What is spinal stenosis?
Spinal stenosis is a narrowing of the spinal canal. When the spinal canal is too narrow, that can put pressure on the nerves and/or the spinal cord, causing pain, numbness and weakness in the back, neck, arms or legs.
Spinal stenosis is typically classified according to the portion of the back where it occurs: lumbar spinal stenosis (lower back), cervical spinal stenosis (neck area), or thoracic spinal stenosis (upper or middle back.)
“Spinal stenosis can occur in any spinal area, but it’s most common in the cervical and lumbar spines, especially when it’s related to aging, because those are the areas that see the most mobility,” said Dr. Jessica Shellock, a spine surgeon on the medical staff at Texas Health Center for Diagnostics and Surgery.
Anyone may develop spinal stenosis, but the chances of developing the disorder increase with age. Spinal stenosis in children or younger adults is usually due to an injury or a birth defect (congenital spinal stenosis.)
Aging and age-related changes in the spine, injury, other diseases, or inherited conditions may cause spinal stenosis. Over time, wear-and-tear in the spinal bones can cause bone overgrowth, which narrows the spinal canal.
Two forms of arthritis that can lead to spinal stenosis are osteoarthritis and rheumatoid arthritis. Osteoarthritis, the most common, is a degenerative disease in which the tissues in the joint break down over time. Rheumatoid arthritis, a chronic inflammatory disease, affects the joints, causing pain, swelling, stiffness, and loss of function. Although not a common cause of spinal stenosis, rheumatoid arthritis can cause damage in the spine that leads to spinal stenosis.
Another cause of spinal stenosis is a herniated or “slipped” disc, in which a disc breaks through its outer layer, putting pressure on the spinal nerves. Discs are the cushion-like pads located between the vertebrae, which act as shock absorbers in the spine. As discs age, they may dry out and crack, causing the disc to bulge.
Injury is another cause of spinal stenosis, particularly when it occurs in younger people. These injuries are typically sustained in athletic activities, such as gymnastics or weightlifting, or in automobile accidents.
Tumors of the spine – abnormal growths of soft tissue – may also narrow the space in the spinal canal and cause bone changes, leading to spinal stenosis.
Common symptoms of spinal stenosis
Symptoms of spinal stenosis may include pain, tingling or a “pins and needles” sensation, numbness, cramping or muscle weakness in the arms or legs. Some people with spinal stenosis have no symptoms. Symptoms of spinal stenosis can get worse over time.
The types of symptoms each patient experiences will vary with the location of the narrowing of the spinal canal. Pain may occur in the lower back or may present as a burning pain or ache that radiates down the buttocks and into the legs. Walking, standing, or extending the lumbar area of the spine may cause symptoms to worsen. Flexing the lower back or neck, or sitting, may relieve symptoms.
People with more severe stenosis may have problems with bowel function, bladder function or sexual function. In severe cases, emergency medical treatment may be required if spinal stenosis causes partial or complete leg paralysis.
How do you test for spinal stenosis?
Doctors rely on a variety of tools to diagnose spinal stenosis. Typically, a workup begins with the doctor taking the patient’s medical and family history. The physician may ask the patient to describe their symptoms, the exact location of the pain, and when symptoms began. A physical exam will help the physician to observe any limits in the patient’s ability to move and whether the patient experiences pain or symptoms when hyper-extending the spine (bending backwards) or if the pain improves when bending forward. The physician may also observe the patient’s gait and balance. These clues help diagnose spinal stenosis as well as determine the location of the problem.
“Lumbar spinal stenosis often presents with leg pain that is accompanied by a history of inability to stand or walk distances,” said Dr. Shellock. “Often, patients find that if they sit down, their pain improves. Cervical spinal stenosis may not present as lower extremity pain – instead, the patient may have clumsiness, gait disturbances, or balance disturbances.”
Imaging tests are also another key part of the diagnostic process. These may include x-rays (to detect injuries, calcifications, or inherited conditions); magnetic resonance imaging (MRI) to help diagnose damage or disease of the spine. The physician may also order a computerized tomography (CT) scan to take images of the back.
How do you treat spinal stenosis?
Treatment of spinal stenosis may include physical therapy, medication, injections and surgical intervention such as a laminectomy/decompression, artificial disc replacement, endoscopic spine surgery or spinal fusion.
Typically, non-surgical treatments are the first line of defense. These may include:
Physical therapy can help maintain motion of the spine and strengthen abdominal and back muscles, helping stabilize the spine. With a physician or physical therapist’s guidance, many patients find relief through a program of gentle exercise such as walking or stationary cycling.
Medications to help manage the pain and inflammation caused by spinal stenosis may include nonsteroidal anti-inflammatory (NSAIDs) medications, prescription or over-the-counter pain relievers, and anti-inflammatory or numbing injections for pain that radiates or travels due to nerve compression or irritation.
Spinal injections. “Many patients can benefit from spinal injections, which may provide some improvement symptomatically, allowing the patients to be more functional,” said Dr. Shellock.
