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Home >> Spine Problems >> Stenosis

Stenosis

Stenosis occurs when there is not enough room in the spinal canal for the spinal nerves. To create the space it needs, the spine places pressure on the disc that is creating a bulge, by causing the ligaments to thicken or joints to enlarge. This results in pain, especially after prolonged standing and can create a weak feeling in the legs.

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Causes

While narrowing of the spinal canal may be genetic, degenerative disc disease is the primary contributing factor to the development of stenosis. Changes in stability, density and size of the spine may result in reduced space for the spinal structures as well as increased pressure.

When one area of the spine is injured, it is more likely that spinal health in other areas will fail. Conditions that may encourage the development of stenosis include scoliosis, osteoarthritis, rheumatoid arthritis, spinal tumors and trauma.

Symptoms

Symptoms of stenosis include a deep aching in the low back, buttocks and thigh, and intense numbness or pain in the legs and sometimes the shoulders. Walking and exercise can bring on symptoms. If you have stenosis, you may notice that sitting sometimes relieves pain, bending over or flexing the spine forward may also bring relief. Consequently, people with stenosis may walk with a hunched over posture and find that their pain worsens when bending backward. Severe cases of stenosis will display more serious symptoms such as loss of bowel and bladder function and loss of feeling in an arm/leg.

Diagnosis

Outlined below are some of the diagnostic tools that your physician may use to gain insight into your condition and determine the best treatment plan for your condition.

Medical history:

Performing a detailed medical history allows the doctor improved understanding of the possible causes of your back and neck pain. Moreover, this knowledge may help outline the most appropriate treatment.

Physical exam:

The physical exam is helpful in allowing your physician to isolate the source of pain. Simple tests for flexibility and muscle strength may also be conducted.
X-rays are usually the initial step in diagnostic testing methods. While x-rays show bones and the space between bones, they are of limited value because they do not show muscles and ligaments.

MRI (magnetic resonance imaging):

Involves magnetic field and radio waves to produce highly detailed pictures of the inside of your body. As x-rays only show bones, MRIs are necessary to envision soft tissues like discs in the spine. This type of imaging is very safe and usually pain-free.

CT scan/myelogram:

Comparable to an MRI, a CT scan provides diagnostic information about the internal structures of the spine. A myelogram is engaged to diagnose a bulging disc, tumor, or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into the low back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected into the spinal canal to reveal where problems exist.

Electrodiagnostics:

As part of a diagnostic workup, electrical testing of the nerves and spinal cord may be performed. These tests, called electromyography (EMG) or somato sensory evoked potentials (SSEP), help your doctor understand how your nerves or spinal cord are affected by your condition.

Bone scan:

In an effort to detect infection, malignancy, fractures and arthritis in any part of the skeleton, bone imaging is used. Bone scans are also helpful in locating lesions for biopsy or excision.

Discography:

Used to determine the internal structure of a disc. It is performed via local anesthetic and by injecting a dye into the disc under X-ray guidance. Both X-ray and CT scan are performed to establish whether disc composition is normal or abnormal. Additionally, your doctor will note any pain associated with this injection. The benefit of a discography is that it enables the physician to verify the disc level that is causing your pain. This exam helps reduces the risk of operating on the wrong disc as well as ensures surgery will be more successful.

Injections:

Pain-relieving injections help relieve back pain and give the physician important information about your problem, as well as provide a bridge therapy.

Treatment

In many cases, changing posture and using spinal injections can control the symptoms for a long period of time. Stenosis can be treated without surgery, however in some cases, surgery may be required in order to create more space around the nerves.

Flexing forward and bending over may relieve pain. Taking anti-inflammatories may be beneficial, especially ibuprofen. Acetominophen may be taken for pain, if you are allergic to ibuprofen.

A physical therapy program that incorporates stretches and movements that extend the spine may be followed. Injections may be used to reduce inflammation and control pain symptoms. Try our home remedy exercises provided. Do not continue if they cause an increase in pain or symptoms.

The most common surgery to treat stenosis is called a laminectomy, which helps create more space for the surrounding spinal nerves.

FAQ

What causes spinal stenosis?

Although degenerating discs are the most common cause of spinal stenosis, spinal tumors, injury, bone disease and other conditions can lead to stenosis as well. For example, primary stenosis results from diseases that are present at birth, while acquired stenosis is typically the result of degeneration in the spine.

When should I see a doctor?

If pain interferes with your daily activities, you should consult a spine specialist to treat your stenosis. Leg pain that worsens is especially an indicator of spinal stenosis. This type of pain is not a normal part of the aging process.

What should I expect from treatment?

Treatment for spinal stenosis aims at minimizing the effects and symptoms of the stenosis but does not stop the progression of degenerative changes. Adopting a healthy lifestyle that includes exercise can help prevent disc degeneration. Learn more about degenerative disc disease.

When is surgery seriously considered?

If your pain is severe enough or if walking has become difficult, your physician may consider surgery as an option for you. However, nonsurgical, conservative treatments are usually effective at treating spinal stenosis.