Spinal stenosis is the narrowing of one or more spaces within your spine. Less space within your spine reduces the amount of space available for your spinal cord and nerves that branch off your spinal cord. A tightened space can cause the spinal cord or nerves to become irritated, compressed or pinched, which can lead to back pain and sciatica.
The column of bones known as the spine provides stability and support to your upper body, enabling you to twist and turn.
The spinal cord is made up of spinal nerves, which conduct signals from your brain to the rest of your body. The nerves are usually protected by the surrounding bone and tissues. If the spinal nerves are damaged or impaired, it can affect functions such as walking, balance, and sensation.
There are multiple types of spinal stenosis. They include:
• lumbar spinal stenosis, which affects the lower back
• cervical spinal stenosis, which affects the neck
• foraminal stenosis, which affects the openings in your bones (foramen)
• tandem spinal stenosis, which affects at least two areas of the spine
Spinal stenosis can greatly vary from person to person. Signs and symptoms may include one or more of the following:
• Pain. The pain might be dull and confined to the neck or lower back, or it could be an electric-like pain that radiates into the arm(s) or leg(s). The pain can vary over time, possibly flaring up during certain activities. Sometimes the pain is more of a pins-and-needles tingling sensation.
• Numbness. Reduced sensation or total numbness may occur in the arm, leg, and/or other areas of the body.
• Weakness. Reduced strength or problems with coordination may be experienced in the arm, leg, and/or other parts of the body. Severe compression of the spinal cord or cauda equina (nerve roots running below the spinal cord) could result in bowel and/or bladder dysfunction.
Spinal stenosis does not always cause pain. While rare, numbness or weakness might be present with little or no pain.
The most common cause of spinal stenosis is ageing. As you age, tissues in your spine may start to thicken and bones may get bigger, compressing the nerves.
Certain health conditions may also contribute to spinal stenosis. They include –
• Achondroplasia: Achondroplasia is a type of dwarfism that interferes with bone formation in the spine as well as other parts of the body.
• Ankylosing spondylitis: Ankylosing spondylitis is a type of arthritis that causes chronic inflammation in the spine. It can lead to the growth of bone spurs.
• Congenital spinal stenosis: Congenital spinal stenosis occurs when you’re born with a spinal canal that’s naturally narrow.
• Ossification of the posterior longitudinal ligament (OPLL): In this condition, calcium deposits form on the ligament that runs through the spinal canal.
• Osteoarthritis: In osteoarthritis, the cartilage that cushions your joints breaks down. The condition can affect the cartilage between vertebrae and may also cause bone spurs to grow in the spine.
• Paget’s diseaseof the bone: Paget’s disease of the bone is a chronic condition that causes bones to get weaker and grow larger than usual.
• Rheumatoid arthritis: Rheumatoid arthritis involves chronic inflammation, which can cause bone damage and the development of bone spurs.
• Scoliosis: Scoliosis is an abnormal curving of the spine. It may result from certain genetic conditions, neurological abnormalities, or unknown causes.
• Spinal injuries: Slipped (herniated) discs and bone fractures may cause vertebrae or bone fragments to put pressure on the spinal nerves.
• Spinal tumors: These tissue growths may develop in the spinal canal, trigger inflammation, and cause changes in the surrounding bone.
Your health care provider may ask about your symptoms and medical history. You may have a physical exam. You also may need an imaging test to help find the problem.
▪︎ Imaging tests
These tests may include:
• X-rays. An X-ray of the back can show bone changes that may be making the space within the spinal canal smaller.
• Magnetic resonance imaging (MRI). An MRI uses a powerful magnet and radio waves to produce detailed images of hard and soft tissue. The test can detect damage to the disks and ligaments.
• Computerized tomography (CT). This test combines X-ray images taken from many different angles. This can show herniated disks, bone spurs and tumors.
Treatment for spinal stenosis depends on how severe your symptoms are.
Your health care provider might prescribe:
• Nonsteroidal anti-inflammatory drugs (NSAIDs). If common pain relievers don’t provide enough relief, prescription NSAIDs might be helpful.
• Antidepressants. Nightly doses of tricyclic antidepressants, such as amitriptyline, can help ease chronic pain.
• Anti-seizure drugs. Some anti-seizure drugs, such as gabapentin (Neurontin, Gralise), are used to reduce pain caused by damaged nerves.
• Opioids. Medications such as oxycodone (Oxycontin, Roxicodone, others) and hydrocodone (Hysingla ER) can be habit-forming.
▪︎ Physical therapy
A physical therapist can teach you exercises that may help:
• Build up your strength and endurance
• Maintain the flexibility and stability of your spine
• Improve your balance
▪︎ Self-help remedies
• Apply heat: Heat usually is the better choice for pain due to osteoarthritis. Heat increases blood flow, which relaxes muscles and relieves aching joints.
• Apply cold: If heat isn’t easing your symptoms, try ice (an ice pack, frozen gel pack, or frozen bag of peas or corn). Typically ice is applied 20 minutes on and 20 minutes off. Ice reduces swelling, tenderness and inflammation
▪︎ Steroid injections
Injecting corticosteroids near the space in the spine where nerve roots are being pinched or where worn areas of bone rub together can help reduce inflammation, pain and irritation. However, only a limited number of injections are usually given (typically three or four injections per year) because corticosteroids can weaken bones and nearby tissue over time.
▪︎ Decompression procedure
This outpatient procedure, also known as percutaneous image-guided lumbar decompression (PILD), specifically treats lumbar spinal stenosis caused by a thickening of a specific ligament (ligamentum flavum) in the back of the spinal column. It is performed through a tiny incision and requires no general anesthesia and no stitches.
Surgery options involve removing portions of bone, bony growths on facet joints or disks that are crowding the spinal canal and pinching spinal nerves.
Types of spine surgery include:
• Laminectomy (decompression surgery): The most common type of surgery for this condition, laminectomy involves removing the lamina, which is a portion of the vertebra. Some ligaments and bone spurs may also be removed. The procedure makes room for the spinal cord and nerves, relieving your symptoms.
• Laminotomy: This is a partial laminectomy. In this procedure, only a small part of the lamina is removed – the area causing the most pressure on the nerve.
• Laminoplasty: In this procedure, performed in the neck (cervical) area only, part of the lamina is removed to provide more canal space and metal plates and screws create a hinged bridge across the area where bone was removed.
• Foraminotomy: The foramen is the area in the vertebrae where the nerve roots exit. The procedure involves removing bone or tissue this area to provide more space for the nerve roots.
• Interspinous process spaces: This is a minimally invasive surgery for some people with lumbar spinal stenosis. Spacers are inserted between the bones that extends off the back of each vertebrae called the spinous processes. The spacers help keep the vertebrae apart creating more space for nerves.
• Spinal fusion: This procedure is considered if you have radiating nerve pain from spinal stenosis, your spine is not stable and you have not been helped with other methods. Spinal fusion surgery permanently joins (fuses) two vertebrae together. The vertebrae are held together with screws, rods, hooks or wires until the vertebrae heal and grow together. The healing process takes six months to one year.
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