The Complete Guide to Spinal Stenosis: Causes, Symptoms, and Effective Treatments

Your back consists of a stack of 24 vertebral bones. These bones support your trunk and provide a hard bony covering for the spinal cord. Your spine has been given different names based on its location–the neck region is called the cervical region, the upper back region is called the thoracic region, and the lower back region is called the lumbar region. The spinal cord gives multiple nerves as side branches. These nerves have to pass the bony holes to reach limbs and the trunk.

Back Pain

The compression or pinching of the nerves while exiting from the spinal canal can cause irritation of nerves and long-term compression can lead to permanent damage to those nerves.

What is the cause of spinal stenosis?

The most common cause is an age-related degenerative change in the spine, which means wear and tear changes (osteoarthritis in medical terminology). Other causes include:

• Bone spurs compressing the nerves: Bony spurs refer to the overgrowth of bone, which may be due to osteoarthritis and Paget disease.
• Slippage of intervertebral discs: Between each vertebra, there is a soft pad of cushion called an intervertebral disc, which acts as a shock absorber. When this disc protrudes, it can compress the nearby located nerve.
• Thickened ligaments: Arthritis of vertebral joints causes ligaments to thicken. These thickened ligaments can pinch off the nerves.
• Spinal injuries and fracture: Fracture or dislocation of a vertebral bone can lead to the compression of nerves nearby.
• Congenital spinal stenosis: It is a condition in which a person is born with a narrow spinal canal. Other congenital disorders of a vertebral column, like scoliosis (abnormal sideways bending of the vertebral column), can also pinch off spinal nerves.

What symptoms you may experience?

Since spinal stenosis is a gradual process, it takes a long time to develop symptoms, which slowly worsen over time. Symptoms depend upon the location of spinal stenosis. The most common location is the lower back (lumbar spinal stenosis).

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Symptoms of stenosis of the lower back (lumbar spinal stenosis) are:

• Numbness and a tingling sensation in the thigh, legs, or feet.
• Sciatica: Sciatica means radiating pain from the buttock to the legs. You may experience an electric-like sensation.
• Pain in the lower back that comes and goes.
• Weakness in the leg or foot.
• The pain is worsened by standing, walking downhill, and relieved by bending forward and walking uphill.
• A sensation of heaviness in the legs.
• Loss of control over bowel or bladder in severe cases.

Spinal stenosis in the neck region is called cervical spinal stenosis. Its symptoms include:

• Numbness and tingling sensation in the upper arm and hands
• Neck pain
• A weakness of hand muscles (problems in buttoning the shirt and writing)
• Problems with balance.

Can spinal stenosis cause permanent damage?

If nerves are compressed for a long time, the nerve can be irreversibly damaged and you may get permanent paralysis of your limbs. That’s why it will be better to consult your doctor in the early stage.

How is spinal stenosis diagnosed?

Your physician will take a detailed history and do a physical examination. During the physical examination, your doctor may press on your back and assess the sensation in your upper or lower limbs. They’ll also test the motor strength. Your healthcare provider may ask you to bend in different directions to check the mobility of your spine, and your balance, and assess how you move and walk.

X-ray: It is an economical investigation and has low radiation exposure. Therefore, it is considered the first line of investigation to assess any bony spur, changes in bone structure, and loss of bone height.

MRI: MRI (Magnetic Resonance Imaging) uses a large magnet to take images of your body and it has no radiation exposure. It provides a clear view of your spine and nerves, the degree of compression, and the protrusion of the disc.

CT or CT myelogram: CT scan also provides a detailed view of the spinal column. However, a CT scan is good for the visualization of the bone rather than soft tissue. Another disadvantage is that it has a high degree of radiation exposure.

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Your health care provider will rule out other health conditions that mimic the symptoms of spinal stenosis like the following:

• Diabetic neuropathy: damage of peripheral nerves due to the effect of high blood glucose levels for a long time.
• Ankylosing spondylitis: Inflammation of the spine due to autoimmune diseases.
• Peripheral arterial disease: problems in peripheral blood vessels due to deposition of fat and autoimmune diseases.
• Abdominal aortic aneurysm: dilatation of the aorta in the abdomen.
• Cancer.

What are the treatments for spinal stenosis?

Treatment depends upon the cause, location of symptoms, and degree of severity. Initially, self-help care remedies and analgesics are recommended. If these do not relieve the symptoms, then surgery is advised as the last option.

Self-help care remedies

Heat application: Heat dilates blood vessels, improving blood flow, relaxes the muscles, and relieves pain. It is useful for pain that is caused by osteoarthritis.

Cold application: If the heat does not relieve your symptoms, then you can try an ice pack. The cold application reduces swelling and tenderness.

Physical exercise: Exercises that involve the strengthening of muscles can improve the flexibility of your spine.

You can use a cane or walker to walk.

Find a position that helps relieve your pain, such as a slight forward bend help relieve pain of your lumbar spinal stenosis.

Non-surgical treatment options

Oral drugs: Your health care provider may initially prescribe some nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen, Naprosyn, and Acetaminophen. Since NSAIDs cause irritation and ulcer in the stomach, your doctor may add acid-suppressing medications like esomeprazole and pantoprazole.

If these medications do not relieve your pain, your healthcare provider may prescribe you opioids, such as hydrocodone and oxycodone, for short-term pain relief. Since opioids can be habit-forming, these drugs should be taken with caution. Other medications that your healthcare provider may recommend include gabapentin and amitryptiline.

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Steroid: Injecting steroids near the site where the nerve is pinched reduces inflammation and swelling, thus reducing pain. Since steroid weakens your bone, therefore, only 3 or 4 injections are given per year.

