Overview
Spinal stenosis is a condition where the space inside the spine becomes too narrow, putting pressure on the spinal cord and nerves that pass through the spine. It most commonly occurs in the lower back and neck. Symptoms can include pain, tingling, numbness, and muscle weakness, which can worsen over time. The main cause of spinal stenosis is wear-and-tear changes related to arthritis, but it can also be caused by tumors, spinal injuries, or a small spinal canal from birth. Surgery may be necessary for severe cases, but it can't cure arthritis, so arthritis pain may continue.
Understanding the disease
Symptoms
Symptoms of spinal stenosis depend on which part of the spine is affected. In the lower back, spinal stenosis can cause pain or cramping in one or both legs, which gets worse when standing or walking and improves when bending forward or sitting. In the neck, spinal stenosis can cause numbness, tingling or weakness in a hand, leg, foot, or arm, problems with walking and balance, neck pain, and issues with the bowel or bladder.
Risk Factors
The risk factors for developing spinal stenosis are:
- Age: Most people with spinal stenosis are over age 50.
- Scoliosis or other spinal problems: Younger people may be at higher risk of spinal stenosis if they have scoliosis or other spinal problems.
Development
Spinal stenosis occurs when the space inside the spine becomes too narrow, putting pressure on the spinal cord and nerves that pass through the spine. This pressure can cause a variety of symptoms, such as pain, tingling, numbness, and muscle weakness. The most common cause of spinal stenosis is wear-and-tear changes in the spine related to arthritis. Other factors that can contribute to spinal stenosis include bone spurs, herniated disks, thick ligaments, and tumors. These conditions can cause the spinal canal to narrow, compressing the nerves and potentially leading to symptoms. Risk factors for spinal stenosis include advancing age and having pre-existing spinal conditions like scoliosis.
Assessment and Diagnosis
Triage
You should see a doctor if spinal stenosis is suspected, especially if you experience symptoms such as pain, tingling, numbness, or muscle weakness in the legs, back, or neck that worsen over time. If you have significant pain, difficulty walking, problems with bladder or bowel function, or loss of sensation, it's essential to consult a healthcare professional for proper evaluation and treatment.
Diagnosis
To diagnose spinal stenosis, your healthcare provider will likely ask about your symptoms and medical history. They may perform a physical exam and request imaging tests such as X-rays, magnetic resonance imaging (MRI), or computerized tomography (CT). Imaging tests help identify issues causing the narrowing of the spinal canal, like herniated disks, bone spurs, or tumors. If you cannot have an MRI, a CT scan may be recommended.
Management and Treatment
Complications
Potential complications of spinal stenosis may include:
- Loss of function: Severe spinal stenosis can lead to a loss of function in the affected limbs, causing weakness and difficulty walking or performing daily activities.
- Incontinence: In severe cases, spinal stenosis can cause bowel or bladder dysfunction, resulting in incontinence.
- Increased risk of falls: Spinal stenosis in the neck can cause balance problems, increasing the risk of falls, especially in older adults.
- Nerve damage: Prolonged compression of the spinal cord or nerves can result in permanent nerve damage, leading to chronic pain or loss of sensation in the affected areas.
- Surgical complications: Although rare, surgery for spinal stenosis carries potential risks, such as bleeding, infection, nerve injury, or spinal fluid leakage. It is essential to manage spinal stenosis through conservative treatments like physical therapy, pain management, and bracing when necessary. In some cases, surgery may be necessary to relieve symptoms. However, it is crucial to discuss the potential risks and benefits of any treatment option with a healthcare professional.
Treatment
Treatments for spinal stenosis depend on the severity of the symptoms and the underlying cause. In many cases, non-surgical treatments can help alleviate symptoms. These may include:
- Pain medications: Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help manage pain associated with spinal stenosis.
- Physical therapy: A physical therapist can help design an exercise program to strengthen the muscles that support the back and improve flexibility.
- Epidural steroid injections: These injections administer corticosteroids directly into the epidural space around the affected nerves, which can help reduce inflammation and alleviate pain.
- Lifestyle modifications: Maintaining a healthy weight, wearing supportive shoes, and avoiding prolonged standing or sitting can help reduce symptoms. When non-surgical treatments are not effective or when the condition is severe, surgery may be recommended. Surgical options include:
- Laminectomy: This procedure involves removing the bony structure that is causing the spinal stenosis, creating more space for the nerves.
- Foraminotomy: This procedure enlarges the opening through which nerves exit the spine, relieving pressure on the affected nerves.
- Spinal fusion: In some cases, a combination of a laminectomy and spinal fusion may be performed to stabilize the spine and relieve pressure on the nerves. It is essential to consult with a healthcare professional to determine the most appropriate treatment for your specific case of spinal stenosis.
Preparing for medical consultation
To prepare for an appointment for spinal stenosis, you should:
- Note any symptoms you've been experiencing, including any that may seem unrelated to the reason for the appointment.
- List your key medical information, including all conditions you have and the names of any prescription and over-the-counter medications you're taking.
- Be aware of any pre-appointment restrictions, and ask if there's anything you need to do in advance, such as restricting your diet.
- Bring any previous imaging tests, X-rays, or medical records relevant to your situation.
- Consider taking a family member or friend along to help remember information discussed during the appointment. Remember to write down questions to ask your doctor, such as:
- What may be causing my symptoms?
- Are there any other possible causes?
- What kinds of tests do I need? Do these tests require any special preparation?