Spinal stenosis surgery is another option, if more conservative forms of treatment fail.
“From a surgical standpoint, depending on the complexity of an individual situation, options may include simply opening the space up with a procedure called a surgical laminectomy or decompression,” said Dr. Shellock. “But surgery may also involve stabilizing the affected segment of the spine by fusing or placing screws and rods to make sure that there's no abnormal motion."
Laminectomy is the name for the procedure to remove the bone, bone spurs and ligaments that are compressing the nerves. This procedure is also called a decompression. Laminectomy can be performed as open surgery, in which the spine surgeon uses a single, larger incision to access the spine. The procedure can also be done using a minimally invasive method, with smaller incisions. Ultra-minimally invasive surgery, using endoscopic surgical techniques, may allow for an even smaller incision and shorter recovery time. The surgeon uses an endoscope, a small camera that’s worked through the body in a tube. The camera guides the surgeon as he or she works.
Disc replacement surgery is a procedure in which a damaged disc is removed and replaced with an artificial disc. You may also see this procedure referred to as “artificial disc replacement surgery” (ADR surgery), “total disc arthroplasty,” or “total disc replacement” (TDR), or simply “disc replacement.” A key advantage of disc replacement surgery: because there’s no fusing of bones, the patient does not lose range of motion in the spine. Plus, with disc replacement, patients have a significantly lower chance of needing more spine surgery in the future, compared to spinal fusion surgery.
Spinal fusion is another type of spine surgery that may be recommended if arthritis has progressed to the point where the spine is unstable. This involves uniting (fusing) the vertebrae above and below the disc into one solid piece of bone. Fusion surgery does involve some risk but can provide substantial benefit. There are many surgical approaches and methods available to fuse the spine. All involve placement of a structural cage between the vertebrae. Most surgeons will place some type of bone graft material or bone-promoting substance within the cage to help encourage healing of the fusion. The surgeon may also in some cases use supplemental hardware such as plates, screws and cages, which acts an internal splint to hold the vertebrae together while the bone grafts heal.
Patients typically stay in the hospital for one to two days after fusion surgery. Fusion requires a longer period for recovery compared to other types of spinal surgery; a fusion generally takes 9 to 12 months to fully heal. Patients’ activities will be restricted during all or part of this healing period. The total time for recovery varies with the patient’s age and other health factors.
Choosing the right surgical option for treating spinal stenosis is an important decision which the patient and surgeon make together.
“The best surgical option will depend on the individual patient’s symptoms and the findings from an imaging study, such as an X-ray or MRI,” said Dr. Shellock. “A patient should discuss their options thoroughly with their physician to decide which procedure is best.”
How can you prevent spinal stenosis
Because most cases of spinal stenosis are due to normal “wear and tear” conditions, such as osteoarthritis and loss of bone and muscle mass, no prevention method is guaranteed.
However, patients can take steps to lower their risk or slow the progression of spinal stenosis. These include common sense measures for good health: eating a balanced diet, maintaining a healthy body weight, avoiding smoking (or quitting smoking), maintaining good posture and exercising.
While patients should avoid exercises that cause pain, it’s important to stay active. Too much rest may be more harmful than helpful. Patients should check with their healthcare provider before starting a home exercise program.
How to live with spinal stenosis after diagnosis and treatment?
Living with spinal stenosis can be challenging. However, these self-care tips may help.
Make adjustments in your daily routines that might trigger pain. Pace activities so you don’t overdo it.
Use assistive devices to help give you stability when you walk around.
Try changing your posture. Some people may find that flexing the spine can relieve some of their symptoms. Flexing opens the spaces in the spine, which can take pressure off the nerves and can help decrease pain.
Practice healthy habits. For example, maintain a healthy weight and if you smoke, quit.
What is the main treatment for spinal stenosis?
Laminectomy is a surgery that doctors perform to treat spinal stenosis by removing the bony spurs and the bone walls of the vertebrae. This helps to open up the spinal canal and remove the pressure on the nerves. Doctors may perform a discectomy during a laminectomy. Spinal fusion, artificial disc replacement and endoscopic spine surgery are also common surgical options for treating spinal stenosis.
How serious is spinal stenosis?
People with spinal stenosis may experience numbness, weakness or cramping in the arms or legs, pain going down the leg or arm, abnormal bowel or bladder function, and loss of sexual function. In severe cases, spinal stenosis may cause partial or complete leg paralysis that requires emergency medical treatment.
If you or someone you know is suffering from spinal stenosis, take the next step and make an appointment with an experienced spine specialist. Our patient navigator is standing by to help you find the doctor that is right for you! Call or email today.
Texas Health Center for Diagnostics & Surgery is a surgical hospital serving the people of Collin, Dallas and Denton counties. The hospital is an award-winning facility that offers a wide range of services including robotic surgery, spine surgery, joint replacement surgery, orthopedic surgery, gynecological surgery, urological surgery, ENT surgery as well as spinal injections, outpatient GI procedures and advanced imaging studies.