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What is Spinal Stenosis?

X-Ray of Spinal Stenosis.THE SPINAL CORD and its branching nerves lie within a tunnel called the spinal canal. Spinal stenosis refers to a narrowed portion of the spinal canal. This narrowing is typically due to trauma or spondylosis, otherwise known as arthritic degenerative changes, caused by wear and tear, of the spinal bone, joints, and discs forming the spinal canal. As the stenotic area becomes more severe, it causes increased pressure to be exerted on the spinal cord and nerve roots.

The more pressure placed on these sensitive nerve structures, the more dysfunction and discomfort the patient will experience. The signs and symptoms associated will be radiating paresthesia such as pain, numbness, tingling, or weakness in the arms or legs, the need to lean forward at the waist, to relieve the pain, also a loss of balance and coordination. In severe cases, there will be a loss of balance or bladder control or even paralysis. The knowledgeable and experienced team at Centers for Neurosurgery, Spine & Orthopedics treats all levels of spinal stenosis by helping conservatively avoid, stop or surgically remove the problematic spinal disease.

Spinal Stenosis places pressure on the spinal column and nerves, including the primary nerves that control extremities.

Symptoms

Since spondylosis or arthritis is usually the cause of spinal stenosis, symptoms present gradually and then worsen over time. Trauma can also cause spinal stenosis but the same symptoms have a more rapid onset. Spinal stenosis can occur at any level of the spine including the thoracic region but it most commonly it occurs at the level of the neck (cervical spine) or low back (lumbar spine). Symptoms based on the affected spine level may include:

  • Neck (cervical) Stenosis:
    • Neck pain with pain and/or paresthesias radiating into one or both arms.
    • Numbness and tingling into the arms, hands, and fingers.
    • Weakness in the arms, hands, and fingers with loss of dexterity and grip strength at the hand. Symptoms may be in one or both arms.
    • Loss of balance, coordination, or bowel/bladder function. These symptoms are severe signs of spinal cord compression and warrant immediate evaluation by a spine surgeon or neurosurgeon.
  • Lower back (lumbar) Stenosis:
    • Lower back and buttock pain with pain and/or paresthesias radiating into one or both legs.
    • Numbness and tingling into the legs and feet.
    • Weakness in the legs. Symptoms can occur in one or both legs.
    • Loss of balance, coordination, or bowel/bladder function. These symptoms are severe signs of spinal cord compression and warrant immediate evaluation by a spine surgeon or neurosurgeon.

Any signs of weakness should warrant an evaluation by a neurosurgeon or spine surgeon as soon as possible. Symptoms may be worsened during prolonged standing and walking because the lumbar spinal canal becomes further narrowed. In the seated or forward bent position, the spinal canal opens, relieving pressure on the nerve roots and thus diminishing the problematic symptoms. For instance, a spinal stenosis patient find comfort leaning forward , placing their upper body weight on a shopping cart while walking around a store.

Spinal stenosis symptoms should not be ignored or minimized. If symptoms begin to occur, there are conservative measures to alleviate  neck or low back pain as well as any numbness, tingling, or weakness radiating into the arms and legs. For a same day painless assessment, contact CNSO for an evaluation and treatment plan.

Causes

The spinal cord and nerves travel through the spinal canal within thespinal column. The joints of the spine, discs, and vertebrae, that comprise this spinal canal can be congenitally malformed or change over time. As bones, joints, and discs degenerate arthritic changes cause deformities, bone spurs and calcifications which crowd into the spinal canal further narrowing it. This is referred to as stenotic changes that can cause excessive pressure on the spinal cord or nerves.

Patients over the age of 50 are at the greatest risk for developing spinal stenosis secondary to spondylosis of the spine. Spinal stenosis can also be caused by degenerative disc disease or a herniated disc, trauma, tumors, spondylolisthesis, congenital deformities such as  scoliosis, thickening of spinal ligaments, and lastly, genetic disease.

Diagnosis

A diagnosis of spinal stenosis maybe suspected  after a thorough history and exam are performed by a neurosurgeon or an orthopedic spine doctor. The diagnosis is confirmed by CT or MRI imaging of the suspected level of the spine. The location of symptoms (arms or legs), exacerbating factors (upright stance and walking), relieving factors (sitting or bending forward) will help to narrow in on the diagnosis and the level of the spine that is affected.

