Spinal stenosis is a condition that causes narrowing in the spinal canal. It is a common cause of neck and low back pain in older adults.
This condition can cause substantial discomfort, disrupting daily activities and, in severe cases, leading to progressive disability. Understanding spinal stenosis and exploring the treatment options available can greatly help in managing its symptoms and improving one's quality of life.
What is spinal stenosis?
Spinal stenosis is a condition in which the space within your spine narrows, putting pressure on the spinal cord and nerves that travel through the spine. This narrowing can happen in any part of the spine but is most common in the lower back (lumbar spine) and the neck (cervical spine).
The condition can cause a range of symptoms, which can vary from mild to severe and can significantly impact daily activities. Mild spinal stenosis may cause no symptoms.
Common symptoms of spinal stenosis
Symptoms of spinal stenosis vary depending on the location and severity of the spinal narrowing. Common symptoms include:
- pain in the lower back or neck. Pain tends to be worse when the spine is straight, and may be improved by leaning forward (for lumbar spinal stenosis) or bending the neck forward (for cervical spinal stenosis) as this creates more space in the spinal canal.
- numbness, tingling, weakness, or a combination of these in the hands, arms, feet, or legs
- difficulty walking or maintaining balance
- in severe cases, problems with bladder or bowel control.
If any of these symptoms occur suddenly and worsen rapidly, particularly a loss of bladder or bowel control, see a doctor right away. This may be a sign of a serious condition caused by compression of nerve roots in the lower part of the spinal cord that can cause permanent damage if not treated promptly.
What can cause spinal stenosis?
The most common causes of spinal stenosis are conditions related to the natural aging process. As we get older, joint and disc degeneration in our spines can lead to conditions like osteoarthritis and degenerative disc disease. These can cause changes that lead to squeezing and narrowing of the spinal canal and nerve openings, causing pain and discomfort.
Any changes that cause narrowing of the spinal canal can contribute to the development of spinal stenosis. Examples include:
- Osteoarthritis. This common form of arthritis can cause bony enlargement of the small joints in the spine (facet joints), leading to narrowing of the spinal canal.
- Herniated discs. Intervertebral discs act as cushions between the vertebrae. They can dry out and crack, allowing some of the inner material to escape and press on the spinal cord or nerves.
- Spinal injuries. Trauma from car accidents or other injuries can dislocate or fracture the vertebrae, leading to spinal stenosis. Scar tissue can also form, leading to narrowing.
- Spondylolisthesis. This is a condition in which one or more spinal vertebra slips out of alignment, narrowing the spinal canal.
- Tumors. Abnormal growths can develop inside the spinal cord, within the membranes covering the spinal cord, or in the space between the spinal cord and vertebrae.
- Congenital spinal stenosis. Some people are born with a small spinal canal, which increases their risk of developing spinal stenosis.
Certain bone diseases and autoimmune disorders can affects bones and joints in the spine, causing spinal stenosis. For example, ankylosing spondylitis is a type of arthritis that causes inflammation in the spine. Over time, vertebrae may fuse together and stiffen. This can narrow the spinal canal and put pressure on the spinal cord and nerves.
Managing symptoms
Managing the symptoms of spinal stenosis often involves a combination of treatments. Initial treatment may involve physical therapy that focuses on stretching, strengthening, and aerobic exercises to enhance muscle stability and improve posture. These exercises can help relieve pressure on the spine and reduce pain.
Other common nonsurgical options include:
- Medications. Over-the-counter pain relievers like acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or naproxen (Aleve) can help reduce pain and inflammation. In some cases, doctors may prescribe stronger pain medications, muscle relaxants, or nerve pain medications.
- Steroid injections. Corticosteroid injections can reduce inflammation and relieve pain in the affected area. These injections are not a long-term solution, but can provide temporary relief.
- Alternative therapies. Some people find symptom relief through acupuncture, chiropractic care, or massage therapy. Discuss these options with your doctor to ensure they are safe and appropriate for your condition.
Using a cane or walker can improve balance and help reduce pain while walking. Losing weight, practicing good posture, and avoiding activities that worsen symptoms can also help.
Surgical treatments for spinal stenosis
Surgery is usually reserved for people who don't get better with other treatments, or whose symptoms are causing major disability.
Several surgical options are available, and each has its risks and benefits. The right one for any given individual will depend on the cause and location of the stenosis.
- Laminectomy. This procedure involves removing part of the lamina, the thick bone that forms the roof of the spinal canal. This creates more space within the spinal canal, relieving pressure on the spinal cord and nerves.
- Minimally invasive decompression. In this surgery, parts of bone or tissue that are pressing on the nerves are removed. This creates more space in the spinal canal, reducing pain, numbness, and weakness in the legs.
- Interspinous process spacers. These small devices are inserted between the bones of the spine to keep the space open and reduce pressure on the spinal nerves.
- Spinal fusion. This procedure may be necessary if spinal stenosis has caused instability in the spine. It involves fusing two or more vertebrae together to stabilize the spine and reduce pain.
Surgery can provide significant relief for many people, but it also comes with potential complications and a recovery period that can vary in length.
