Spinal Stenosis

Spinal stenosis is narrowing of the spaces in the spine that cause pressure on the spinal cord and nerves. It is typically a result of degenerative arthritis that leads to overgrowth of bone and soft tissues that pinches on nerves, leading to pain and disability.

 

Who is affected by spinal stenosis?

 

Spinal stenosis affects both men and women over the age of 50 years. However, it can occur in young people born with a narrow spinal canal, or those who suffer a spinal injury.

 

 

What causes spinal stenosis?

 

The normal vertebral canal provides adequate room for the spinal cord. With spinal canal narrowing, there is pressure on the spinal nerves and ligament stretching. This results from degenerative aging, as well as acquired conditions. When surfaces of vertebral bone project out of alignment, they can produce pain. When facet joints thicken, and bone spurs occur due to arthritis, this decreases the neural foramen, which is the space available for nerve roots. Pain occurs from impingement on these nerves. 

 

 

Stenosis is actually very common in individuals over the age of 50. Typically, however, it is not symptomatic.

What are the symptoms of spinal stenosis?

 

Symptoms associated with spinal stenosis include buttock and thigh pain, aching and possibly back pain too. When an individual with spinal stenosis walks, there is often an exacerbation of symptoms.

 

How is spinal stenosis diagnosed?

 

Spinal stenosis is diagnosed by:

 

  • Medical history – The doctor asks questions about symptoms, injury, conditions, and general health.
  • Physical examination – The doctor assesses the patient to evaluate movement limitations.
  • X-rays 
  • Magnetic resonance imaging (MRI) – May show very specifically which nerve roots are being pinched.

 

How is spinal stenosis treated?

 

  • Medications – These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and indomethacin, as well as analgesics. In addition, anticonvulsants and antidepressants have been shown to help with nerve-related pain such as Lyrica and Neurontin.

 

  • Corticosteroid injections – The doctor can inject the epidural space with a steroidal agent to relieve nerve root pain.

 

  • Physical therapy – Prescribed exercises can maintain spine motion, strengthen back and abdominal muscles, and build endurance. These efforts are used to stabilized the spine. Pain relief measures used are electrical stimulation, massage, ultrasound, and heat/cold therapy.

 

  • Surgery – Traditional surgery involves open surgery known as a laminectomy. While it often works well, half of patients end up with back pain and stiffness afterwards. With the latest OLLIF minimally invasive keyhole procedure, spinal stenosis is treated indirectly with patients experiencing relief without these symptoms afterwards.

 

 

Resources

 

Kailihmann L, Cole R, Kim DH, et al. (2009). Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J, 9(7), 545-550.