Spinal stenosis is a very common spinal condition. It is most common in the lumbar (lower) spine, but also frequently occurs in the cervical (upper) spine. Spinal stenosis occurs when the spinal canal is narrowed, either with wear and tear on the spine over time or thickened ligaments. This narrowing of the spinal canal can put pressure on the spinal cord or spinal nerves, resulting in pain, numbness, and muscle weakness.
Causes and Symptoms of Spinal Stenosis
Spinal stenosis often occurs with aging and wear on the spine. Bone overgrowth and herniated discs can narrow the spinal canal, reducing the space for the spinal cord and/or nerves. The ligaments in your back can also become thickened over time, which can reduce the space in the spinal canal. Injuries to the spine can also narrow the spinal canal, either due to swelling of the tissues surrounding the spine, or displaced bone from fractured vertebrae. Although less common, some people are born with a narrow spinal canal.
Nerves branch out from the spinal cord and run throughout the body to carry messages from the brain to the muscles to carry out normal functions. For this reason, symptoms may be present in the extremities, rather than the back. If a patient is suffering from spinal stenosis in the neck, numbness, weakness, and/or tingling are often experienced in one of the arms or hands. In very severe cases, patients may experience loss of bladder or bowel control.
If spinal stenosis affects the lower back, similar symptoms may be experienced in the legs. Spinal stenosis in the lower back can result in pain and cramping in the legs, especially when standing or walking for long periods of time. This collection of symptoms is known as sciatica. The pain usually decreases when bending forward or sitting. This is often referred to as the “shopping cart sign”; patients with lumbar spinal stenosis often feel relief from their symptoms when leaning forward over the shopping cart while shopping at a grocery store.
Treatment of Spinal Stenosis
Spinal stenosis is treated with nonsurgical methods first, unless symptoms are severe. Nonsurgical treatment may involve non-steroidal anti-inflammatory medications (NSAIDs) to help with pain and inflammation, muscle relaxants to help with muscle spasms, and physical therapy to build up strength, endurance, and flexibility. Steroid injections can also help to reduced pain and inflammation, relieving some of the pressure on the spinal nerves.
If symptoms are severe or worsening, or conservative treatment fails to relieve symptoms, surgery may be recommended. The goal of surgery is to relieve pressure on the spinal cord and nerve roots. There are two procedures that are often used to relieve the symptoms of spinal stenosis: laminectomy and spinal fusion.
During a laminectomy, also known as a decompression, the surgeon removes any bone, bone spurs, or ligaments that press on the spinal nerves. If the spine is unstable, a spinal fusion may be needed to maintain stability. During this procedure, a bone graft is taken from the patient’s hip and placed into the space between the affected vertebrae. Plates, screws, and rods may be used to hold the bone in place. When the bones heal, they will fuse into one solid piece of bone.
Depending on the type of procedure needed, a short hospital stay may be required following surgery. Patients are often encouraged to begin walking as soon as they are able, and physical therapy is often recommended to help build strength, flexibility, and endurance to support the spine.
Patients with desk jobs can often return to work within a few days or weeks of surgery. Full recovery can take as long as two to three months, but most patients are able to return to their normal lifestyles after they have recovered.