What is Spinal Stenosis?

Spinal stenosis is the narrowing of open spaces in the spine. This can put pressure on the spinal cord and the nerves that travel to the limbs. It can occur in the lower back (most common) and/or the neck.

Most often, spinal stenosis is a result of osteoarthritis, caused by wear-and-tear changes in the spine. It usually occurs in adults over the age of 50, although it can occur in younger people who suffer an injury to the spine or who are born with narrowing of the spinal canal.

Baptist Health is known for advanced, superior care in diagnosing and treating spinal stenosis. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Types of Spinal Stenosis

There are two types of spinal stenosis and each type is classified by their location on the spine. A person can have more than one type.

The two types are classified as:

Cervical Spinal Stenosis

This narrowing of the spinal canal occurs in the neck region of the body.

Lumbar Spinal Stenosis

This is the most common form of spinal stenosis and occurs in the lower back region of the body.

Signs and Symptoms

Spinal stenosis affects many people, and often there are no experienced symptoms. Symptoms can develop gradually over time, as the condition worsens. Depending on the severity of the condition, symptoms may include pain, tingling, or numbness in the neck, back, arms, hands, legs, and feet. Spinal stenosis can originate in the back or neck areas.

In the neck (cervical spine):

• Neck pain
• Tingling or numbness in the arm, hand, leg, or foot
• Weakness in the arm, hand, leg, or foot
• Problems maintaining balance when walking
• In more severe cases, bowel or bladder dysfunction (incontinence or increased urinary urgency)

In the lower back (lumbar spine):

• Lower back pain
• Tingling or numbness in leg or foot
• Weakness in leg or foot
• Pain or cramping in one or both legs when standing for a long duration of time, which typically decreases when bending forward or sitting

If you are experiencing any of these symptoms, please contact your Baptist Health primary care physician.

Diagnosis

A healthcare professional will take a medical history, conduct a physical exam, and may recommend an MRI or CT scan to further assess and diagnose the issue. Diagnostic tests for spinal stenosis may include:

• MRI: Magnetic resonance imaging takes detailed pictures of the spine, making visible any damage to ligaments, tendons, or disks, and can detect tumors. 
• CT or CT myelogram: A computerized tomography provides detailed cross-sectional x-ray images of the spine. In a CT myelogram, a contrast dye is injected in order to highlight the spinal cord and nerves and make visible any ligament or tendon damage, herniated disks, bone spurs, or locate any tumors.
• X-rays: This can assess for any issues with bone structure or bone spurs that may be causing a narrowing of the spinal canal.

Causes

There are several causes in developing spinal stenosis. The broad cause of spinal stenosis is anything that causes the spinal canal to narrow or become compressed. This structural change to the spine causes the spinal cord or nerve roots to become compressed or pinched, which leads to neck pain, lower back pain, and sciatica.

More specific causes for the structural change includes:

• Overgrowth of bone: Osteoarthritis is the normal wear and tear on the body, which leads to the breaking down of cartilage. Cartilage is what protects the joints in the spine, and when it is worn down, the bones start to rub against each other. The body responds by growing more bone, or bone spurs. The bone spurs lead to a more narrowed and compressed spinal canal, and can cause the nerves to pinch. Paget’s disease, a condition in adults, can also cause bone growth that leads to a narrowing of the spine.
• Herniated discs: Between each vertebra in the spine is a protective pad or disc. These discs act as shock-absorbers for the spine. As people age, the discs can flatten, dry out, or crack, which can cause the gel-like substance in the middle of the disc to push out into the spinal canal and press against the spinal cord or a nerve.
• Thickened ligaments: Over time, the ligaments that hold the bones of the spine together can thicken and become stiff. The thickened ligaments can protrude into the spinal canal.
• Spinal injuries: Vehicular accidents and other traumatic incidents can cause spinal injuries that impact the spinal canal and create structural changes that press against the spinal cord or nerves. 
• Tumor: Abnormal growths can grow inside the spinal cord, inside the membranes that encase the spinal cord, and in between the spinal cord and vertebra. However, tumors of this kind are uncommon and are visible through imaging tests (MRI’s or CT’s).

Risk Factors

Men or women over the age of 50 are at a higher risk for developing spinal stenosis, although it can develop in people of all ages. Wear and tear over time can lead to this condition. Other risk factors such as injury or trauma to the spine, congenital disorders or degenerative conditions can lead to the development of spinal stenosis.

Prevention

Spinal stenosis changes caused by aging can’t be completely prevented. But, you may be able to limit symptoms by:

Avoid smoking: Smoking decreases bone density, which can lead to spinal stenosis.

Maintain healthy habits: Get regular exercise to maintain back strength, flexibility and a healthy weight.

Posture: Good posture eliminate stress on the spine and can reduce the symptoms of spinal stenosis.

Prognosis

For some people, spinal stenosis symptoms can be relieved with non-surgical treatments.

Treatment

Treatment for spinal stenosis varies, depending on the severity and longevity of symptoms. A medical professional will conduct a physical exam and may use other diagnostic tests to determine the best course of treatment. It may be recommended to try physical therapy, medications, or surgery for more severe cases.
Medications that may be recommended include:

• Pain relievers: These may include anti-inflammatory medications such as ibuprofen, naproxen, and acetaminophen that seek to help in reducing pain and inflammation. It is not recommended for long-term use. 
• Antidepressants: Certain antidepressants can help to reduce symptoms from chronic pain.
• Anti-seizures: These medications can help to reduce pain caused by damaged or pinched nerves.
• Opioids: These medications may be considered for short-term pain reduction, and in some cases, may be used cautiously for long-term pain management. Opioids have the risk of becoming habit-forming. 

If physical therapy, and medications prove ineffective, a medical professional may recommend a procedure or surgery.

Two common procedures that can treat spinal stenosis are:

• Steroid injections, which can help reduce inflammation
• A decompression procedure: The decompression procedure uses needle-like instruments to remove the thickened ligament, which creates more space in the spinal canal.

Additionally, some patients may opt for alternative medicine choices, such as acupuncture, massage therapy, or chiropractic treatment.

Complications

On rare occasions, left untreated, spinal stenosis may lead to the following issues:

• Weakness
• Numbness
• Balance issues
• Incontinence
• Paralysis

If you are experiencing any of these symptoms, please contact your Baptist Health primary care physician.