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What is Spinal Stenosis?
Spinal stenosis is a condition which causes a narrowing of the space within the spinal canal or nerve roots between the vertebrae of the spine. This can put pressure on the spinal cord and any of the nerves roots running from the neck to the lower back. Spinal stenosis most commonly occurs in the cervical (the neck) and lumbar (lower back) regions of the spine. Although some people may have spinal stenosis without experiencing any symptoms, many people experience pain, numbness, tingling, and muscle weakness, all of which can worsen over time if left untreated.
Spinal stenosis can either be congenital (present at birth) or acquired (due to age-related degeneration, injury, or pathological factors). The most common cause of spinal stenosis is degeneration of the spine caused by osteoarthritis. This is the most prevalent type of arthritis and is due to wearing down of the cartilage that protects joints. Unfortunately, there is no cure for spinal stenosis, however, it can be managed with medication, exercise, and if necessary, surgery.
Types of Spinal Stenosis
Spinal Stenosis can affect any part of the spine including the cervical, lumbar, and thoracic regions
- Cervical stenosis: This occurs when the spinal canal in the neck becomes narrowed. If the space within the spinal canal becomes too narrow, this can cause a condition known as myelopathy. Myelopathy is the clinical term for severe spinal cord compression that causes sometimes irreversible nerve damage to the spinal cord.
- Lumbar stenosis: Spinal stenosis in the lumbar region affects the nerves which run through the lower back to the legs. Two other conditions which may be associated with lumbar stenosis are:
- Degenerative spondylolisthesis: A condition in which one of the vertebrae slips over the bone beneath it.
- Degenerative scoliosis: A condition that causes a curvature of the spine.
- Thoracic stenosis: Rarely, spinal stenosis may occur in the thoracic region of the spine (the upper and middle back).
There are three types of spinal stenosis but first, you must understand the anatomy of the spine:
Anatomy of the Spine
Types of Spinal Stenosis
Also referred to as lateral spinal stenosis, this is the most commonly occurring type of spinal stenosis. It occurs when obstructions develop in the spine’s neural foramen – the holes through which the nerve roots pass. Bone spurs, facet joint hypertrophy, and herniated and bulging discs can compress the nerve roots causing symptoms of stenosis.
Central Canal Stenosis
Central Canal Stenosis
Central canal stenosis occurs due to a build-up of bony overgrowth (osteophytes), thickening of ligaments (ligamentum flavum hypertrophy), or herniated and bulging discs which narrow the spinal canal and puts pressure on the nerve roots. Arthritis is the most common cause of this type of spinal stenosis.
Far Lateral Stenosis
Far Lateral Stenosis
This type of stenosis occurs when the narrowing extends beyond the neural foramen. Far Lateral Stenosis can be caused by bone spurs (endplate osteophytes), far lateral herniated discs, facet joint hypertrophy, or Bertolotti's syndrome. In some cases, foraminal stenosis and far lateral stenosis may be combined.
Spinal Stenosis Symptoms
Although the results of an MRI may reveal evidence of spinal stenosis, not everyone experiences symptoms. When symptoms do occur, they may include:
Cervical Spinal Stenosis:
- Difficulty walking
- Problems maintaining balance
- Tingling or numbness in an arm, hand, leg, or foot
- Neck pain
Thoracic Spinal Stenosis:
- Problems with balance
- Difficulty walking
- Pain or numbness in the hands or legs
Lumbar Spinal Stenosis:
- Lower back pain
- Tingling or numbness in a leg or foot
- Leg pain when standing or walking for long periods
- Weakness is a leg or foot
In addition, Spinal Stenosis may cause:
- Neurogenic claudication: This is a common symptom of central spinal stenosis, it is a result of compression of the spinal canal.
- Radiculopathy: This is a common symptom of foraminal (lateral) spinal stenosis, it is caused by a compression of the nerve roots that exit the spinal cord.
- Myelopathy: This condition can occur with any of the three forms of spinal stenosis. It can cause weakness or clumsiness in the hands, difficulty with walking and balance, and numbness in the arms or legs. In severe cases, it can also result in problems with bladder or bowel control.
