Spinal Stenosis Causes, Symptoms, and Treatment

Pinching of the Spinal Cord Due to Narrowing of the Spinal Canal

Spinal Stenosis
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Spinal stenosis is a condition that occurs as the spinal canal narrows, restricting or compressing the nerve roots and spinal cord. It is often caused by osteoarthritis of the spinal column. Common symptoms are pain in the legs or lower back when standing or walking.

The narrowing of the spinal canal often happens in the lower back (lumbar spine) and neck (cervical spine) or, on rare occasion, the thoracic region of the spine (upper back).

The symptoms of pain, weakness, or numbness can occur in several areas, depending on the region of the spinal cord that is being pinched.

Causes

Spinal stenosis can be a congenital condition, with some people having a narrow spinal canal from birth. But more often, it results from degenerative changes in the spine, the wear and tear that leads to osteoarthritis. Bony overgrowth from osteoarthritis, thickening of a ligament in the back, and bulging discs can contribute to the condition. If you are over age 50, you have a risk of spinal stenosis. Women are more at risk than men.

Other conditions that can cause spinal stenosis include inflammatory spondyloarthritis, spinal tumors, trauma, or Paget's disease. Your risks are increased if you had a previous spinal injury or surgery on your spine.

Symptoms

People who have lumbar spinal stenosis often have pain in their legs and lower back after walking.

The pain subsides after sitting down or leaning over. In cases of cervical spinal stenosis, patients can have symptoms similar to lumbar stenosis but with prominent neck pain and peculiar sensations in the arms, poor leg function, or incontinence. There also can be numbness, weakness, or cramping of the legs.

Bowel, bladder, and sexual function may be affected and there can be some degree of leg paralysis with spinal stenosis. Interestingly, not all patients with X-ray evidence of spinal stenosis develop symptoms. For this reason, spinal stenosis refers to the condition where you have symptoms and not to the narrowing itself.

Diagnosis

Spinal stenosis can be diagnosed by a history and physical examination, but imaging studies (X-rays, CT scan, MRI) often are used to evaluate causes and severity of the disease. You might also have an electromyogram (EMG) performed to check the function of the nerves in your legs. Blood tests will be done to check for other conditions you may have and rule out other possibilities.

Treatment

Exercise is important to maintain muscle strength and stability when walking. You may be referred to a physical therapist who can give you exercises to perform that will help maintain and strengthen your muscles, especially in your arms and upper legs. This can help control the pain. If you haven't been able to exercise due to the pain, you may be started with flexion-based exercise and work up to walking or swimming for 30 minutes, three times per week.

NSAIDs and cortisone injections are used to control pain and inflammation.

Surgery is a possibility when all else fails. However, most people with spinal stenosis do not require surgery. Decompression laminectomy removes the buildup of bone in the spinal canal and often a spinal fusion is also performed.

Sources:

Klippel JH. Primer on the Rheumatic Diseases. New York, NY: Springer; 2008.

Spinal Stenosis. American College of Rheumatology. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Spinal-Stenosis.

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