Spinal Stenosis: Symptoms, Causes & Treatment

What Is Spinal Stenosis?

Spinal stenosis is a condition that occurs when the spinal canal, the bony tunnel that runs through your spine, narrows. This narrowing puts pressure on the spinal cord and the nerves that branch out from it, which can cause pain, numbness, tingling, and weakness. Spinal stenosis most commonly affects the lower back (lumbar spine) and the neck (cervical spine), but it can occur anywhere along the spine. Our experts at PrimeCare have outlined everything you need to know.

Types of Spinal Stenosis

Spinal stenosis can be categorized into three types:

• Lumbar Spinal Stenosis: This is the most common type, affecting the lower back (lumbar spine). Symptoms like pain, numbness, and weakness often radiate into the buttocks and legs.
• Cervical Spinal Stenosis: This type affects the neck (cervical spine). It can cause neck pain, numbness, tingling, or weakness that may extend down the arms and into the hands.
• Thoracic Spinal Stenosis: This is the least common type, affecting the middle back (thoracic spine). Symptoms are less frequent than in other locations but may include pain, numbness, and difficulty breathing in severe cases.

How Common Is Spinal Stenosis?

Spinal stenosis is a surprisingly common condition. Studies estimate that between 250,000 and 500,000 Americans experience symptoms of stenosis each year. Furthermore, data suggests that roughly 5 out of every 1,000 people over the age of 50 will encounter spinal stenosis. These numbers highlight how common this condition is, especially as we age. Furthermore, lumbar spinal stenosis is the most frequent diagnosis for spine surgery in adults over 65, showcasing how often stenosis translates into clinical symptoms that require intervention.

Spinal Stenosis Symptoms

Spinal stenosis can present differently depending on the location of the narrowing. We’ve provided a breakdown of common symptoms of spinal stenosis:

Lumbar Spinal Stenosis (Lower Back) Symptoms

• Pain: This is a frequent symptom, often described as a dull ache in the lower back. You might also experience pain that radiates into the buttocks and legs, known as sciatica.
• Numbness, Tingling, or Cramping: These sensations can occur in the buttocks, legs, and feet.
• Weakness: This can affect your legs, making it difficult to walk, climb stairs, or stand for extended periods.
• Loss of Balance: In severe cases, stenosis can impact your balance and coordination.
• Pain with Certain Activities: Standing, walking downhill, or extending your back can worsen the pain, while bending forward, sitting, or walking uphill may provide some relief.

Cervical Spinal Stenosis (Neck) Symptoms

• Neck Pain: This is a common symptom, and the pain may radiate down into the shoulders and arms.
• Numbness, Tingling, or Weakness: These sensations can occur in the arms, hands, fingers, and legs depending on the location of the nerve compression.
• Balance Problems: Stenosis in the neck can affect your balance and coordination.
• Hand Function Difficulties: You might experience clumsiness, weakness, or difficulty gripping objects due to nerve compression.

What Are the Stages of Spinal Stenosis?

Spinal stenosis often progresses through stages based on the severity of narrowing as seen on imaging tests like MRI scans. Here's a breakdown of the possible stages:

• Stage 0: No stenosis (narrowing) of the spinal canal. This stage may not cause any symptoms.
• Stage I: Mild Stenosis: Mild narrowing is present, and symptoms may be mild or occasional, such as occasional pain that doesn't significantly impact daily activities.
• Stage II: Moderate Stenosis: More pronounced narrowing is evident. Symptoms become more frequent and may include pain, numbness, tingling, and weakness. These symptoms might worsen with certain activities and improve with rest or changes in posture.
• Stage III: Severe Stenosis: Significant narrowing causes substantial compression on the nerves and spinal cord. Symptoms become chronic and severe, with constant pain, numbness, tingling, and weakness significantly impacting mobility and daily activities. It’s possible to experience loss of balance and coordination.

Spinal Stenosis Causes and Risk Factors

Spinal stenosis can develop due to various factors that narrow the spinal canal. These causes can be broadly categorized into two main groups: acquired and congenital.

