Spinal stenosis (or narrowing) is a common condition that affects
many adults 50 yrs old and older. This occurs when the small spinal
canal, containing the nerve roots and spinal cord, becomes constricted
or compressed. This can lead to a number of problems, depending
on which nerves are affected. In general, spinal stenosis can cause
cramping, pain or numbness in the legs, back, neck, shoulders and/or
arms; a loss of sensation in the extremities; and sometimes, in
rare cases, problems with bladder or bowel function. In general,
spinal narrowing is caused by osteoarthritis, or "wear and
tear" arthritis, of the spinal column. This results in a "pinching"
of the spinal cord and/or nerve roots.
People suffering from spinal stenosis may have trouble walking
any significant distance, and usually must sit or lean forward over
a grocery cart, countertop or assistive device such as a walker.
a person with spinal stenosis complains about developing tremendous
pain in the legs or calves and lower back after walking. Pain occurs
more quickly when walking up hills. This is usually very reproducible
and is almost immediately relieved by sitting down or leaning over.
When the spine is flexed forward, more space is available for the
spinal cord, causing a reduction in symptoms.
What causes it?
Spinal stenosis is usually caused by progressive degenerative changes
in the spine. This is usually called "acquired spinal stenosis"
and can occur from the narrowing of space around the spinal cord
due to bony overgrowth (bone spurs) from osteoarthritis, combined
with thickening or calcification of one or more ligaments in the
back. Stenosis can also be caused by a bulge or herniation of the
intervertebral discs. This must be differentiated from the stenosis
caused by the bony overgrowth that can occur on the vertebral bodies,
or facet joints. Spinal decompression therapy may not be appropriate
in moderate to severe cases of spinal stenosis with many spurs and
thickened ligaments. On the other hand, if the stenosis of the central
canal is primarily from bulging discs, or herniated discs, then
non-surgical spinal decompression may be very successful.
Sometimes people are born with a smaller spinal canal. This is
called "congenital spinal stenosis" and may become problematic
at an earlier age.
Who gets it?
The risk of developing spinal stenosis increases in those who:
- Are born with a narrow spinal canal
- Are female
- Are 50 years of age or older
- Have had previous injury or surgery of the spine
Conditions that can cause spinal stenosis include:
- Osteoarthritis and osteophytes (bone spurs) associated with
- Inflammatory spondyloarthritis
- Spinal tumors
- Paget's disease of the bone
- Previous surgery
How is it treated?
Typically, spinal stenosis is treated with conservative non-surgical
therapies. One important therapy is exercise. Keeping the muscles
of the hip, back, and legs toned allows for improved stability and
will improve walking.
Medications such as nonsteroidal anti-inflammatories (NSAIDs) also
may be appropriate and helpful in pain relief. Cortisone injections
into the epidural space, the area around the spinal cord, may provide
temporary relief to people suffering from this disorder.
Non-surgical spinal decompression therapy may help those with herniated
or bulging discs, lateral canal stenosis, and facet syndrome.
Under severe and rare circumstances, surgery to correct this disorder
may be appropriate. In these severe cases, nerves to the bladder
or bowel may be affected, leading to partial or complete urinary
or fecal incontinence. If you experience either of these problems,
seek immediate medical care! Decompression laminectomy, which is
the removal of a build-up of bony spurs or increased bone mass in
the spinal canal, can free up space for the nerves and the spinal
cord. However, adequate decompression of the neural elements and
maintenance of bony stability are necessary for a good surgical
outcome for patients with spinal stenosis.
Several studies report that surgical treatment produces better
outcomes than non-surgical treatment in the short term. However,
these results tend to deteriorate over time. In addition, lumbar
decompressive surgery can be complicated by epidural hematoma, deep
venous thrombosis, dural tear, infection, nerve root injury and
recurrence of symptoms.