Spinal Stenosis Causes
There are a number of causes of spinal stenosis such as:
- Osteoarthritis: when the protective cushioning of the vertebrae wears down
- Arthritis: swelling of the vertebrae
- Natural wear and tear: this is known as degenerative spinal stenosis
- Herniated or bulging discs: impaired disc can create pressure on the spinal cord or nerves
- Ligamentum flavum hypertrophy: the enlargement of the ligamentum flavum which is a connective tissue composed mostly of elastin fibers that joins the adjacent laminae and facet joints together. When this ligament is enlarged the circumference of the spinal canal is reduced.
- Facet joint hypertrophy: the enlargement of the facet joints
- Scoliosis: unnatural curvature of the spine
- Spinal defects at birth: this is known as congenital spinal stenosis
- Spondylolisthesis: vertebra shifts that compress the spinal cord or nerve roots
- Paget’s disease: a disorder which cause the bones to become malformed
- Tumors: these may form inside the spinal canal (intramedullary tumors)
- Achondroplasia: a form of dwarfism
Ligaments of the Spine
Spinal Stenosis Risk Factors
Risk factors for Spinal Stenosis include:
- Age: Most people with this condition are over 50 years of age.
- Deformity: some infants are born with a congenital spinal deformity which narrows the spinal canal.
- Trauma: injury to the spine can lead to stenosis.
Spinal Stenosis Diagnosis
After discussing your medical history and your symptoms, your doctor will perform a physical examination. Your doctor may also order one or more tests to confirm diagnosis. These may include:
- Imaging tests: such as X-ray, MRI, or CT scan
- Spinal nerve test: such as an electromyogram
- Bone test: such as a bone scan
Spinal Stenosis Treatment
There are both non-surgical and surgical treatments for spinal stenosis., Wwhich one you will receive will depend on a number of factors including:
- The type of spinal stenosis
- The area affected
- Your symptoms
Non-Surgical Treatments for Spinal Stenosis Pain Relief
Medications: The first-line of treatment for spinal stenosis is medication. Your doctor may prescribe one or a combination of the following:
- Anti-inflammatory medications: Non-steroidal anti-inflammatory drugs (NSAID). Not only do these medications reduce inflammation, they also help to ease compression on the pinched nerve and thereby alleviate pain.
- Pain relievers: You may benefit by taking over-the-counter pain relievers such as Ibuprofen, Advil, or Aleve.
- Antidepressants: In some cases, tricyclic antidepressants have been shown to ease severe pain.
- Anti-seizure medications: Certain anti-seizure medications may help to relax the muscles and reduce pain caused by nerve damage.
- Opioids: If you are suffering from chronic pain, your doctor may prescribe an opioid such as hydrocodone, for a short period of time.
Physical Therapy: In many cases, back pain can become worse due to the weakening of the back muscles. Finding a gentle exercise routine that you can manage and using it on a regular basis will help to strengthen your back so that the muscles can effectively cushion your spine from any impact. If you suffer from spinal stenosis your doctor may recommend physical therapy. The benefits include:
- Improving your balance
- Strengthening your core
- Increasing spinal flexibility
Epidural Steroid Injections: Corticosteroids may be injected directly into the affected area around the spine. They help to reduce inflammation and alleviate pain.
Spinal Decompression Therapy: Percutaneous image-guided lumbar decompression (PILD) is also known as decompression therapy. It is a non-invasive procedure that can be used to remove any overgrowth of spinal ligament to open up space in the spinal canal and relieve compression of the nerve root. This procedure is only suitable for patients with lumbar spinal stenosis who have a thickening of the spinal ligaments.