Decompression: If ligament thickening is compressing the nerves, a decompression procedure is performed to remove the portion of the thickened ligament. The advantage of this procedure is that some patients recover very quickly and can walk after a couple of hours.

Surgery

Since there are very delicate structures in your spine, surgery is considered when all other treatment options fail to relieve your symptoms. Your healthcare provider may recommend surgery in the following circumstances:

• If you have difficulty walking and maintaining balance.
• If your symptoms are decreasing your quality of life and you are unable to tolerate your pain.
• If pressure on the spinal cord is suspected.
• If you lost control over your bowel and bladder.

What are the surgical treatments?

Surgery aims to remove the factor that is compressing your nerve. There are different types of spinal surgery:

Laminectomy: Lamina is a small part of the vertebra. The removal of the lamina is called a laminectomy. This is the most common type of surgical procedure for the treatment of spinal stenosis. During this procedure, if any bony spur is found, it will be removed. Removing the lamina creates enough space, relieving the pressure on the spinal nerves.

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Laminotomy: This is the mini version of laminectomy where only a small part of the lamina is removed.

Laminoplasty: In this procedure, after removing the lamina, metal plates and screws are fitted to create a hinged bridge across that space.

Foraminotomy: Foramen refers to the hole from where your nerves exit the spinal cord. Foraminotomy refers to the widening of that hole by removing some nearby bone or tissue.

Interspinous process spaces: Spacers are placed in between the vertebral bones to create enough space for the nerves. It is a minimally invasive surgery.

Spinal fusion: Spinal fusion permanently fuses two vertebrae with the help of screws and plates. It is considered if your symptoms are not relieved with all the above methods and your spine is unstable.

What are the risks of spinal surgery?

Similar to other surgeries, it carries the risk of infection, bleeding, clotting, and anesthetic complications. Some risks that are specific to spinal surgery include:

• Nerve injury
• Injury to coverings of the spinal cord
• Need for the additional surgical procedure
• Loosening of screws and plates and their failure
• No relief of symptoms

How to prepare for surgery?

If you smoke, then quit smoking. Also, perform regular physical exercises to remain physically fit and strong. If you are taking any medications for any of your health conditions, let your physician know about it because those drugs might need to be stopped before surgery. If you have any questions or concerns, discuss them with your surgeon.

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How long will I have to stay in the hospital after surgery?

It depends upon the type of surgical procedure that you have undergone, your age, and your health status.

If you have undergone a laminectomy, then you may be discharged after a day or two. If you have undergone spinal fusion, then you may need to stay in the hospital for 5 days. If you are an old person, then you will be transferred to a rehabilitation facility before they will discharge you.

What to expect during the recovery period?

You will be given pain medications to relieve pain and swelling after surgery. You need to do physical exercise daily so that your back does not stiffen. Your physical therapist will teach you some exercises to strengthen your back muscles.

When can I return to my normal daily life after surgery?

It depends upon the type of surgery you have undergone. If you have undergone spinal fusion, then it may take three months or even longer

When can I return to my job?

Again, this depends upon the type of surgery you have undergone. If you have undergone a laminectomy, then you can do a desk job a few days after returning home. If you have undergone spinal fusion, then you might have to rest at home for a few weeks.

Is it possible to prevent spinal stenosis?

Since most cases of spinal stenosis are caused by osteoarthritis (wear and tear phenomenon due to the normal aging process), you cannot prevent it completely. But some measures are advised to lower your risk and slow the progression, such as:

• Exercise regularly
• Eat a healthy and balanced diet
• Quit smoking
• Maintain good posture

Will surgery guarantee the cure of spinal stenosis?

The result of the surgery depends upon your present health condition, location, the severity of spinal stenosis, the expertise of your surgeon, and your commitment to the recovery plan. Most people who have undergone surgery have good to excellent results.

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Some FAQs on spinal stenosis

Can I treat it with acupuncture or chiropractic measures?

Acupuncture and chiropractic manipulation will help relieve symptoms in some people, but these measures cannot cure your spinal stenosis. If you have herniated disc, then chiropractic measures might even worsen your condition.

That being said, consult your healthcare provider and get evaluated on whether you are fit for this type of treatment option. Other alternative treatment options include yoga, massage, and biofeedback.

Can spinal stenosis heal on its own?

Since the most common cause of spinal stenosis is the wear and tear phenomenon of your vertebral joints, it will not heal on its own. In some conditions, like herniated discs, it may get better on its own–with time and a short amount of rest, physical exercise, and analgesics.

Can spinal stenosis happen in more than one location of my body?

Yes. It can happen in multiple locations at the same time or at different times.

 Can spinal stenosis be reversed?

No. It cannot be reversed but it can be slowed down with certain measures like eating healthy foods, exercising regularly, maintaining a healthy weight, and following the advice of your healthcare provider

Can spinal stenosis cause pain in my groin, hips, and thighs?

Yes. Spinal stenosis can compress the sciatic nerve that travels from your hip to your feet. This condition is called sciatica where you might experience shooting pain radiating from your thigh to your foot.

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 What types of healthcare professionals are involved?

In addition to your regular physician, other healthcare professionals involved in your care are:

• Orthopedic surgeon: to operate on your bone.
• Neurosurgeon: to operate on your nerves.
• Neurologist: to treat your nerve disorder
• Pain management specialist: to manage your pain
• Radiologist: to interpret your X-ray, MRI, and CT scan.
• Physical therapist: to help develop your exercise plan.
• Physiatrist/ rehabilitation specialist: to treat your problem with non-surgical approaches.

References

https://www.niams.nih.gov/health-topics/spinal-stenosis

dickinsonneurosurgery.com

https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Spinal-Stenosis