The exam typically includes:

  • Range of motion testing – an assessment of the movement of the spine in multiple directions relative to any pain elicited.
  • Neurological assessment – a group of motor, sensory, and reflex tests that aid in pinpointing the region of the spine from which thesymptoms originate. This assessment includes testing:
    • Strength of the limbs
    • Sensation to light touch and pinprick
    • Reflexes
    • Walking and balance assessments
  • Palpation – Palpation of muscles and other structures of the spine to determine the source of pain.

Depending on the exam findings, a doctor may make a diagnosis of spinal stenosis and advise you to begin conservative treatment which is usually physical therapy for core strengthening and postural training. If symptoms are not too severe to attempt physical therapy, or if the symptoms could be attributed to other types of spine pathology, the doctor will order further imaging studies to confirm the diagnosis. The two commonly ordered imagining studies are:

  • X-ray: examines the bones iof the spine. An x-ray can locate arthritic changes in the vertebrae, including the location and severity of bone spurs. They can also be used to determine the extent of loss normal curvatures of the spine or the existence of pathological curvatures of the spine both of which may be contributing to spinal stenosis symptoms.
  • MRI (magnetic resonance imaging): An MRI is the optimum type of image to view nerves and the spinal cord. It will be ordered to locate the exact level of pressure on the spinal cord or nerves as well as the root cause. It can also locate tumors and damage to discs and ligaments of the spine that may also be contributing to the discomfort.

Treatment of Spinal Stenosis

Conservative Treatment

Conservative treatment includes over the counter or prescription medication, physical therapy, or epidural steroid injections. One or a combination of each may be used to treat spinal stenosis symptoms.

  • Commonly used medications:
    • Over-the-counter non-steroidal anti-inflammatory (NSAIDS) medications such as Advil or Tylenol may be used to treat mild or moderate symptoms.
    • Anti-depressants are effective for chronic pain symptoms, including chronic pain caused by spinal stenosis.
    • Anti-seizure medications can be used to treat nerve pain caused by a pinched nerve(s) from spinal stenosis.
    • Opioids are carefully used when pain symptoms are severe. Often, they are prescribed for short-term use and are only used as a last resort if nothing else is helping with the pain.
  • Physical Therapy:
    • Physical Therapy is usually the first treatment prescribed to manage spinal stenosis symptoms. Physical therapists can perform manual therapy and provide a tailored program of stretching and exercises to alleviate symptoms more quickly than with medication or injections alone. If surgery is necessary, physical therapy post-surgery will both improve and speed up recovery. (discussed below).
  • Epidural Injections:
    • A physician performs a painless, real-time, image-guided steroid injection near the nerve roots identified as the source of the pain. Corticosteroids help to resolve the pain by decreasing inflammation and swelling of the irritated nerves. Injected steroids can also decrease swelling and irritation of the spinal cord. The steroid acts like “a bucket of water thrown on the fire” drenching the burning inflammation that is causing the pain.

Surgery Treatment

For about 95% of patients, conservative treatments resolves the symptoms and allows a return to normal functioning. For the unfortunate few who do not improve, or the symptoms continue to worsen, surgery is the only option to halt the pain and the progression. Surgical Intervention includes:

  • Laminectomy – By removing the bony overgrowth causing the stenosis, the surgeon creates space, within the spinal canal, for the previously crowded spinal cord and nerves. The nerves now have more room to move, free from impingement, so as the nerves heal, the symptoms quickly resolve.
  • Fusion – In some cases there is a significant amount of diseased brittle bone that needs to be removed. Vertebral bones may need to be realigned if there are pathological curvatures. In either case, when the spine is unstable the surgeon must also stabilize the spine so that it can function as a stable unit by creating a fusion. Fusions require bone grafts and hardware for life long stability.

Let Centers for Neurosurgery, Spine & Orthopedics Help

Most spinal stenosis symptoms are due to degenerative changes or spine trauma. The dedicated and caring team at Centers for Neurosurgery, Spine & Orthopedics includes recognized board-certified neurosurgeons, orthopedic spine surgeons, pain management doctors, physiatrists, rehabilitation specialists, and certified physical therapists working together to create a comprehensive and customized care plan for each patient. With locations throughout Northern NJ, contact CNSO to schedule an appointment today.

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