Spinal stenosis is the narrowing of open spaces in the spine. In the normal spine, the central canal has ample space to allow the spinal cord to pass through. On both sides of the spine, small openings in the vertebrae called foramen allow the nerves leaving the spine to pass through as they travel out to different parts of the body. In spinal stenosis, there is a narrowing of the spinal cord canal or the foramen. This can lead to compression of the spinal cord and pinched nerves which cause pain that radiates to other parts of the body.
Stenosis usually results from age-related spinal degeneration and is most common in adults age 50 and older. It can be caused by osteoarthritis and resulting bone spurs, degenerated or herniated disks, and in rare cases by synovial cysts, infection, and tumors. Narrowing can occur in any part of the spine.
Forms of stenosis
- Lumbar Stenosis or narrowing in the lower back region of the spine. Lumbar stenosis often causes leg pain (especially when walking), leg weakness and symptoms similar to sciatica. Because stenosis in this region of the spine can mimic a problem with the veins in your leg known as a vascular insufficiency, your doctor will rule out vascular problems before making a diagnosis of lumbar stenosis.
- Cervical Stenosis Cervical stenosis can cause severe symptoms including a shuffling gait, frequent tripping, extreme weakness, and even paralysis. Symptoms often affect the arms, hands, and legs Spinal cord compression occurring in cervical stenosis is called myelopathy. People with cervical stenosis often require surgery to reduce pressure on the spinal cord and nerves and stabilize the spine.
Stenosis rarely occurs in the thoracic region (middle and upper back) because this area of the spine is stabilized and strengthened by attachment to the ribs and moves much less than the lumbar and cervical regions.
Spinal Stenosis Develops Slowly
Spinal degeneration and narrowing occurs gradually. People developing spinal stenosis may notice a gradual decline in their ability to perform physical activities and a tendency to lean forward. Acute symptoms of stenosis include:
- Pain or cramping in the legs, back, or buttocks that worsens when standing or walking and improves shortly after sitting down.
- Pain that improves when bending forward (such as leaning on a counter for support or leaning on a shopping cart while walking)
- Muscle weakness
- Numbness or tingling
Relieve Spine Pain at MedStar Montgomery: To treat your pain and restore function, your physician must first accurately diagnose the location of your stenosis.
- Taking your medical history to understand when your symptoms began and when your pain or discomfort is most severe.
- Physical exam performed by our orthopedists to determine where your pain and discomfort is localized. Physicians may ask you to move and bend your back and limbs in different directions.
- Imaging tests to examine the spine and nerves themselves using state-of-the-art imaging techniques, which may include:
- X-ray, which can help determine if your spine is narrowing, your vertebrae are thinning or if a disk or vertebra has slipped;
- MRI, which uses powerful magnets and computer technology to create a picture of your muscles, tissues, nerves, and disks;
- CT scan with myelogram, which combines X-ray technology with computers to provide a very detailed picture of the spine and uses an injected X-ray dye to show soft tissue that may be causing your stenosis; and
- Selective nerve root blocks, injections of a local anesthetic into a specific nerve to pinpoint which nerve is causing your pain and weakness.
Many people with spinal stenosis find significant pain relief and restoration of function through non-surgical treatments. After making a diagnosis of stenosis, physicians generally recommend trying these approaches before resorting to surgery. Your treatment plan may include a combination of prescription or over-the-counter medications to relieve pain and reduce inflammation, pain-relieving epidural injections, and physical therapy.
Physical therapy can increase strength in the muscles supporting the spine and improve your ability to stand, walk, and perform other activities without pain or discomfort. Your physician may recommend activity modifications that put you in a forward position, opening up the spinal canal and relieving pressure on the spinal cord. Suggestions may include leaning on a walker or shopping cart when walking, or exercising while leaning forward on a stationary bike.
When stenosis is severe, surgery may be recommended. MedStar Montgomery’s fellowship-trained surgeons will recommend the appropriate procedure to treat your specific condition. Surgeries commonly performed to relieve pain and improve function for severe stenosis cases include:
- Laminectomy: A minimally-invasive procedure which involves making small incision in the spine to reach the narrowed bones and remove the area of compression.
- Laminectomy with Spinal Fusion: If the narrowing is extensive and the laminectomy procedure to remove the narrowed bones will destabilize the spine, surgery will include a spinal fusion. This procedure joins vertebrae with together with a bone graft and uses a titanium plate and screws to stabilize the area while the graft heals.
- Anterior Cervical Discectomy and Fusion (ACDF): This procedure may be recommended for patients with cervical stenosis if the neck is bending far forward. In the ACDF procedure, a degenerated or herniated disc is removed through the front of the neck in order to correct narrowing, reduce spinal pressure, and relieve pain. This procedure is combined with a fusion surgery to stabilize the neck.