Spinal Stenosis

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Spinal stenosis develops when either the spinal canal or spinal nerve pathways narrow.  The term stenosis means to abnormal narrowing.  The spinal canal is a vertical hole that contains the spinal cord.  The shape and structure of the spine’s bones help to protect the spinal cord.  In the low back (lumbar spine), the spinal cord becomes the cauda equina; a bunch of nerves resembling a horse’s tail.  Discs between each vertebral body serve to create natural passageways called foramen through which spinal nerve roots exit the spine.

Cervical spinal stenosis is a common cause of neck pain especially in people over age 50 or those with a history of neck injury or trauma.  Some people are born (congenital) with stenosis.  There are three types of cervical spinal stenosis:

  • Cervical central stenosis means part of the spinal canal is narrow
  • Cervical foraminal stenosis means one or more of the spinal nerve root pathways is narrowed
  • Both cervical central stenosis and foraminal stenosis

Lumbar spinal stenosis

is a common cause of low back pain in people over age 50.  Wear and tear and common conditions including osteoarthritis, degenerative disc disease, and development of bone spurs (osteophytes) contribute to stenosis.

Typical symptoms

Cervical Spine Stenosis Lumbar Spinal Stenosis
Neck pain; mild to severe Low back pain; mild to severe
Numbness, weakness (shoulders, arms, or legs) Numbness, weakness (buttocks, legs)
Hand clumsiness; coordination difficulties Difficulty and pain when walking, standing, bending backward
Burning, tingling sensations in the arms or legs Pain relieved by resting or leaning forward
Difficulty walking Burning, tingling sensations in legs
Bladder or bowel dysfunction (rare) Bladder or bowel dysfunction (rare)
Paralysis (rare) Paralysis (rare)

Talk with your doctor

Sudden pain or pain that is severe, or that becomes chronic or progressive, requires evaluation by your doctor.  Perhaps your doctor has already diagnosed you with cervical or lumbar spinal stenosis.  If that is the case, he will want to know about any new symptoms, especially weakness, problems with balance or when walking, or bladder or bowel dysfunction.

Diagnosis

Your doctor collects and compares information gathered while talking with you about your medical history and past and existing symptoms.  A physical and neurological examination looks for limitations of movement, balance difficulties, and what exacerbates and relieves pain.  During the exam he tests your reflexes, muscle strength, sensations, or other signs of neurologic loss.  Your doctor may order imaging studies such as plain x-ray, CT, or MRI to study and confirm you diagnosis to direct your treatment plan.

Treatment

Most cases of cervical and lumbar spinal stenosis do not require surgery.  Often, one or more non-surgical treatments are very effective at relieving symptoms.  These include:

  • Medications: non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain; muscle relaxants to calm spasm; and, occasionally narcotic painkillers.
  • Cold/heat therapy
  • Spinal injections
  • Physical therapy: stretching to increase flexibility, therapeutic exercise to build muscle strength and endurance; posture and importance of maintaining good posture (ergonomics) at rest, work, and during other activities.
  • Alternative therapies, such as acupuncture

Surgery may be recommended if pain cannot be managed, spinal instability develops, or neurologic symptoms develop or progress.  Your doctor will explain why he recommends surgery and the type of procedure involved, including what to expect before and after surgery.

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