What is spinal stenosis?

Spinal stenosis occurs when the spaces in your spinal canal become narrowed. The spinal canal is a tunnel between each vertebrae forming your spine. It houses your spinal cord. With less space within your spinal canal, this cramps up your spinal cord and the nerves branching off it, called nerve roots.

Closing of the vertebrae bones irritates or compresses the spinal cord or nerves, which may lead to back pain and related nerve problems such as sciatica. Several conditions and injuries can cause the spinal canal to narrow.

Spinal stenosis can come at any time, though it has a much higher likelihood of attacking people over the age of 50 years.

This condition mainly affects two areas of your spine:

Lower back (lumbar spinal stenosis): Your lower back has five vertebrae, the most prominent bones in your spine.
Neck (cervical spinal stenosis): Your neck has seven vertebrae, C1 through C7.

Your middle back, the thoracic spine, can also be affected by spinal stenosis, but this is rare.

What are the symptoms and complications of spinal stenosis?

The symptoms of spinal stenosis generally worsen as nerves become more compressed.

If you have spinal stenosis, you may have:

Weakness in your legs or arms
Numbness in the legs or buttocks
Pain in the lower back that occurs when standing or walking
Trouble with your balance
Sitting in a chair generally eliminates these symptoms. However, symptoms return when you stand or walk.

Spinal stenosis also can lead to other complications and problems:

Bowels
Bladder
Sexual function

What causes spinal stenosis?

The foremost cause of spinal stenosis is age. Due to old age, tissues in your spine can start turning thick, while bones grow larger, compressing the nerves.

Some health conditions can cause spinal stenosis. They are as follows:

Achondroplasia: This is a form of dwarfism that affects bone formation in the spine and other parts of the body.
Ankylosing Spondylitis: This is one form of arthritis that causes chronic inflammation in the spinal column, and it also causes bone spurs.

Congenital Spinal Stenosis is when a person is born with a naturally narrow spinal canal.

OPLL: This is a condition in which the calcium depositions occur in the ligament that runs through the spinal canal.
Osteoarthritis: This condition causes cartilage to break down. Cartilage cushions joints and provides a gliding surface for bones. Osteoarthritis affects the cartilage between vertebrae and grows bone spurs within the spine.
Paget's disease of the bone: This is a chronic disease of bones that is characterized by weakening and excessive enlargement of the affected bones.
Rheumatoid arthritis: Rheumatoid arthritis is caused by chronic inflammation that causes bone erosion and the subsequent formation of bone spurs.
Scoliosis: It is an abnormal curving of the spine. Genetic diseases, neurological conditions, or unknown causes might cause it.
Spinal injuries: Bone fractures could compress spinal nerves through the vertebrae or bone fragments; slipped (herniated) discs can also compress spinal nerves.
Spinal tumors: These tissue growths could grow within the spinal canal, trigger inflammation, and change the bone in the surrounding area.

What is the diagnosis for spinal stenosis?

Your physician will perform a history, ask you some questions about your symptoms, and conduct a physical examination. They may check your spine by feeling the back and pressing on some areas to see if it hurts. To determine if some positions of the spine trigger specific symptoms, your provider might instruct you to bend in different directions.

You will also be submitted to imaging studies so your doctor can "visualize" your spine and determine what is there, what it is, and how severe the issue is. You may need some of the tests from this list:

Spine X-ray: X-rays emit a small quantity of radiation, which can be used to view bone changes. They can establish, for example, whether the disk has experienced shrinkage or bone spur formation.
MRI: Magnetic Resonance Imaging (MRI) utilizes radio waves and a solid magnet to produce cross-sectional pictures of your spine. Pictures of your nerves, disks, and spinal cord are apparent. It can even point out any tumors.
CT scan or CT myelogram: A CT scan is a series of X-rays that form cross-sectional images of your spine. A CT myelogram uses a contrast dye so your provider can see your spinal cord and nerves more clearly.

How is spinal stenosis treated?

There are many options to treat spinal stenosis. What is best for you depend on:

The cause.
The location of the problem.
The severity of your symptoms.

Your doctor will start by advising you to go home and receive care if your symptoms are not severe. They then will advise you on what physical therapy, the kind of medications to be taken, injections, and surgery in case all those above do not improve your situation but deteriorate the symptoms.

At-home care for spinal stenosis-

At-home care may be carried out under the following means:

Applying heat: Generally, heat is better than cold as an osteoarthritis pain reliever. Heat increases blood flow and relaxes muscles, so aching joints don't bother you as much. Caution is advised when using hot pads; a high setting can burn you.
The use of ice: If heat is not helpful for your symptoms, it's time to try ice. Use an ice pack, a frozen gel pack, or a frozen bag of peas. Continue to apply ice for 20 minutes on and 20 minutes off. Ice reduces swelling, tenderness, and inflammation.
Exercising: Consult your doctor first, but exercise can help alleviate the pain. It also helps strengthen the muscles that will support the spine and also enhance flexibility and balance.

