The Basics of Spinal Stenosis


BackPainSpinal stenosis is the medical term for the narrowing of spaces in the spine, which results in pressure on the spinal cord and nerves. Approximately 75% of spinal stenosis cases involve the lumbar spine (low back). For most patients, the narrowing of the spine from stenosis causes the nerve root to be compresses, leading to shooting, burning pain down the back of the leg.

Around 375,000 Americans suffer with spinal stenosis, which is more common in people older than 60 years. Lumbar spinal stenosis is the leading cause of spine surgery in the U.S. Foraminal stenosis of the lower back is more common than cervical stenosis.

Causes of Spinal Stenosis

  • Age – Age-related changes to the back structures is the most common cause of stenosis. The tough connective tissues (ligaments) between the bones of the spine (vertebrae) thicken, and spurs develop on the bones. These bony growths protrude into the spinal canal and compress nerves. Also, the discs lose fluid and deteriorate, causing pressure on nerves.
  • Spinal arthritis – This is a form of osteoarthritis that affects the vertebrae bones.
  • Heredity – Some people are born with a small spinal canal, causing symptoms of stenosis to occur at a young age.
  • Spine tumors – Abnormal growths can impinge into the spinal canal and lead to bone resorptioSpinal Stenosisn or displacement of bone.
  • Trauma – Injury to the spine can result in stenosis, as fragment of bone penetrate the spinal canal.

Symptoms of Spinal Stenosis

Spinal stenosis results in low back pain and leg pain. Associated symptoms include:

  • Frequent falling due to clumsiness
  • Numbness along the back of leg and into foot
  • Difficulty walking due to pain and weakness
  • Tingling sensations
  • Hot and/or cold sensations

Diagnosing Spinal Stenosis

Spinal stenosis is difficult to diagnose because the symptoms occur in many other conditions. The doctor will ask many questions and do a medical history, inquiring about injury and back problems. In addition, several tests are used to diagnose the condition, including:

  • X-rays – Plain radiographs to visualize the bony structures of the spine.
  • Computed tomography with myelogram – A test used to assess soft tissue and structures of the back.
  • Magnetic resonance imaging (MRI) scan – Used to assess discs, spinal cord, and spinal nerves.

Treatment Options

 

  • Medications – These include anti-inflammatories, tricyclic antidepressants, muscle relaxaLumbar_Transforaminal_Epidural(1)nts, and painkillers.

 

  • Physical therapy – The therapist works with the patient who learns exercises to strengthen back muscles, improve flexibility, and stretch soft tissue structures.

 

  • Epidural steroid injection – A long-acting steroid is instilled into the epidural space of the spine, where the nerve inflammation occurs.

 

  • Facet joint denervation – Use of radiofrequency energy to destroy the nerves as they exit the spinal cord in the facet joint region.

 

  • Microendoscopic decompression – Surgery done to decompress the nerve to relieve impingement.
  • Foraminotomy or facetectomy – Removal of a part of the bony structure (facet) that protrudes in the spinal canal, and decompression of the nerve root.

 

  • Laminotomy – Removal of the bony structure (lamina) and growth (spur) to relieve pressure and pain.

 

Resources

Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, et al. Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J. Jul 2009;9(7):545-50.

Jenis LG, An HS. Spine update. Lumbar foraminal stenosis. Spine (Phila Pa 1976). Feb 1 2000;25(3):389-94.

Pearson A, Lurie J, Tosteson T, Zhao W, Abdu W, Weinstein J. Who Should Have Surgery for Spinal Stenosis?. Spine (Phila Pa 1976). Jun 11 2012