FAQ’s on Spinal Stenosis
What is spinal stenosis?
Our spine, or vertebral column, is made up of stacked vertebrae that protect the spinal cord and the nerves, as well as serve as the attachment of the various muscles and tissues of the back. Spinal stenosis refers to the narrowing of the openings of the spine, and can occur at the spinal canal (the main compartment that houses the spinal cord) or at the various foramina that allow nerves to exit the spinal column. The most common sites of spinal stenosis are at the lumbar (lower back) and cervical (neck) area. Thoracic (chest/mid-level) stenosis is less common.
What are the symptoms of spinal stenosis?
The presentation of spinal stenosis depends on the location of the stenosis and the affected nerve. Most patients would complain of standing discomfort, numbness, weakness, and other bilateral symptoms. These symptoms may be persistent and progressive or may occur intermittently. Symptoms are aggravated by spinal extension and relieved during spinal flexion. It may be noted that symptoms disappear in the seated or supine position. Older people are more prone to spinal stenosis, although there are also cases of congenital spinal stenosis.
Caution should be taken in cases of cervical spinal stenosis, which may lead to major body weakness and paralysis. Bowel and bladder function may also be affected. Lumbar spinal stenosis has been shown to be correlated to poorer quality of life.
What causes spinal stenosis?
Spinal stenosis can come from congenital or inherited conditions. Some people may just have inherited smaller spinal canals, or curved spines (scoliosis) that are more prone to narrowing. Degenerative conditions such as osteoarthritis, rheumatoid arthritis, and aging may cause structural changes to the canals and foramina, leading to narrowing of the canals, and irritation of the nerves. Trauma, poor healing, and tumors of the spine can also cause spinal stenosis.
How is spinal stenosis diagnosed?
Your physician will take a complete medical history and will conduct a complete physical exam. Additional imaging studies may also be requested. If an X-ray of the affected area is not sufficient, then the physician may also request additional imaging studies such as Computerized Tomography (CT) scans and Magnetic Resonance Imaging (MRI) studies.
How should spinal stenosis be treated?
Spinal stenosis should address the underlying structural cause. Non-operative surgical management should be offered to the patient as the first treatment strategy. This includes treatment with anti-inflammatory medications and physical therapy. Steroid injections have been shown to relieve pain. Physical therapy has also been shown to improve outcomes, and can even lessen the likelihood of requiring surgery. Your doctor may also prescribed lifestyle changes such as more frequent exercise, weight loss and diet modifications.
It is best to reserve surgery for progressive symptoms and neurologically catastrophic presentations. Most surgical techniques focus on decompressing the narrowing through laminectomy, foraminotomy, or corpectomy. Newer operative techniques such as laser ablation and minimally invasive surgery have been shown have good outcomes as well. However, you must always remain aware of the general risks of surgery, which can include surgical site infection, intraoperative damage to nerves and muscle tissue, blood loss, etc.
Fritz JM, Lurie JD, Zhao W, et al. (2013). Associations between physical therapy and long-term outcomes for individuals with lumbar spinal stenosis in the SPORT study. The Spine Journal. doi: 10.1016/j.spinee.2013.09.044
Lee GW, Jang SJ, Kim JD. (2014). The efficacy of epiduroscopic neural decompression with Ho:YAG laser ablation in lumbar spinal stenosis. European Journal of Orthopaedic Surgery & Traumatology. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/24398702
McKillop AB, Carroll LJ, Battié MC. (2013). Depression as a prognostic factor of lumbar spinal stenosis: a systematic review. The Spine Journal. doi: 10.1016/j.spinee.2013.09.052
Otani K, Kikuchi S, Yabuki S, et al. (2013). Lumbar spinal stenosis has a negative impact on quality of life compared with other comorbidities: an epidemiological cross-sectional study of 1862 community-dwelling individuals. The Scientific World Journal. doi: 10.1155/2013/590652
Park CH, Lee SH. (2014). Correlation Between Severity of Lumbar Spinal Stenosis and Lumbar Epidural Steroid Injection. Pain Medicine Journal. doi: 10.1111/pme.12348
Polikandriotis JA, Hudak EM, Perry MW. (2013). Minimally invasive surgery through endoscopic laminotomy and foraminotomy for the treatment of lumbar spinal stenosis. Journal of Orthopaedics. doi: 10.1016/j.jor.2013.01.006