Spinal Stenosis Surgery
There are several options for surgical treatment of spinal stenosis. The type of surgery you receive will depend on the type of spinal stenosis and previous treatment outcomes. At the Miami Neuroscience Center at Larkin, we specialize in spinal decompression and minimally invasive surgery. Some of these surgical options include:
This is the most common spinal stenosis surgical procedure used to treat lumbar spinal stenosis, though it may also be used to treat cervical and thoracic stenosis. You will be given a general anesthetic and your surgeon will make a small incision above the affected area of your spine. He or she will remove parts of the vertebrae or any thickened ligaments that are compressing the spinal nerves and causing symptoms. The incision will then be closed with sutures
You should be able to return home within 24 hours. You should be able to return to light activities within a few days. Complete recovery from the surgery can take up to a few weeks. During your recovery period, you should avoid any heavy lifting or strenuous exercise. If you have spinal fusion at the same time as your laminectomy, the recovery time will take between two and four months.
Other decompression surgeries that enlarge the Spinal Canal include:
This is a minimally invasive procedure in which a portion of a bulging or herniated disc is removed with microscopic precision. Removing the protruding disc relieves pressure on the spinal cord or nerve roots of the affected vertebral level. This procedure is performed through a small incision with minimal muscle and tissue damage. The patient will be unconscious during the procedure using a general anesthetic. The procedure can generally be completed within two hours and can be performed on an outpatient basis.
Most patients return home the same day of surgery. You will be prescribed pain medication for the next few weeks while recovering from the surgery. Our doctors will advise that you perform light activities for up to 6 weeks and avoid lifting heavy objects and avoid sudden jerking movements. You should experience the benefits of the procedure shortly after surgery with the cessation of shooting or radiating pain.
This surgical procedure is performed on patients who are suffering from foraminal stenosis in which bone thickening is blocking the spine’s neural foramen. The aim of this procedure is to remove excess bone and open up the space in the neural foramen so that the nerves are no longer compressed.
Prior to surgery, you will be given a general anesthetic. The surgeon will make a small incision in your spine above the affected area. After moving your muscles to the side, the surgeon will cut or shave the neuralneuro-foramen to relieve compression of the nerve. Depending on the severity of the condition, other small pieces of bone may also be removed from the rear of the vertebrae to make a larger space. If your spinal column needs stabilizing after the foraminotomy, the surgeon may also perform a spinal fusion. The surgeon will then put your muscles and tissues back in place and suture the incision.
If the surgery was for cervical spinal stenosis, you will wear a soft neck brace after the procedure. If the surgery was for thoracic or lumbar stenosis you may be given a back brace. Typically, you will be able to return home within 24 hours following surgery, but you will need to move your neck or back very carefully. You should be able to perform light activities within 4 weeks. During recovery from cervical foraminotomy, you should avoid twisting your neck or turning your head quickly. During recovery for thoracic or lumbar foraminotomy, you should avoid bending, lifting, or any strenuous exercise.
This procedure may be performed along with a laminectomy if the bones in your spine need stabilizing. Spinal fusion could be a viable option if treatments with medications and epidural injections have been unsuccessful, or if you have a condition such as scoliosis or degenerative disc disease. The aim of this procedure is to join two vertebrae together to prevent movement between the two bones that can cause pain by compressing nerves. After spinal fusion your back will not be quite as flexible as before.
There are two ways to perform spinal fusion:
Anterior interbody fusion: This procedure is less common than posterior fusion, but it may be a viable option if:
- You have had previous surgery for posterior fusion
- The surgeon needs easier access to your vertebrae
- It may allow more flexibility to your spine after surgery
For this procedure you will be given a general anesthetic. The surgeon will make an incision in your lower abdomen to access your vertebrae. After removing any unwanted build-up of tissue and clearing a space in the spinal canal, the surgeon will then implant a spacer between the two adjoining vertebrae. The spacer may be made from metal, or plastic. Typically, it will also contain some bone graft material to enhance healing. In some cases, the surgeon will also add screws to ensure that the implant remains in place. The surgeon with then close the incision with sutures.
Posterior Spinal Fusion: This procedure is the same as for anterior lumbar interbody fusion except that the surgeon will approach your spine from the back.
