The spine, or backbone, is made up of small bones (vertebrae) stacked along with discs one on top of another. A healthy spine when viewed from the side has gentle curves to it. The curves help the spine absorb stress from body movement and gravity.When viewed from the back, the spine should run straight down the middle of the back. When abnormalities of the spine occur, the natural curvatures of the spine are misaligned or exaggerated in certain areas, as occurs with lordosis, kyphosis, and scoliosis.
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:
The types of spinal stenosis are classified according to where on the spine the condition occurs. It’s possible to have more than one type. The two main types of spinal stenosis are:
Cervical stenosis. In this condition, the narrowing occurs in the part of the spine in your neck.
Lumbar stenosis. In this condition, the narrowing occurs in the part of the spine in your lower back. It’s the most common form of spinal stenosis.
Symptoms:
Many people have evidence of spinal stenosis on an MRI or CT scan but may not have symptoms. When they do occur, they often start gradually and worsen over time. Symptoms vary depending on the location of the stenosis and which nerves are affected.
In the neck (cervical spine)
Numbness or tingling in a hand, arm, foot or leg
Weakness in a hand, arm, foot or leg
Problems with walking and balance
Neck pain
In severe cases, bowel or bladder dysfunction (urinary urgency and incontinence)
In the lower back (lumbar spine)
Numbness or tingling in a foot or leg
Weakness in a foot or leg
Pain or cramping in one or both legs when you stand for long periods of time or when you walk, which usually eases when you bend forward or sit
Back pain.
Causes:
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. Paget’s disease, a bone disease that usually affects adults, also can cause bone overgrowth in the spine.
Herniated disks:The soft cushions that act as shock absorbers between your vertebrae tend to dry out with age. Cracks in a disk’s exterior may allow some of the soft inner material to escape and press on the spinal cord or nerves.
Thickened ligaments. The tough cords that help hold the bones of your spine together can become stiff and thickened over time. These thickened ligaments can bulge into the spinal canal.
Tumors: 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. Swelling of nearby tissue immediately after back surgery also can put pressure on the spinal cord or nerves.
Diagnosis:
To diagnose spinal stenosis, your doctor may ask you about signs and symptoms, discuss your medical history, and conduct a physical examination. He or she may order several imaging tests to help pinpoint the cause of your signs and symptoms.
X-rays – An X-ray of your back can reveal bony changes, such as bone spurs that may be narrowing the space within the spinal canal. Each X-ray involves a small exposure to radiation.
Magnetic resonance imaging (MRI) – An MRI uses a powerful magnet and radio waves to produce cross-sectional images of your spine. The test can detect damage to your disks and ligaments, as well as the presence of tumors. Most important, it can show where the nerves in the spinal cord are being pressured.
CT or CT myelogram – If you can’t have an MRI, your doctor may recommend computerized tomography (CT), a test that combines X-ray images taken from many different angles to produce detailed, cross-sectional images of your body. In a CT myelogram, the CT scan is conducted after a contrast dye is injected. The dye outlines the spinal cord and nerves, and it can reveal herniated disks, bone spurs and tumors.
Spinal stenosis surgery:
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’s best for your situation. If your symptoms are mild or you aren’t 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 don’t help, he or she may recommend medications or physical therapy. Surgery may be an option if other treatments haven’t helped.
Medications
Pain relievers. Pain medications such as ibuprofen (Advil, Motrin IB, others), naproxen (Aleve, others) and acetaminophen (Tylenol, others) may be used temporarily to ease the discomfort of spinal stenosis. They are typically recommended for a short time only, as there’s little evidence of benefit from long-term use.
Antidepressants. Nightly doses of tricyclic antidepressants, such as amitriptyline, can help ease chronic pain.
Anti-seizure drugs. Some anti-seizure drugs, such as gabapentin (Neurontin) and pregabalin (Lyrica), are used to reduce pain caused by damaged nerves.
Opioids – Drugs that contain codeine-related drugs such as oxycodone (Oxycontin, Roxicodone) and hydrocodone (Norco, Vicodin) may be useful for short-term pain relief. Opioids may also be considered cautiously for long-term treatment. But they carry the risk of serious side effects, including becoming habit forming.
Physical therapy
It’s common for people who have spinal stenosis to become less active, in an effort to reduce pain. But that 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
Steroid injections
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 won’t fix the stenosis, it can help reduce the inflammation and relieve some of the pain.
Steroid injections don’t work for everyone. And repeated steroid injections can weaken nearby bones and connective tissue, so you can only get these injections a few times a year.
Decompression procedure:
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. Only patients with lumbar spinal stenosis and a thickened ligament are eligible for this type of decompression.
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.