Acquired Causes

• Age-Related Changes: This is the most common cause. Intervertebral discs (the cushions between vertebrae) wear down and lose height with age. Additionally, bone spurs (osteophytes) can form on the vertebrae, encroaching on the spinal canal. This process, often linked to osteoarthritis, is what typically leads to lumbar spinal stenosis.
• Ligament Thickening: Ligaments that hold the spine together can thicken and bulge due to arthritis or inflammation, reducing space within the canal.
• Spinal Injuries: Fractures, dislocations, or ligament tears in the spine can cause misalignment or instability, leading to stenosis.
• Herniated Discs: When the soft inner core of a disc bulges or leaks out, it can press on the spinal cord or nerves.
• Spinal Tumors or Cysts: These growths within the spine can compress the spinal cord and nerves.
• Bone Diseases: Paget's disease of bone, a condition that disrupts the normal bone renewal process, can lead to bone enlargement and contribute to stenosis.

Congenital Causes

• Narrow Spinal Canal: Some people are born with a naturally narrow spinal canal which puts them at higher risk for stenosis later in life.

This breakdown highlights that most cases of spinal stenosis are acquired through wear and tear or injuries. However, congenital factors can also play a role in some cases.

What Are the Complications of Spinal Stenosis?

In severe cases, spinal stenosis can lead to significant complications. Loss of bladder or bowel control (incontinence) and sexual dysfunction are potential consequences due to nerve compression. These issues can greatly impact a person's quality of life. In very rare and extreme cases, severe stenosis can even cause partial or complete paralysis in the legs.

How Is Spinal Stenosis Diagnosed?

Diagnosing spinal stenosis typically involves a two-pronged approach: a thorough medical history and physical examination followed by imaging tests.

Medical History and Physical Exam:

• Your doctor will ask about your symptoms, including their onset, location, severity, and any aggravating or relieving factors.
• They'll also discuss your medical history, including past injuries, surgeries, and any other health conditions.
• During the physical exam, your doctor will assess your range of motion, reflexes, muscle strength, and sensation in the affected areas. Specific tests may be performed to check for nerve compression, such as the straight leg raise test for lumbar stenosis.

Imaging Tests:

Imaging tests help visualize the structures within your spine and identify any abnormalities contributing to stenosis. Common tests used include:

• X-Rays: These provide a basic view of your bones and can reveal bone spurs or misalignment.
• Magnetic Resonance Imaging (MRI): This advanced imaging technique creates detailed pictures of your bones, soft tissues (like discs and ligaments), and the spinal cord, allowing for precise identification of the location and cause of stenosis.
• Computed Tomography (CT) Scan: A CT scan can provide detailed cross-sectional images of your spine. In some cases, a CT myelogram may be used. This involves injecting a contrast dye into the spinal canal before the CT scan to better visualize the spinal cord and nerves.

Electrodiagnostic Tests (Less Common):

In some cases, your doctor may order additional tests to assess nerve function, such as:

• Electromyography (EMG): This test measures the electrical activity of your muscles to detect nerve damage.
• Nerve Conduction Studies: These studies evaluate how well electrical signals travel through your nerves.

By combining the information from your medical history, physical exam, and imaging tests, your doctor can accurately diagnose spinal stenosis and determine how severe your condition is.

What Is the Treatment for Spinal Stenosis?

Spinal stenosis treatment focuses on managing symptoms and improving your quality of life. The approach typically starts with conservative measures and progresses to more invasive interventions if needed. Here's a breakdown of the common treatment options:

Non-Surgical Treatments

• Rest and Activity Modification: Avoiding strenuous activities that aggravate your symptoms can provide relief. Your doctor may recommend using a cane or walker for additional support.
• Physical Therapy: Physical therapy exercises can strengthen core and back muscles, improve flexibility, and teach proper posture and body mechanics to reduce pressure on the spinal cord and nerves.
• Pain Medication: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain. In some cases, your doctor may prescribe stronger medications, such as prescription pain relievers, muscle relaxants, or medications to relieve pain in spinal nerves.
• Anti-Inflammatory Medications: Prescription nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and pain.
• Corticosteroid Injections: Injecting corticosteroids around the affected nerves can provide targeted pain relief, although these injections may not be suitable for everyone and repeated use can have side effects.
• Alternative Therapies: Some people find relief with acupuncture, massage therapy, or chiropractic care. However, be aware that the evidence for the effectiveness of these therapies specifically for spinal stenosis is limited.

