September 1, 2015 - Spinal stenosis is an abnormal narrowing of the spinal canal. The spinal canal, also known as the backbone, is formed by thirty-three vertebrae which are stacked on top of each other and normally have a capacious canal through which runs the spinal cord. The spinal cord is a rope-like group of nerves which lead from the brain and control movement and feeling throughout the body.
When the spinal cord is squeezed too tightly by the surrounding vertebrae various signs and symptoms can occur. These symptoms reflect where the compression is most severe. About three quarters of the time the low back area is affected, with the remaining area being in the neck. The low back symptoms include pain, numbness, tingling, cramping in the legs and feet, and weakness, usually made worse by walking and slightly relieved by bending forward, lying down with knees drawn up, or just rest.
When the neck or cervical area is involved there can be worsening balance, falling, dropping objects, difficulty buttoning clothing or picking up coins, and loss of bowel and/or bladder control.
The most common reason for spinal stenosis is degenerative arthritis which is a wear-and-tear type of arthritis associated with aging, previous injury, overuse, and sometimes heredity; this type of arthritis often develops without an obvious cause.
Interestingly, not everyone with similar backgrounds and environments develops spinal stenosis. To a great extent, the diameter of your spinal canal, as you develop from youth, determines your risk for problems later in life. And there is little one can do other than take care of oneself and avoid injuries.
One should seek medical attention for unexplained pain, numbness, tingling, cramping, or any change in bowel or bladder function. There are many other potential causes for these symptoms, such as circulation problems, growths, or other benign changes which are self-limited. Nonetheless, anything lasting more than six weeks should be addressed.
For a physician to determine the correct diagnosis, the patient’s medical history must be obtained, a physical examination conducted and then, based on the results, imaging studies—such as X-rays, computerized axial tomography (CT scan), or a magnetic resonance imaging (MRI) scan—be considered. These studies help show if there is any arthritis in the spine causing a compression of the spinal cord.
There are many treatments for spinal stenosis and all have benefits along with drawbacks. In general, being conservative is best, so starting with physical therapy is prudent. Exercises to strengthen and increase flexibility can be very helpful. Sometimes medications which decrease inflammation can also add to relief, as the soft tissue swelling can be diminished and give the nerve roots more space. Injections of cortisone into the region causing the pain have also been used with good immediate relieve but long term results are variable.
Surgery is usually reserved for intractable pain or severe disability. Simply stated, opening the canal or widening the window where the nerves exit the spine is the overall objective of the surgery. This surgery is more complicated as the nerves are very fragile and the spinal cord is difficult to access. The cervical neck or low back are the two most common areas where specialized back surgeons usually operate.
Overall, spinal stenosis is becoming more common as our population ages and we have led and continue to lead active lives. Understanding the underlying problem helps with the diagnosis and treatment options. Nonetheless, stay active, involved, and informed and you will be well served.
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Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.