Depending on your pain management and ability to move, you will remain in the hospital for 1 to 3 days following surgery. Your doctor may give you a back brace to help you stand and walk without disturbing the fusion. You will have physical therapy for several weeks after surgery to help you regain mobility. During the recovery period, you should avoid heavy lifting, strenuous exercise, bending, or twisting your back.
At Miami Neouroscience Center we help patients with Spinal Stenosis using the latest techiques and treatments, contact us today.
How to Prevent Spinal Stenosis
Although many people will experience at least a little degenerative change in their spine as they age but, spinal stenosis is not inevitable. Here are some tips for spinal stenosis prevention:
Exercise regularly: Regular exercise can protect you from spinal stenosis in a number of ways:
- Helping you maintain spinal flexibility
- Increasing blood flow to your back and decreasing harmful metabolites
- Preventing you from gaining excess weight
- Strengthening muscles around the spine
Stretching: Even if exercise is too difficult for you, due to other health conditions, gentle stretching can still help you stave off spinal stenosis. As well as preventing stiffness, stretching can also help to increase your range of motion.
Maintain good posture: Always maintain a good posture when you are sitting, standing or walking, particularly if you spend a lot of time sitting or on your feet. When you are lifting an object, always bend your knees and hold the object close to your chest before standing. This will help you to avoid injuries and minimize wear and tear on your spinal column.
Maintain healthy weight: Carrying excess weight puts extra strain on all parts of your body, but your spine in particular. Eating a healthy diet, avoiding excess alcohol consumption, and exercising regularly can help you maintain a healthy weight.
FAQ - Spinal Stenosis Frequently Asked Questions
Although in many cases, spinal stenosis is considered to be a degenerative condition, it is also influenced by genetics. This is particularly true of lumbar stenosis.
Men and women over the age of 50 and people who are born with a narrow spinal canal are likely to get spinal stenosis. It may also affect people who have suffered an injury to the spine.
You can minimize the pain of spinal stenosis by avoiding high impact exercise such as jogging. You should also avoid long periods of sitting or standing.
Yes, there are a number of non-surgical treatment options. They include pain medications, epidural steroid injections, physical therapy and stretching exercises.
Chiropractic therapy can be beneficial for spinal stenosis. Spinal manipulation can help to maintain flexibility and restore your range of motion.
If left untreated, spinal stenosis can result in permanent damage to the spinal cord. This could cause bowel and bladder incontinence as well as paralysis.
A person may become paralysed by spinal stenosis if the condition is left untreated. Myelopathy (severe spinal cord compression) can cause permanent nerve damage leading to extreme pain and loss of function and sensation.
In many cases, symptoms can be relieved with medication, exercise or physical therapy. In severe cases it can be successfully treated with surgery.
Around 250,000-500,000 American adults have symptoms of spinal stenosis.
Mayo Clinic, "Spinal Stenosis", March 2018. https://www.mayoclinic.org/diseases-conditions/spinal-stenosis/symptoms-causes/syc-20352961
Michele C. Battié, PhD; Alfredo Ortega-Alonso, PhD; Riikka Niemelainen, PhD; Kevin Gill, MD; Esko Levalahti, MSc; Tapio Videman, MD, PhD; Jaakko Kaprio, MD, PhD, "Lumbar spinal stenosis is a highly genetic condition partly mediated by disc degeneration" NCBI (National Center for Biotechnology Information), December 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4308556/
John K Hsiang, MD, PhD; Michael B Furman, MD, MS; Stephen Kishner, MD, MHA; Patrick M Foye, MD; Patrick M Foye, MD; Robert Pannullo MD; Paul L Penar, MD, FACS; Kirk M Puttlitz, MD; K Daniel Riew, MD; Jeremy Simon, MD; Francisco Talavera, PharmD, PhD; Amir Vokshoor, MD; J Michael Wieting, DO, MEd, FAOCPMR, FAAPMR, What is the prevalence of spinal stenosis?" Medscape, March 2018. https://www.medscape.com/answers/1913265-68823/what-is-the-prevalence-of-spinal-steno
To see if you have a Spinal Stenosis and to learn more about your treatment options please call us at 786.871.6856 or schedule a consultation today!