What is spinal stenosis and how does it occur?

Spinal stenosis is the narrowing of the canal that your spinal cord travels through.  This canal narrowing ultimately leads to compression of the spinal cord and exiting nerve roots.  Spinal stenosis can occur anywhere along the spine, yet is most common in the neck and lower back.

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Many things can lead to spinal stenosis.  Over time, many processes of aging can cause spinal stenosis.   For example, with arthritis, your body produces bony spurs (osteophytes) that can jut into and narrow the canal.  Also, as you age, the disks between your spine bones will degenerate and lose height, leading to the foramen where your nerve exits the spine narrrowing.   One vertebrae “slipping” forward on another vertebrae (Spondylolisthesis) can also lead to narrowing of the spinal canal.  Herniated disks, hypertrophy (enlargement) of some spinal ligaments, and masses are additional causes of spinal stenosis.  Some people are just born with spinal stenosis (Congenital spinal stenosis).  Often the spinal stenosis is due to a combination of the above factors. 

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Symptoms:

Patients usually experience low back or neck pain.  Low back pain may radiate to the buttocks and down the leg, while neck pain may radiate to the shoulder and down the arm.  Patients often state that symptoms are relieved with flexion (sitting, leaning over a shopping cart, sleeping in the fetal position).  These patients may furthermore experience numbness, tingling, and weakness in either their lower or upper extremities depending on the location of the stenosis and how compressed the spinal cord is.

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It is important to note that one cause of spinal stenosis, a herniated disk, can lead to a disorder known as Cauda Equina Syndrome.  In this condition, the large disk herniation severely compresses the large bundle of nerves at the end of the spinal cord.  Symptoms include loss of bowel or bladder function and numbness and tingling in the underwear region.  These symptoms are extremely serious and patients with Cauda Equina Syndrome must undergo emergent surgery to decompress the bundle of nerves.

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Diagnostic Testing:

X-rays are usually ordered to evaluate for arthritis and other bony pathology that may be contributing to the patients symptoms.  An MRI is the imaging modality of choice and is able to classify the degree and location of canal stenosis.  An MRI can also help diagnoses herniated disks, masses, and enlarged spinal ligaments that may be narrowing the canal.  A CT scan is often ordered in addition to work up the bony pathology exact amount of canal compromise.

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Treatment Options:

Nonoperative treatment is first-line treatment for spinal stenosis.  Treatment includes activity modification, weight loss, and a variety of medications (so long as there are no contraindications to taking those medications) that decrease pain and reduce inflammation.  Medications that directly target nerve pain may also be prescribed.  Physical therapy is also important to strengthen the supporting muscles of the spine. Last resort nonoperative treatment includes an epidural injection (injection around the irritated nerve itself) of a cortisone-like drug designed to reduce inflammation and swelling of the nerve.

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Surgical Treatment:

 

Surgery is recommended for those patients who have progressive neurologic compromise such as constant numbness, or evidence of weakness on exam, or who have failed nonoperative management.  Multiple types of surgical procedures are employed, however, the basics of it involves decompressing (opening up) the spinal canal, taking pressure off the spinal cord.  Should you need surgery, Dr. Steven Lee will refer you to one of his trusted spine surgeons.

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*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice.  Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.

 

*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.