The spinal cord is a long, tubular structure that connects the brain to the peripheral nervous system, allowing you to move your body, feel your surroundings, and experience pain. The spinal column protects our spinal cord and is made up of bones, joints, discs, soft tissues and nerves. Its primary function is to protect the spinal cord, which rests in the canal formed by the vertebrae.
Cervical spinal stenosis causes pressure on the spinal cord and exiting spinal nerves. Lumbar spinal stenosis causes pressure on the freely traveling and exiting lumbar spinal nerves. That can be caused by several factors including degenerative changes such as disc herniations or arthritis. This process is typically gradual. If the narrowing is minimal, no symptoms will occur. Too much narrowing can compress the nerves and cause problems.
Understanding what spinal stenosis is and the types of treatments spine specialists offer can help you get back to enjoying your favorite activities pain-free.
What Is Spinal Stenosis?
In medical terms, “stenosis” refers to an abnormal narrowing or contraction of a body passage or opening. In terms of the spine, it means a narrowing of the spinal cord, or the bone passage in which the spinal nerves sit. Spinal stenosis is a common orthopedic injury that occurs most often in the lower back and the neck and can lead to severe discomfort and prevent you from carrying out regular activities if not treated properly.
The spinal cord is an essential part of the central nervous system because it connects the brain to the entire body. Over time, the spinal cord may narrow, and the open spaces between the vertebrae may start to get smaller. The tightness may pinch the spinal cord or the nerves around it, causing pain, numbness, or tingling in your arms, legs or torso.
Some people with spinal stenosis may not have symptoms. Others may experience pain, tingling, numbness and muscle weakness. Symptoms can worsen over time. Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves.
Types of Spinal Stenosis
Lumbar Spinal Stenosis
Lumbar spinal stenosis occurs when the roots of the spinal cord located in the lower back area become compressed. You can feel radiating pain, numbness, tingling or weakness in your lower back which is most often transferred to the buttocks and legs. Gradually, you will feel pain while walking and it can become a difficult task to even take a step.
Cervical Spinal Stenosis
Cervical stenosis is a condition in which the spinal canal is too small for the spinal cord and nerve roots. This can cause damage to the spinal cord, a condition called myelopathy, or pinch nerves as they exit the spinal canal (radiculopathy).Occasionally, damage to the spinal cord and nerve roots may occur, resulting in a condition called myeloradiculopathy.
Thoracic stenosis is the narrowing of the spinal canal in the thoracic spine, located in the middle of the back. The spinal canal is the pathway that holds the spinal cord and the central nervous system, allowing the nerve roots to send signals between the spine and the brain.
What Are the Symptoms of Spinal Stenosis?
While not everyone has symptoms, those that do may experience stiffness, numbness, and back pain. Symptoms of spinal stenosis often begin gradually and worsen over time. They may even vary depending on the location of the stenosis:
- In the Neck (Cervical Spine)
- Numbness, weakness or tingling in the leg, foot, arm or hand
- Problems with walking or balance
- Neck pain
- In the Lower Back (Lumbar Spine)
- Numbness, weakness, or tingling in the leg or foot
- Pain or cramping in one or both legs after standing for long periods of time
- Back pain
What Causes Spinal Stenosis?
The backbone (spine) runs from your neck to your lower back. The bones of your spine form a spinal canal, which protects your spinal cord (nerves).
Some people are born with a small spinal canal. But most spinal stenosis occurs when something happens to narrow the open space within the spine. Causes of spinal stenosis may include:
- Overgrowth of Bone
Wear and tear damage from osteoarthritis on your spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal.
- Herniated Disks
Disc herniation occurs when a spinal disc tears or ruptures, causing the disc’s inner, jelly-like material to leak into the spinal canal. The soft material can press against or irritate nerves or the spinal cord and obstruct the nerves’ movement through the canal.
- Thickened Ligaments
Age and degenerative changes from arthritis cause the ligaments that support vertebrae to become thicker and stiffer over time. Thickened ligaments can press against nearby nerves or the spinal cord. Additionally, some ligaments might start to buckle and collapse into the spinal canal, narrowing the open spaces.
Abnormal growths can form inside the spinal cord, within the membranes that cover the spinal cord or in the space between the spinal cord and vertebrae. These are uncommon and identifiable on spine imaging with an MRI or CT.
- Spinal Injuries
Car accidents and other trauma can cause dislocations or fractures of one or more vertebrae. Displaced bone from a spinal fracture may damage the contents of the spinal canal.
What Are the Treatment Options for Spinal Stenosis?
Treatment for spinal stenosis depends on the location of the stenosis and the severity of your signs and symptoms.
