Spinal Stenosis

Spinal stenosis occurs most commonly in people over the age of 50 and is present in approximately 8% of people globally.

Though degenerative changes can cause spinal stenosis in younger people, other causes need to be considered. Some people are born with a small spinal canal which may narrow as they age. Most commonly, it is caused by wear-and-tear changes in the spine related to osteoarthritis. However, bone spurs, herniated disks, tumors, traumatic injury, congenital spinal deformity such as scoliosis, and genetic diseases affecting bone and muscle development can also cause spinal stenosis.

Spinal stenosis is usually classified according to where on the spine the condition occurs.

The most common forms are cervical spinal stenosis, which is at the neck, and lumbar spinal stenosis, at the lower back. Thoracic spinal stenosis, at the mid-back, is much less common. It's possible to have more than one type.

• In lumbar stenosis, the spinal nerve roots in the lower back are compressed which can lead to symptoms of sciatica—tingling, weakness, or numbness that radiates from the low back and into the buttocks and legs.
• Cervical spinal stenosis is considered far more dangerous because it involves compressing the spinal cord. It may lead to myelopathy, a serious condition causing major body weakness and paralysis. This form is frequently due to chronic degeneration but may also be congenital or traumatic. Treatment frequently is surgical.

Symptoms typically are experienced gradually and may include pain, numbness, or weakness in the arms or legs. They also vary depending upon the location of the affected area on the spine. Cases may worsen or become severe over time with an increase in pain and the loss of bladder control, loss of bowel control, or sexual dysfunction.

Symptoms of cervical spinal stenosis include:

• 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)

Symptoms of lumbar spinal stenosis are:

• 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

If untreated spinal stenosis may progress in severity and, in rare cases, cause permanent numbness, weakness, balance problems, incontinence or paralysis.

The proper diagnosis of spinal stenosis involves a complete evaluation of the patient’s spine. At Semmes Murphey Clinic, the process usually begins with an in-depth medical history and physical examination.

The medical history is very important because it will tell the physician about subjective symptoms, possible causes for spinal stenosis, and other possible causes of the patient’s back pain.

During the physical exam, the physician will investigate any areas of sensory abnormalities, numbness, irregular reflexes, and any muscular weakness to help determine exactly where nerve compression is occurring.

The doctor may then order other tests or scans to determine the extent and location of the nerve compression, including:

• An X-ray of the back can reveal bone issues, 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) uses a powerful magnet and radio waves to produce cross-sectional images of your spine. The test shows more than just the spine and can detect damage to the nerves, muscles and ligaments, as well as the presence of tumors. Most important, it can help show the exact cause and location of the compression.
• A computerized tomography (CT) or CT myelogram is especially useful if you can't have an MRI. This test 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.

After the diagnosis is complete, the physician will discuss treatment options, either surgical or non-surgical or both, that are best for your situation.

Treatment for spinal stenosis depends on the location of the stenosis and symptom severity.

If symptoms are mild or occur rarely, the doctor may simply monitor the patient with regular follow-up appointments. He or she may offer some self-care tips that can be done at home. If these don't help, he or she may recommend medications or physical therapy.

Non-surgical treatments include:

• Exercise, if pain is not severe and will allow, can help maintain or improve overall good health. Depending on your situation, options may include aerobic exercise, such as riding a stationary bicycle, walking, or swimming to help relieve symptoms.
• Oral medications to relieve pain and inflammation, both over-the-counter and prescribed, should be discussed with your physician.
• Weight loss can usually help relieve symptoms and slow progression of the stenosis.
• Physical therapy can help build strength, maintain flexibility and improve balance. 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 help create a weight loss or self-care program which may lead to a decrease in pain and other symptoms.
• Lumbar epidural steroid or anesthetic injections may help reduce the inflammation and relieve some of the pain. But they don't work for everyone and are not a long-term solution to spinal stenosis.
• Assistive devices, such as a cane or walker, can help provide stability and relieve pain by allowing you to bend forward while walking.
• Alternative therapies, used along with conventional treatments, have been known to help patients cope with spinal stenosis pain. Be sure to discuss any of these options—such as massage therapy, chiropractic treatment or acupuncture—with your physician before trying them.

Surgical treatments:

Surgery may be an option if other treatments haven't helped and the symptoms are severe.

The goals of surgery include relieving the pressure on the spinal cord or nerve roots by creating more space within the spinal canal. Surgery to decompress the area of stenosis is the most definitive way to try to resolve symptoms of spinal stenosis.

Research shows that spine surgeries result in fewer complications when done by highly experienced surgeons like the ones at Semmes Murphey Clinic.

Examples of surgical procedures to treat spinal stenosis include:

• Laminectomy sometimes called decompression surgery, this procedure eases the pressure on the nerves by creating more space around them by removing the back part (lamina) of the affected vertebra.

In some cases, that vertebra may need to be linked to adjoining vertebrae with metal hardware and a bone graft (spinal fusion) to maintain the spine's strength.

• Laminotomy This procedure removes only a portion of the lamina, typically carving a hole just big enough to relieve the pressure in the affected area.
• Laminoplasty Performed only on the cervical or neck vertebrae, this procedure opens up space within the spinal canal by creating a hinge on the lamina. Metal hardware bridges the gap in the opened section of the spine.
• Interlaminar implant Inserting a U-shaped device or cushion between two bones in the lower back helps improve or maintain motion in the spine and keeps the spine stable. It also helps maintain the height between the bones in the spine so nerves are not “pinched” and can exit freely and extend to lower extremities.
• Minimally invasive surgery. Invented and perfected by the surgeons at Semmes Murphey Clinic, this procedure removes bone or lamina in a way that reduces the damage to nearby healthy tissue and usually results in quicker recovery time and less need for spinal fusions.

In most cases, the above-mentioned space-creating operations help reduce spinal stenosis symptoms. But there are no guarantees and there is a chance some people's symptoms may stay the same or get worse after surgery. The physicians at Semmes Murphey Clinic will talk openly about the likelihood of a successful surgery with the risks when patients are deciding if or which surgery is best for them.

Potential future treatments that are in the clinical trial stages are monitored by the physicians at Semmes Murphey Clinic. In fact, many of these trials are being conducted or overseen by SMC physicians. Rest assured that when better treatments are proven, Semmes Murphey will also add them to the arsenal of possible answers to spinal stenosis.

This information was provided by the specialists at Semmes Murphey Clinic. Readers are encouraged to research trustworthy organizations for information. Please talk with your physician for websites and sources that will enhance your knowledge and understanding of this issue and its treatments.