Spinal Stenosis

Common Causes of Spinal Stenosis

Spinal stenosis is most often caused by wear-and-tear damage related to aging, though there may be several other underlying conditions that contribute to it, including:

• Osteoarthritis of the spine: Age is one of the biggest contributing factors to spinal stenosis, as older adults are more likely to experience spinal arthritis or spondylosis. Other conditions related to age can also play a role in spinal degeneration, including bulging disks, bone spurs and thickened ligaments.
• Congenital defects of the spinal cord: Some people are born with a narrow spinal canal, which may cause symptoms of spinal stenosis later in life.
• Spinal injury or trauma: Spinal injuries can cause swelling around the spinal column, which can eventually lead to stenosis.
• Spinal infections: Infections like discitis or abscesses can cause severe inflammation of the spinal column and surrounding soft tissue, creating an environment in which stenosis is more likely to occur.
• Tumors: Spinal tumors may be malignant or benign, but they can compress nearby nerves and cause narrowing of the spinal canal, leading to stenosis.

Types of Spinal Stenosis

There are two primary types of spinal stenosis, which indicate where the spinal canal is narrowing, and where pain is ultimately felt.

Lumbar Spinal Stenosis

Lumbar spinal stenosis is the most common type, originating in the lower back. This type of stenosis compresses the nerves that run through the legs, typically causing pain, weakness and numbness in the lower extremities. It may also cause compression to the sciatic nerve — the longest nerve in the body — resulting in symptoms of sciatica.

In lumbar spinal stenosis, patients may feel relief by bending forward or sitting down. Pain may worsen with walking long distances or standing for an extended period of time.

Cervical Spinal Stenosis

Cervical stenosis is localized to the neck and cervical spine, typically causing pain and stiffness in that region. It may also cause numbness and tingling through the arms and hands. Because cervical stenosis involves compression of the spinal cord, it can have a great neurological impact, sometimes resulting in issues with dexterity and balance.

Cervical stenosis is more likely to be related to degeneration of the spinal column and is generally found in adults over the age of 50.

Signs & Symptoms of Spinal Stenosis

While the symptoms of spinal stenosis are largely the same for both cervical and lumbar types, the location of the symptoms will vary.

Pain

Pain is one of the most prominent indicators of spinal stenosis. For patients with lumbar spinal stenosis, back pain that originates near the base of the spine and radiates down through the buttocks and legs is most common. It may be relieved by sitting down or leaning forward (neurogenic claudication).  In cases of cervical stenosis, the pain is usually centered in the neck, though it can be felt in the shoulders, arms and hands as well. 

Numbness

Numbness is a common symptom in both types of spinal stenosis, usually described as a feeling of pins and needles or tingling in the extremities. This numbness is most often felt in the legs and feet of patients with lumbar stenosis, and in the arms and hands of those with cervical stenosis.

Sciatica

Many people believe sciatica is a standalone medical condition, but in reality, it is a collection of symptoms resulting from another underlying cause. Lumbar spinal stenosis is a major cause of sciatica, which happens when the sciatic nerve is compressed. Sciatica leads to sharp, shooting or severe pain that radiates from the back, through the buttocks, and down the leg. It is characterized by one-sided symptoms, muscle weakness and tingling in the legs and feet.

Weakness

Weakness in the limbs is common in both types of stenosis. In lumbar stenosis, the weakness is felt primarily in the legs, while cervical stenosis causes a loss of strength in the arms and hands. Lumbar spinal stenosis can lead to difficulty walking. Cervical stenosis can, in severe cases, lead to muscle wasting (atrophy) in the hands.

Neurological Problems

Both types of stenosis can cause neurological issues, though it’s more common with cervical stenosis, which causes direct spinal cord compression. This can lead to issues with balance, coordination and grip strength. It may cause a person to trip more frequently, bump into objects or shuffle their feet.

Bowel or Bladder Incontinence

How Spinal Stenosis Is Diagnosed

Treatment Options for Spinal Stenosis

Non-Surgical Treatments

• Medication: For pain relief, your doctor may suggest starting with over-the-counter pain relievers like nonsteroidal anti-inflammatory drugs (NSAIDs). If those don’t work, prescription medicine and a pain management plan may be recommended.
• Injections: For severe pain, your doctor may suggest epidural injections or nerve blocks for longer-lasting relief.
• Physical therapy: Physical therapy can improve your strength, posture and flexibility, and a physical therapist can recommend exercises or stretches that can help alleviate some symptoms of spinal stenosis.
• Bracing: Back braces may be recommended to help stabilize the spine and offer additional support.

Surgical Treatments for Lumbar Spinal Stenosis

Surgery for lumbar stenosis is focused on decompressing the affected nerve roots and restoring function. Recommended decompression procedures may include:

• Laminectomy: Laminectomy removes parts of the bone and tissue compressing the spinal canal. Laminotomy, a similar procedure, accesses the spinal cord through a hole in the lamina to reduce compression.
• Spinal fusion: A spinal fusion procedure fuses together the affected vertebrae for greater stabilization and to relieve compression.

Surgical Treatments for Cervical Stenosis

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