Surgical Treatments

If conservative measures fail to provide adequate relief, spinal stenosis surgery might be considered. The goal of surgery is to create more space in the spinal canal by removing bone spurs, ligaments, or parts of the vertebrae. Common surgical procedures for spinal stenosis include:

• Laminectomy: This is the most common surgery for spinal stenosis. The surgeon removes a portion of the lamina, the bony roof of the spinal canal, to create more space for the nerves.
• Laminotomy: This is a less extensive procedure than a laminectomy, where only a small portion of the lamina is removed.
• Spinal Fusion: In some cases, spinal fusion may be combined with decompression surgery to provide additional stability to the spine. This involves fusing together two or more vertebrae with bone grafts or metal hardware.

PrimeCare Orthotics & Prosthetics Can Help

While PrimeCare Orthotics & Prosthetics doesn't directly perform surgery, we can be a valuable partner in managing your spinal stenosis. We offer various orthotic devices, such as spinal braces and supports, that can help improve your posture, reduce pain, and enhance stability. Our team of experts can work with you and your doctor to develop a personalized treatment plan that addresses your specific needs and helps you manage your spinal stenosis effectively.

Can I Prevent Spinal Stenosis?

While there's no guaranteed way to prevent spinal stenosis entirely, especially the age-related kind, you can certainly take steps to promote spinal health and potentially slow its progression. Here are some key strategies to keep in mind:

• Maintain a Healthy Weight: Excess weight puts extra stress on your spine, accelerating wear and tear. Reaching and maintaining a healthy weight can significantly benefit your spinal health.
• Exercise Regularly: Regular exercise strengthens the muscles that support your spine, improving flexibility and stability. Low-impact activities like swimming, walking, or yoga are especially beneficial.
• Practice Good Posture: Always strive for proper posture when sitting, standing, and lifting objects. This helps distribute stress evenly on your spine and reduces strain on specific areas.
• Use Proper Lifting Techniques: When lifting objects, bend your knees and keep your back straight to avoid putting undue stress on your spine.
• Quit Smoking: Smoking restricts blood flow, which can hinder healing and contribute to spinal degeneration. Quitting smoking is a significant step towards overall health and can benefit your spine as well.
• Consider Ergonomics: If you sit for extended periods, make sure your workstation is ergonomically designed. This means you’ll want a supportive chair with proper lumbar support that helps maintain good posture while seated.

Small habits can make a huge difference. By incorporating these practices into your daily routine, you can promote spinal health and potentially reduce your risk of developing or worsening spinal stenosis.

What Is the Prognosis for Spinal Stenosis?

Spinal stenosis is a progressive condition, meaning it tends to worsen over time. However, the prognosis for individual cases varies depending on several factors:

• Severity of Stenosis: The degree of narrowing in the spinal canal significantly impacts the prognosis. Milder cases may progress slowly, while severe stenosis can lead to a more rapid decline in function.
• Location of Stenosis: Stenosis in the cervical spine (neck) can affect balance and coordination more than lumbar stenosis (lower back). This can influence a person's overall well-being and independence.
• Age and Overall Health: Younger individuals with good health tend to have a better prognosis compared to older adults with pre-existing health conditions.
• Treatment Adherence: Following a prescribed treatment plan, including conservative measures like exercise and physical therapy, can significantly improve the prognosis and slow the progression of stenosis.

While there's no cure for spinal stenosis, the good news is that many people can manage the condition effectively and maintain a good quality of life. Early diagnosis and treatment are crucial. Here's a breakdown of what you can expect:

• Non-Surgical Treatments: In most cases, conservative measures like pain medication, physical therapy, and lifestyle modifications can effectively manage symptoms and improve function.
• Surgical Intervention: In severe cases where conservative options fail, surgery can create more space in the spinal canal and alleviate nerve compression. This can dramatically improve a person's quality of life.