Spinal Stenosis: Causes, Symptoms, Diagnosis, and Treatment
“If you would seek health, look first to the spine.”
Often attributed to Socrates (and sometimes Hippocrates), the above quote highlights the fact that the spine has been understood as an important part of human anatomy since ancient times. While the ancients didn’t fully understand everything about the function of the central nervous system, their observations allowed them to determine that a healthy spine was a preferable condition.
Centuries later, this fundamental truth is still widely accepted: spinal health is an important part of both overall health and being able to live a normal, active lifestyle. Technically known as the vertebral column, the spine is important because it is the primary means of support and stability for the torso. Indeed, the spine is the very thing that defines as vertebrates, the subphylum in taxonomic rankings that humans share with all animals that have spines.
As with any part of the body, there are unfortunately some conditions that adversely affect the spine, causing sometimes major problems for those who suffer from them. One of the conditions that many people report having symptoms of is spinal stenosis, an ailment that can gradually affect the spine over time.
What is Spinal Stenosis?
In addition to providing skeletal support via a series of connected vertebrae and intervertebral discs, the spine also houses and protects the spinal canal, a cavity within the spine that houses the spinal cord. This long bundle of nerves is directly connected to the brain and together with the brain comprise the central nervous system. When the nervous tissues in the spinal cord are damaged or adversely affected in some way, basic functions like walking and motor skills and sensations can be affected.
Spinal stenosis occurs when there is a narrowing of some part of the spinal canal inside the spinal column. When this narrowing happens, it can begin to put pressure on the spinal cord itself. Both the narrowing and the resultant pressure usually happens gradually over time. As it narrows and the pressure increases, a person can feel mild to severe pain in the back and throughout the body, especially when walking on inclines or climbing steps.
For reasons still unknown to doctors and scientists, the narrowing of the spinal canal doesn’t always lead to these painful symptoms. Some people’s spinal canals narrow and they are totally unaware of any problem. It is because of this distinction that spinal stenosis as a specific affliction only refers to the symptoms that can result from the narrowing rather than the narrowing itself.
What Causes Spinal Stenosis and Who Does it Affect?
A small minority of people are born with a naturally narrower spinal cavity; the condition that can arise from this inborn difference is called congenital spinal stenosis. While having a naturally smaller spinal canal doesn’t guarantee pain or other symptoms, it does provide circumstances that make it more likely for stenosis symptoms to present.
For those who aren’t born with congenital spinal stenosis, there are a number of other possible causes:
- Spinal injury: any kind of traumatic spinal injury (such as being in a car accident) can damage or fracture a vertebra, causing it to be displaced and put pressure on the spinal nerves.
- Back surgery: back surgery can cause the tissue near the spine to swell as it heals; this swelling can also put pressure on the spinal cord.
- Bone overgrowth: usually a result of osteoarthritis, bone spurs can form on the vertebrae that eventually impinge on the spinal cavity; another potential source of this is Paget’s disease.
- Herniated discs: normally the intervertebral discs between the vertebrae function as ‘shock absorbers’ for the spine; if those discs become damaged or displaced, the resulting abnormality can adversely impact the spinal cord.
- Tumors: though somewhat rare, it is possible for a tumor to form inside the spinal cavity and cause a bulge to press in on the spinal cord.
- Ligament thickening: the ligaments that bind the vertebrae together can, over time, thicken and become stiff; in these cases the thickening can make the spinal cavity more narrow.
While spinal stenosis can occur in anyone, it does tend to be more likely in people over 50 years old and women. Those who have had a spinal injury earlier in life may also be more likely to develop it in their later years.
Symptoms of Spinal Stenosis
There are three types of spinal stenosis that are differentiated by where in the spine they are located: cervical, thoracic, and lumbar. Lumbar stenosis is the most common, followed by cervical and thoracic. There are some minor differences in the symptoms that can be found in each type.
Lumbar spinal stenosis (located in the lumbar spine) is usually associated with tingling, numbness, cramping, or weakness in a foot or leg. Patients also describe leg cramps or pain in one or both legs when they have been standing or walking for a while; sitting down offers some quick relief. Additionally, people with lumbar spinal stenosis will tend to feel low back pain.
The primary difference with cervical spinal stenosis is neck pain rather than lower back pain. Patients also report tingling or weakness in the legs, but it can also be felt in the arms. Another symptom that sometimes happens is bladder dysfunction in the form of incontinence or urinary urgency.
Thoracic stenosis can also cause tingling, numbness, and weakness in the extremities as well as pain in the middle and upper back. Bladder dysfunction can also be present as well as an overall loss of balance.
How is Spinal Stenosis Diagnosed?
Since back pain and many of the other symptoms can potentially be indicative of a range of other conditions, doctors will typically look at medical history and discuss the symptoms before conducting a physical examination. If warranted, the doctor will order one or more imaging tests to see more clearly what is happening in the spinal cavity:
- X-ray: This test is useful for identifying changes or abnormalities in the bones of the spine like bone spurs or a generally smaller spinal cavity.
- MRI: short for magnetic resonance imaging, this test can provide the doctor with cross-section scans of your spine that can detect tumors as well as problems with the intervertebral discs or the ligaments. It can also very clearly reveal where the spinal cord is receiving pressure.
- CT myelogram: for those who for whatever reason can’t get an MRI, a computerized tomography (CT scan) is a useful alternative that utilizes x-rays from different angles to give doctors a similar cross-sectional look at the spine.
How is Spinal Stenosis Treated?
The treatment options for spinal stenosis largely depend on the location within the spine and the severity of the symptoms. For more mild cases, doctors may use a non-surgical treatment like pain-relieving medication; this could include over-the-counter drugs (like ibuprofen, naproxen, or acetaminophen), antidepressants, anti-seizure drugs, or even opioids. In most situations, though, the pain relievers are not meant to be long-term solutions. Steroid injections (cortisone) may also be used for some people; this can help reduce inflammation and swelling in the nerve roots that may contribute to the stenosis.
Another treatment option is physical therapy. For many patients, ongoing back pain can lead them to eschew exercise or physical activity in an effort to reduce the pain. The unfortunate side effect of this is that the back muscles can get weaker and end up causing more pain. A physical therapist can help gradually build up muscle, improve flexibility, and restore balance.
For patients specifically with lumbar stenosis and ligaments that have become thick, the doctor may also recommend ‘percutaneous image-guided lumbar decompression’ (PILD). This complicated-sound procedure involves removing some of the thickened ligaments with a needle in order to reduce pressure (decompression).
Finally, for patients with severe cases that can’t be adequately addressed by other treatments, doctors have a variety of surgeries available that can provide relief. These spine surgery options range from minimally invasive to more complex, including the use of metal hardware as in a laminectomy. For the most part, these surgeries can help relieve some of the symptoms, but some patients have reported no change or even worse symptoms.
Spinal Stenosis Appointment
Spinal stenosis is the kind of condition that can be a very different experience for different people. If you have had some of the symptoms discussed here and would like to get more information, contact NewSouth NeuroSpine to make an appointment.