. There are 3 types of spinal stenosis — lumbar, cervical and thoracic — that are diagnosed based on the location of narrowed portion of the spinal canal. It's possible to have more than one type of spinal stenosis.

  • Cervical stenosis — Cervical stenosis is diagnosed when narrowing affects the area around the spine’s top seven vertebrae.

  • Thoracic stenosis — When spinal stenosis affects anywhere along the longest portion of the spine, extending from the bottom of the neck to the abdomen, thoracic stenosis is diagnosed.

  • Lumbar stenosis — The most common type of spinal stenosis, lumbar stenosis affects the lower back. The lumbar spine, which includes the spine around five vertebrae, begins about 6 inches below the shoulder blades.

Symptoms

Some people with cervical and lumbar spinal stenosis don’t have any symptoms. They find out they have it coincidentally, from X-rays or other medical imaging. People with symptomatic stenosis commonly complain of:

  • Persistent pain — The pain might be in the back or neck, in the buttocks, or even extend into the legs and feet.

  • Loss of motor control in the legs or feet — This results in limping or frequent tripping, which often causes a decline in physical activity.

  • Pins-and-needles or hot or cold sensation — These symptoms are caused by poor nerve conductivity.

Over time, nerve compression can cause more debilitating symptoms, including:

  • Muscle atrophy — People suffering from nerve compression tend to move their limbs less frequently, and as a result, muscle tone declines.

  • Changes in posture — Spinal stenosis may cause people to walk slightly bent over.

  • Erectile dysfunction — Losing the ability to have sex is a symptom of lumbar spinal stenosis.

  • Bowel and bladder incontinence — Nerve compression in the lumbar region can lead to a serious condition called cauda equine syndrome, in which a person may lose control of his or her bowels.

Spinal stenosis also causes symptoms that are specific to the location of the injury:

  • Cervical stenosis not only causes neck pain and spasms, but also numbness or weakness in the arms or legs that can interfere with balance and walking. When the stenosis is severe, it’s possible to experience problems with bladder or bowel function.

  • Thoracic stenosis typically causes pain, spasms and weakness in the legs and buttocks, typically after walking and standing. Thoracic stenosis can lead to bowel and bladder problems, as well as sexual dysfunction.

  • Lumbar stenosis primarily affects the lower parts of the body, often causing numbness and weakness in the foot or leg, particularly after standing for extended periods of time. People with lumbar stenosis may also experience low back pain.

Treatment Options

Non-Surgical Options for Spinal Stenosis

Not all spinal stenosis requires surgery. In fact, short-term, mild symptoms can often be treated with a combination of hot or cold compresses, exercise and over-the-counter pain medications.

  • If symptoms continue, the doctor can prescribe anti-seizure drugs to alleviate pain from damaged nerves or antidepressants to help patients with chronic pain.
  • Opioid pain medications may also be prescribed for short- or long-term pain control.

Depending on its severity, untreated stenosis can become debilitating or even fatal. Mild cases of spinal stenosis can be treated through symptom management. For severe cases, especially those that affect quality of life or the nervous system, doctors might recommend surgery.

The range of treatment options include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) — Both over-the-counter and prescription NSAIDs can alleviate pain.
  • Corticosteroids — Delivered via injection into the spinal column, these medications reduce inflammation.
  • Braces — The symptoms of stenosis in the lumbar spine may respond well to regular use of a back brace.
  • Alternative treatments — Other options for milder symptoms include physical therapy to help spinal stenosis sufferers build muscle strength and flexibility. Acupuncture, chiropractic and other nonmedical treatments are sometimes used to address the symptoms of spinal stenosis, but more research is needed to determine their effectiveness.
Surgical Options

When patients no longer find relief from nonsurgical treatment, or they become debilitated by pain and weakness, it’s time to consider surgery. Surgeons generally recommend a minimally invasive approach to these procedures to preserve healthy tissue and reduce the risk for fusion surgery.

There are several types of surgical spinal stenosis treatment:

Laminectomy

Also known as decompression surgery, this procedure relieves pressure on nerves by removing the lamina — the back portion of the vertebrae to create more space for the nerves. Sometimes, the decompressed vertebrae is fused together with surrounding vertebrae during a process known as spinal fusion. As a result, spinal strength may be improved.

While generally safe, laminectomy carries many of the same risks of any surgery, such as bleeding, clots and infection. Other potential risks include nerve injury or leaks of spinal fluid.

Patients usually return home the same day if fusion isn’t performed, and patients are able to resume work in a few weeks.

Laminoplasty

Only performed to treat cervical spine stenosis, this procedure creates space in the spinal canal by making a hinge on the back part of the vertebrae and wedging the hinge open with bone or metal.

Following surgery, patients may stay in the hospital for several days before returning home. Patients limit activity for a few weeks and may return to work within 4 to 6 weeks.

Laminotomy

During laminotomy, part of the back of the vertebrae is removed to relieve pressure and the spine is stabilized. Often, spinal fusion is performed to stabilize the spine. While many patients will spend one night at the hospital following laminotomy, many will be discharged the day of surgery.

For 2 weeks following the surgery, activity is limited.

Ready for an Appointment?

If you're experiencing signs or symptoms of spinal stenosis, schedule an appointment or call 800-TEMPLE-MED (800-836-7536) today.

Learn more about our doctors and care team who diagnose and treat spinal stenosis.