Non-Surgical Treatment of Spinal Stenosis:

The non-surgical treatments mainly treat the symptoms of spinal stenosis. They include

Oral medications: Nonsteroidal anti-inflammatory drugs can be bought over the counter. This is designed to reduce the pain and discomfort caused by spinal stenosis due to inflammation. However, you are advised to contact your healthcare provider on issues of long-term side effects you might be experiencing as a result of using the medication. Your provider may also use some prescription medications containing a pain component. Such medications include gabapentin or tricyclic antidepressants, for example, amitriptyline. Muscle cramps or spasms might need muscle relaxants.
Physical therapy: Your doctor will, therefore, team up with a physical therapist to design an exercise program that promotes exercises that will strengthen your back and, in doing so, enable better core strengthening, balance, flexibility, and stability in the spine. Strengthening your back and abdominal muscles makes your spine more powerful and flexible. In some instances, a physical therapist may teach you to walk without tension in certain parts of your back, which might just open the spinal canal space and cause pain to your nerves.
Corticosteroid injections: Injecting corticosteroids around pinched spinal nerves may help decrease the swelling, pain, and irritation.

Surgery for spinal stenosis

Spinal stenosis is challenging, and the spine is a susceptible area. Due to this, the providers consider surgery only when everything else isn't working. Fortunately, most people who have spinal stenosis do not need surgery.

Types of spine surgery include:

Spinal stenosis surgery—Laminectomy: This is the most common surgery procedure for spinal stenosis. It involves the partial removal of your vertebra, called the lamina. The surgeon may also remove ligaments and bone spurs, making more room for your nerves and spinal cord.
Laminotomy: A limited laminectomy. In a laminotomy, the surgeon removes the smallest part of the lamina, which is causing pressure on your nerve.
Laminoplasty: This procedure only impacts your neck, also known as cervical spinal stenosis. The surgeon removes part of your lamina to create more space in the canal. The surgeon uses metal plates and screws to build a sort of bridge between the sections where he removed bone.
Foraminotomy is the surgical opening of the foramen; a foramen is the area through which the nerve roots exit your vertebrae. This procedure involves the removal of bone or tissue from this area to provide more space for the passage of nerve roots.
Interspinous process spacers: This is a minimally invasive procedure for some suffering from lumbar spinal stenosis. During the surgery, the doctor places spacers in the bones extending off the back of each vertebrae, known as spinous processes, that open an adequate amount of space between vertebrae and provide much-needed room for nerves.
Spinal fusion: Only when all other treatments fail do doctors use spinal fusion. They consider it only when you have radiating nerve pain because of your spinal stenosis. In such a case, your spine has become unstable, and even other treatments haven't helped. Spinal fusion surgery permanently joins or fuses two vertebrae.

Can I prevent spinal stenosis?

Because most causes of spinal stenosis are normal age-related "wear and tear" conditions, you can't prevent spinal stenosis. However, you can take steps to maintain your spine's health. These may help reduce or slow down the progression of spinal stenosis. They are:

You are eating healthy foods: Make sure you get enough calcium in your diet to strengthen your bones.
It is keeping at a weight that is healthy for you.
To avoid smoking or to quit smoking. Smoking damages your arteries, and that can cause back pain. Any injury may also fail to heal due to this condition.
Exercise regularly: Keeping your muscles strong—especially your back and core muscles—promotes the overall health of your spine.

What is the prognosis for spinal stenosis?

The prognosis (outlook) for spinal stenosis varies depending on several factors, including:

Its location.
The severity.
Your general health.

Usually, the prognosis of spinal stenosis is quite optimistic in most cases. Most people with spinal stenosis can lead relatively everyday, active lives without surgical interventions. However, each patient usually responds differently to varying treatments.

What are the complications of Spinal Stenosis?

In severe cases, it may lead to loss of control over bladder or bowel function (incontinence). Sexual dysfunction also results from the problem, mainly due to issues caused by nerve damage, like impotence or anorgasmia.

Extreme cases may even result in partial or total paralysis of the lower limbs.

Living With

When do I see my healthcare provider about spinal stenosis?

Call your healthcare provider if you develop new back pain or other symptoms, such as numbness or limb weakness.

However, if spinal stenosis treatment is being made that does not help in treating your symptoms, then call your doctor regarding the other options available to you.