Talk to your doctor about the treatment that is best for your situation. If your symptoms are mild or you are not experiencing any, your doctor may monitor your condition with regular follow-up appointments. He or she may offer some self-care tips that you can do at home. If these do not help, he or she may recommend medications or physical therapy. Surgery may be an option if other treatments have not helped.
Your doctor may prescribe:
- Pain relievers. Pain medications are typically recommended for a short time only. These can include such medications as ibuprofen (Advil, Motrin IB, others), naproxen (Aleve, others) and acetaminophen (Tylenol, others).
- Antidepressants. Nightly doses of tricyclic antidepressants, such as amitriptyline, can help ease chronic pain.
- Opioids. Drugs that contain codeine-related drugs such as oxycodone (Oxycontin, Roxicodone) and hydrocodone (Norco, Vicodin) may be useful for short-term pain relief.
In an effort to reduce pain, those suffering the effects of spinal stenosis tend to become less active. But inactivity can lead to muscle weakness, which can result in more pain. A physical therapist can teach you exercises that may help:
- Build up your strength and endurance
- Maintain the flexibility and stability of your spine
- Improve your balance
Your nerve roots may become irritated and swollen at the spots where they are being pinched. While injecting a steroid medication (corticosteroid) into the space around impingement will not fix the stenosis, it can relieve some of the pain by reducing the inflammation in the area.
Steroid injections are a very short-term approach since repeated steroid injections can weaken nearby bones and connective tissue. A patient can only get these injections a few times per year so a more aggressive approach will be necessary.
The procedure is called percutaneous image-guided lumbar decompression (PILD). It has also been called minimally invasive lumbar decompression (MILD), but to avoid confusion with minimally invasive surgical procedures, doctors have adopted the term PILD. With this procedure, needle-like instruments are used to remove a portion of a thickened ligament in the back of the spinal column to increase spinal canal space and remove nerve root impingement. Because PILD is performed without general anesthesia, it may be an option for some people with high surgical risks from other medical problems.
Surgery may be considered if other treatments have not helped. The goals of surgery include relieving the pressure on your spinal cord or nerve roots by creating more space within the spinal canal. Surgery to decompress the area of stenosis is the most definitive way to try to resolve symptoms of spinal stenosis.
Examples of surgical procedures to treat spinal stenosis include:
- Laminectomy is the most common type of surgery. A surgeon removes part of the vertebrae to provide more room for the nerves.
- Foraminotomy is used to widen the part of the spine where the nerves exit.
- Spinal fusion is typically performed in more severe cases, especially when multiple levels of the spine are involved. Bone grafts or metal implants are used to attach the affected bones of the spine together.
What Happens if Spinal Stenosis Is Left Untreated?
You may not experience the onset of the disorder, but it is very common for adults aged 50 and over. Normally, wear and tear is the leading cause of Spinal Stenosis and symptoms will severely affect the quality of life of an individual.
With time, even walking becomes impossible and when spinal stenosis is present, walking for more than a few minutes can become a challenge. The pain and weakness will subside when you sit down, which will lead to a more sedentary lifestyle.
In severe cases of stenosis, the patient may even become disabled. The symptoms can be so severe that extreme weakness makes it impossible to stand up.
Decrease or Loss of Bladder and Bowel Control
In extreme cases, spinal stenosis can weaken the nerves connected to the bladder or bowel weak. If this occurs, you should immediately get in touch with a doctor as surgery may be recommended to relieve you from the symptoms.
Constant Pain and Discomfort
Spinal stenosis will cause pain in different areas of the body including the neck, lower and middle back, your buttocks and legs. The pain will evolve slowly over time and failure to address the symptoms will lead to a lifestyle filled with numbness, pain and muscle weakness.
When Should You See a Spine Specialist for Spinal Stenosis?
The bottom line is that the time to see a surgeon about surgery for lumbar spinal stenosis is when an individual is unhappy with his or her restricted activity level, and has tried reasonable non-operative treatments (like anti-inflammatory medication, physiotherapy, and epidural steroid injection).
You should contact your doctor if you are frequently experiencing numbness, tingling, or pain in your arms, legs, feet, or hands. If left untreated, spinal stenosis could lead to significant nerve damage and prevent you from carrying out regular activities.
Do not let spinal pain hold you back from living your life any longer! The surgeons at Ventura Orthopedics are leaders in the field and have been instrumental in advancing these techniques. We can answer any questions you may have regarding this procedure as an option for you.
To learn more about the procedure or to schedule an appointment with one of our specialists, call us at 800-698-1280.