WHAT IS SPINAL STENOSIS?

Spinal stenosis is a narrowing of the spinal canal that results in compression of the spinal cord. To have a clearer picture of what spinal stenosis is, it is important to understand the anatomy of the human spine. The spine consists of 33 vertebrae stacked one on top of the other, with 7 vertebrae in the cervical region (neck), 12 in the thoracic region (mid-back), 5 in the lumbar region (lower back), 5 fused vertebra in the sacrum (just above the buttocks), and 5 smaller fused vertebrae in the coccyx (commonly known as the tailbone). These vertebrae support the body and have a canal running through their center which holds the spinal cord. Narrowing in any region of this canal can put pressure on the spinal cord causing a multitude of symptoms.

Spinal stenosis can occur due to the natural aging process, usually becoming apparent in the 5th decade, and worsening over time. Narrowing of the spinal canal while aging can be caused by osteoarthritis, degenerative disc disease, osteoporosis, bone spurs, or thickening of spinal ligaments. Narrowing could also be caused by factors not related to aging, such as herniated or bulging discs, tumors, or trauma to the spine. In rare cases spinal stenosis could be congenital, meaning the spinal canal was small from birth, or there are structural deformities that cause the spinal canal to narrow.

Signs and Symptoms

Symptoms from spinal stenosis range from moderate to severe, but are similar with all regions of spinal canal narrowing. They include numbness, tingling, pain, and weakness at or below the level of the affected region. For example, cervical stenosis often causes symptoms in the neck, hand, arm, foot, or leg, whereas lumbar stenosis causes symptoms in the back, foot, or leg. Severe symptoms include bowel and bladder dysfunction, and difficulty balancing while walking.

Diagnosis

• When making a diagnosis, the doctor will look for clues that indicate where the narrowing is present. They will check for areas of muscle weakness, sensory abnormality, and reflex irregularity.
• Oftentimes, lumbar stenosis will mimic a condition known as vascular claudication which causes pain with walking. A test that helps to differentiate between vascular claudication and spinal stenosis is the bicycle test. For this test, the patient will ride a stationary bike until symptomatic, then flex at their waist while continuing to pedal. If the pain is caused by stenosis, the symptoms will improve.
• A physical exam will be followed with imaging studies which may include either an MRI scan or a CT scan with myelogram (using an X-ray dye in the spinal sac fluid).

Treatment

Nonsurgical treatment options for spinal stenosis begin with medications to relieve pain and inflammation such as acetaminophen, and NSAIDs. Weight loss, physical therapy, and stretching may slow the progression of spinal stenosis, and relieve some symptoms, although they are not a cure. A popular option is the use of epidural injections, which use cortisone to provide short-term symptomatic relief.

There are surgical options as well, known as decompression surgeries. The gold standard is a laminectomy, where the narrowed portion of the vertebral bone is removed to make more room for the spinal cord. In cases where the patient also has spinal instability, a laminectomy is often performed with a fusion, which involves stabilizing the vertebrae so they will come together as one bone.

Spinal stenosis is a difficult condition to live with. However, a proper diagnosis and a thoughtful treatment plan can improve the lives of those affected.

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