Spinal stenosis

Overview

Spinal stenosis happens when the space inside the backbone is too small. This can put pressure on the spinal cord and nerves that travel through the spine. Spinal stenosis occurs most often in the lower back and the neck.

Some people with spinal stenosis have no symptoms. Others may experience pain, tingling, numbness and muscle weakness. Symptoms can get worse over time.

The most common cause of spinal stenosis is wear-and-tear changes in the spine related to arthritis. People who have severe cases of spinal stenosis may need surgery.

Surgery can create more space inside the spine. This can ease the symptoms caused by pressure on the spinal cord or nerves. But surgery can't cure arthritis, so arthritis pain in the spine may continue.

Symptoms

Spinal stenosis often causes no symptoms. When symptoms do occur, they start slowly and get worse over time. Symptoms depend on which part of the spine is affected.

In the lower back

Spinal stenosis in the lower back can cause pain or cramping in one or both legs. This happens when you stand for a long time or when you walk. Symptoms get better when you bend forward or sit. Some people also have back pain.

In the neck

Spinal stenosis in the neck can cause:

• Numbness
• Tingling or weakness in a hand, leg, foot or arm
• Problems with walking and balance
• Neck pain
• Problems with the bowel or bladder

Causes

Spinal bones are stacked in a column from the skull to the tailbone. They protect the spinal cord, which runs through an opening called the spinal canal.

Some people are born with a small spinal canal. But most spinal stenosis occurs when something happens to reduce the amount of open space within the spine. Causes of spinal stenosis include:

• Bone spurs. Wear-and-tear damage from arthritis can cause extra bone to grow on the spine. These are called bone spurs. They can push into the spinal canal. Paget's disease also can cause extra bone to grow on the spine.
• Herniated disks. Disks are the soft cushions that act as shock absorbers between your spinal bones. If part of the disk's soft inner material leaks out, it can press on the spinal cord or nerves.
• Thick ligaments. The strong cords that help hold the bones of your spine together can become stiff and thick over time. Thick ligaments can push into the spinal canal.
• Tumors. Rarely, tumors can form inside the spinal canal.
• Spinal injuries. Car accidents and other trauma can cause spinal bones to break or move out of place. Swelling of nearby tissue right after back surgery also can put pressure on the spinal cord or nerves.

Risk factors

Most people with spinal stenosis are over age 50. Younger people may be at higher risk of spinal stenosis if they have scoliosis or other spinal problems.

Diagnosis

Your health care provider may ask about your symptoms and medical history. You may have a physical exam. You also may need an imaging test to help find the problem.

Imaging tests

These tests may include:

• X-rays. An X-ray of the back can show bone changes that may be making the space within the spinal canal smaller. Each X-ray involves a small dose of radiation.
• Magnetic resonance imaging (MRI). An MRI uses a powerful magnet and radio waves to produce detailed images of hard and soft tissue. The test can detect damage to the disks and ligaments. It also can show tumors that may be present.
• Computerized tomography (CT). If you can't have an MRI, you may need a CT scan. This test combines X-ray images taken from many different angles. In a CT myelogram, a contrast dye is injected to outline the spinal cord and nerves. This can show herniated disks, bone spurs and tumors.

Treatment

Treatment for spinal stenosis depends on how severe your symptoms are.

Medications

Your health care provider might prescribe:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). If common pain relievers don't provide enough relief, prescription NSAIDs might be helpful.
• Antidepressants. Nightly doses of tricyclic antidepressants, such as amitriptyline, can help ease chronic pain.
• Anti-seizure drugs. Some anti-seizure drugs, such as gabapentin (Neurontin, Gralise), are used to reduce pain caused by damaged nerves.
• Opioids. Medications such as oxycodone (Oxycontin, Roxicodone, others) and hydrocodone (Hysingla ER) can be habit-forming.

Physical therapy

A physical therapist can teach you exercises that may help:

• Build up your strength and endurance
• Maintain the flexibility and stability of your spine
• Improve your balance

Steroid shots

Your nerve roots may become irritated and swollen at the spots where they are being pinched. Injecting a steroid medication into the space around the pinched nerve may help reduce the inflammation and relieve some of the pain.

However, steroid shots may not be the best choice for spinal stenosis. Some studies have shown that combined injections of steroids and a numbing medicine relieve back pain no better than shots of numbing medicine alone.

This is important because steroids can cause serious side effects. Repeated steroid injections can weaken nearby bones, tendons and ligaments. That's why a person often must wait many months before getting another steroid injection.

Needle procedure for thickened ligaments

Sometimes, the ligament at the back of the lumbar spine gets too thick. Needle-like tools inserted through the skin can remove some of the ligament. This can create more space in the spinal canal to reduce pressure on nerve roots. You may be given medicine to help you feel calm during the procedure. Many people can go home the same day.

Surgery

Surgeries to create more space within the spinal canal may include:

• Laminectomy. This surgery removes the back part (lamina) of the affected spinal bone. This eases pressure on the nerves by making more space around them. In some cases, that bone may need to be linked to nearby spinal bones with metal hardware and a bone graft.
• Laminotomy. This surgery removes only part of the lamina. The surgeon carves a hole just big enough to relieve pressure in a specific spot.
• Laminoplasty. This surgery is done only on spinal bones in the neck. It makes the space within the spinal canal bigger by creating a hinge on the lamina. Metal hardware bridges the gap in the opened section of the spine.

In most cases, these operations help reduce spinal stenosis symptoms. But some people's symptoms stay the same or get worse after surgery. Surgical risks include:

• Infection
• Blood clot in a leg vein
• Tear in the membrane that covers the spinal cord

Lifestyle and home remedies

Your health care provider may suggest:

• Pain relievers. Medications you can buy without a prescription — such as aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, others) and acetaminophen (Tylenol, others) — can help reduce pain and inflammation.
• Weight loss. Losing excess weight can reduce pain by taking some stress off the lower back.
• Exercise. Stretching and strengthening exercises may help relieve symptoms. Talk with your health care team about what exercises are safe to do at home.
• Walking aids. In addition to providing stability, canes and walkers can help relieve pain by allowing you to bend forward while walking.

Alternative medicine

Integrative medicine and alternative therapies may be used with conventional treatments to help you cope with spinal stenosis pain. Examples include:

• Massage therapy
• Chiropractic treatment
• Acupuncture

Preparing for an appointment

You might be referred to a doctor who specializes in disorders of the nervous system (neurologist). Depending on how severe your symptoms are, you may also need to see a spinal surgeon (neurosurgeon or orthopedic surgeon).

What you can do

Before the appointment, you might want to prepare a list of answers to the following questions:

• When did you first notice this problem?
• Has it worsened with time?
• Have your parents or siblings ever had similar symptoms?
• Do you have other medical problems?
• What medications or supplements do you take regularly?
• What spine surgeries or injections have you had done?

What to expect from your doctor

Your health care provider may ask some of the following questions:

• Do you have pain? Where is it?
• Does any position ease the pain or worsen it?
• Do you have any weakness, numbness or tingling?
• Do you feel more clumsy lately?
• Have you had any difficulty controlling your bowel or bladder?
• What treatments have you tried already for these problems?