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Spinal Stenosis

Statistics

• Most common in people over 50 years of age.

What is spinal stenosis?

Spinal Stenosis is a narrowing of the spinal column that results in pressure on the spinal cord or nerve roots. Most patients complain of back pain relieved by rest and increased by activity, however some people experience no back pain. Pressure on the lower part of the spinal cord or on nerve roots branching out from that area can cause numbness, weakness, cramping, or general pain in the legs. Pressure on the upper part of the spinal cord may produce similar symptoms in the shoulders, or even the legs.

The most common cause is simply the degenerative process that accompanies aging, however there are many other possible causes. As people age, the ligaments of the spine may thicken and calcify. Bones and joints may also enlarge, and bone spurs may form. Some people are born with a narrow spinal column. Other causes include rheumatoid arthritis, Paget disease, fluorosis, kyphosis, scoliosis, and trauma.

Image source: NIAMS

The symptoms vary from person to person. Some people experience no symptoms at all. Most patients complain of back pain relieved by rest and increased by activity. Many people experience numbness, weakness, cramping, or general pain in the legs. Others have pain radiating down one leg. Sitting down and crouching usually significantly decreases the pain.

How is it diagnosed?

Spinal stenosis is usually diagnosed by a combination of methods. Physical exam, medical history, x-rays, MRI's and various other types of imaging may be used.

How is it treated?

Treatment of spinal stenosis depends on the severity of the condition. More severe cases may require surgery while others may be helped by conservative, non-surgical practices.

Medications:
NSAIDS (Nonsteroidal anti-inflammatory drugs) are used to reduce the pain and inflammation of spinal stenosis. Available over the counter or by prescription, they fight inflammation or swelling and relieve pain.

Lumbar epidural steroid injections may be helpful in relieving the inflammation of the pinched nerves, which can relieve the pain in the legs and buttocks region. This involves corticosteroid injections into the outermost of the membranes covering the spinal cord and nerve roots.

Exercise:
A physical therapist may be able to prescribe exercises to help maintain motion of the spine and build endurance, which can help stabilize the spine.

Support:
A lumbar brace or corset to provide some support and help regain mobility. This approach is sometimes used for people with weak abdominal muscles or older patients with degeneration at several levels of the spine.

Surgery:
In some cases, the conditions causing spinal stenosis cannot be helped by nonsurgical treatment, even though these measures may relieve pain for a time. The purpose of surgery is to relieve pressure on the spinal cord or nerves and restore and maintain alignment and strength of the spine. This can be done by removing, trimming, or adjusting diseased parts that are causing the pressure or loss of alignment.

What research is being done?

Doctors are comparing the effectiveness of injecting a steroid medicine with that of injecting an analgesic medicine into the outermost membrane covering the spinal cord for relief of pain and disability due to spinal stenosis. Researchers are also comparing surgical vs. nonsurgical treatment of spinal stenosis and two other conditions that cause back pain.

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For more information:

Cush's Bad Back page 
MedicineNet - Spinal Stenosis 
Ortho Spine - Spinal Stenosis

References:
The National Institute of Arthritis and Musculoskeletal diseases, Questions & Answers about Spinal Stenosis
Campbell's Operative Orthopaedics, Ninth Edition, Copyright © 1998 Mosby, Inc.
The American Association of Neurological Surgeons