Spine Conditions

Spinal stenosis occurs when the spinal canal (the tunnel down your spinal column containing your spinal cord and nerves) becomes too narrow. If the spinal canal narrows, it can impact on the nerves and blood vessels that pass through the spine. Spinal stenosis can be seen as a degenerative condition since it often occurs as we become older. Young people may experience it if they have spinal problems such as scoliosis.

This condition most commonly affects the lower back, which is known as lumbar stenosis. Spinal stenosis can also occur in the neck, and this is called cervical stenosis.

A neurosurgeon can diagnose this condition by assessing your medical history, a physical exam and medical imaging, such as an MRI, a CT scan or an x-ray.

What are symptoms of spinal stenosis?

Symptoms include:

• pain in the neck or back
• pain, numbness or tingling in your arms, hands, legs or feet
• muscle weakness
• stiffness
• problems with balance and coordination
• problems with the bowel or bladder

Sometimes, people with spinal stenosis don’t experience any symptoms.

What are the causes?

Spinal stenosis is mostly caused by something restricting the spinal canal. This may include:

• Herniated discs – spinal discs act like cushions between each vertebra of the spine, but sometimes the soft insides leak out and this puts pressure on the spinal cord or nerves.
• Bone spurs – these are bone growths on the spine, which may happen from damage caused by arthritis.
• Thickened ligaments – the cords that help to hold the spine bones together can thicken over time, which puts pressure on the nerves in the spinal canal.
• Spinal injuries or trauma – an injury to the spine can cause spinal bones to break or shift out of place, which can affect the nerves and spinal cord. Swelling of surrounding tissues can also put pressure on them.
• Tumours – tumours can grow inside the spinal canal, although rarely.

How is spinal stenosis treated?

Doctors may treat this condition with physical therapy, medication or spine surgery, depending on what is most suitable for each person.

Physical therapy strengthens the back and abdomen (core), and this helps to support your spine. A physiotherapist or exercise physiologist may recommend gentle exercise, such as swimming, and specific exercises to strengthen your back and core. It’s important to keep a healthy weight, since this helps to ensure there is not too much pressure on your spine.

Medication may help to manage any pain – speak with your doctor about the best options for you.

If your condition does not improve with nonsurgical treatment or is severe, a doctor may recommend treating it with spinal decompression surgery. This works to relieve pressure on the spinal cord or nerves. Lumbar decompression surgery treats spinal stenosis in the lower back while cervical decompression surgery treats it in the neck.

There are several types of spinal decompression surgery, including laminectomy and discectomy or microdiscectomy.

Sources

1. Weinstein JN, Tosteson TD, Lurie JD, Tosteson A, Blood E, Herkowitz H, et al. Surgical versus non-operative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine 2010;35(14):1329.
2. Whitman JM, Flynn TW, Childs JD, Wainner RS, Gill HE, Ryder MG, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine 2006;31(22):2541-9.
3. Djurasovic M, Glassman SD, Carreon LY, Dimar JR, Contemporary management of symptomatic lumbar spinal stenosis. Orthopedic Clinics 2010;41(2):183-91.
4. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Spinal stenosis: Diagnosis, Treatment, and Steps to Take.

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