Spinal Stenosis Understanding

Spinal stenosis can be a pain in the neck, literally! This condition is the result of a gradual narrowing of the spinal canal, which may place pressure on the spinal cord or nerves. This most commonly affects the lumbar (low back) and cervical (neck) areas of the spine. The most common cause of spinal stenosis is aging. The rate of progression of the disease varies as people age and the changes are often quite gradual.

Causes of Spinal Stenosis
Spinal stenosis is usually a natural progression of aging but it can sometimes be caused by the herniation of a spinal disc. It may also be due to arthritis developing in the vertebral joints which decreases the space for the nerve roots which branch off the spinal cord. Paget's Disease, characterized by enlarged and deformed bone growth often affects the spine, causing stenosis.

Lumbar Spinal Stenosis Symptoms
The degree of symptoms vary from mild low back discomfort to a complete inability to walk.

• If the lower portion of the spinal cord is compressed, there is often weakness and pain in the buttock or leg. The pain may be due to compression of the nerve itself or because of compression of blood vessels carrying nutrients and oxygen to the nerve. Each of these processes interferes with the natural function of the nerve roots and decreases the endurance and effectiveness of the spinal nerves. Both cause pain.


• Mild lower back pain may progress to more severe pain in buttocks, thigh or leg that develops with walking and standing. The pain decreases with rest.


• Numbness and weakness in the lower leg may lead to a total lack of sensation.


• Some patients will have leg pain and numbness without any back pain.


• Positioning relieves some symptoms as they increase the amount of space for the spinal nerves. Flexing the lumbar spine and bending forward often helps.


• A patient with spinal stenosis can ride a bike, walk up a hill or a flight of stairs without having any pain. They can often walk for extended distances if they have something to lean on, such as a shopping cart.


• Walking down a hill, an incline, or a flight of stairs or when the patient must walk without the cart, causes the symptoms to reappear.


• Nerves to the bladder and bowel may become compressed and can lead to partial or complete incontinence.

Cervical Spinal Stenosis

• Pain in neck can be mild, at times, becoming more severe


• Headaches


• Pain in the neck and shoulders


• Numbness or weakness in the arm or hand


• Balance problems and clumsiness

The Severity of the Symptoms depends upon several factors:

• The original width of the spinal canal


• The sensitivity of the involved nerves


• The pain tolerance of the patient


• The physical demands of the patient's lifestyle

Diagnosing Spinal Stenosis

• Complete history to determine how long symptoms have been present and if condition is worsening


• Physical Exam to evaluate pain and weakness of extremities


• Neurological exam will identify chronic nerve root depression


• Laboratory tests to rule out unusual causes of nerve root and spinal cord dysfunction


• X-rays of lumbar and cervical spine can identify the amount of spinal degeneration or instability.


• A CAT scan (Computerized axial tomography) helps visualize the spinal column and identifies areas of stenosis.


• A myelogram, in which a dye is injected into the space occupied by the spinal cord and nerve roots, can identify problem areas.


• An EMG (electromyographic) test helps identify compressed nerve roots.

Most patients respond well to non-surgical treatment, medication and a physical therapy regimen.