What is it?
Spinal stenosis is a narrowing of the nerve channels (or canals) in the spine. There is a central canal and there are numerous channels on the side of the spine (e.g. neuroforamen). The narrowing can happen in any part of the spine from the neck to the mid-back to the lower back.
If stenosis occurs predominately on one side of the spine, then the symptoms will only occur in the limb on that side. If stenosis occurs in the central canal or in both the left and right neuroforamen, then symptoms may occur in both the left and right limb.
What causes it?
Many people develop stenosis due to spinal degeneration, but some people are born with narrowing (congenital stenosis) or develop it acutely due to injury.
The narrowing is often due to a combination of factors, including disc herniations, bone spurs, and enlarged joints or ligaments.
At times, just one of these factors is enough to cause a focal stenosis.
What are other side effects/areas of the anatomy affected?
Patients with central spinal stenosis often have what is called neurogenic claudication. When this occurs in the lower back (or lumbar spine) patients will often get pain, cramping, fatigue or weakness in their legs when they stand and walk. When they sit down or lean forward it often gets temporarily better.
When it occurs in the neck (or cervical spine) patients can have pain and weakness in the arms, occasionally in the legs, and can have balance and walking problems.
How is it diagnosed?
Spinal stenosis can be diagnosed by your provider taking a careful history and performing a thorough physical examination.
Diagnostic studies such as an MRI or CT can also help determine whether or not you have spinal stenosis.
What are the treatment options?
Once the diagnosis is confirmed there are several treatment options including physical therapy, medications, activity modification, injections, and surgery.
- Physical therapy – there are many different types of physical therapy. Our team will decide which approach is best for you. In general an active approach in which you are given exercises and stretches is recommended. There is no way to predict how many sessions you will need, though you should feel that there is clear progress within a few visits and many people only need 6 to 8 visits.
- Medications – analgesic medications such as acetaminophen or an anti-inflammatory such as ibuprofen can be helpful temporarily. Our team will tailor your medications to help you stay active. This may include prescription anti-inflammatories, medications that target nerve pain and muscle relaxers. For very acute and severe pain, narcotics may be used for a short period.
- Activity modification – for very acute pain, a temporary decrease in activity without too much restriction may be indicated, though it is recommended to remain as active as possible. Aerobic exercise is very important, and if walking is not tolerated well, biking, water exercise or other modes of exercise may be better suited.
- Injections – epidural steroid injections can be effective for pain in the limbs. There are several different approaches and types of steroid medication. The specific type of injection is individualized after careful history and physical and personal review of the imaging. There is no need for a routine “series” of injections. Your response to the injection will be monitored and further treatment will be recommended depending on your personal results.
- Surgery – when all forms of nonsurgical care fail to provide adequate pain relief and functional improvement then surgery becomes a consideration. The aim of surgery is to decompress or open up the narrowed spinal canal to take the pressure off the spinal cord and/or nerve roots. If at all possible, a minimally invasive approach to surgery will be recommended to allow for a shorter hospital stay and a faster recovery.
Dr. Shiv Jeyamohan discusses the causes of spinal stenosis, and the many treatment options.