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Spinal Stenosis |
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 Spinal stenosis refers to a narrowing of the spinal canal. This could be present at birth but is most often a condition that develops as a person ages. It can also be caused by arthritic changes, injury, or surgery.
When the spinal canal becomes narrowed the nerves which pass through can be compressed. This may cause them to become inflamed which can cause pain in the low back or legs. The onset of symptoms may be slow or sudden. Walking or standing may aggravate the pain.
The main cause of narrowing of the spine and spinal stenosis is the breakdown (degeneration) of tissues caused by the normal aging process.
In mild to moderate cases of spinal stenosis, symptoms can be controlled using nonsurgical treatment. Nonsurgical treatment may include medication to relieve pain, exercise to maintain strength and flexibility, physical therapy, or corticosteroid injections.
Surgery may be considered for severe symptoms that are unbearable or are getting worse or that restrict normal daily activities. If symptoms are severe, they usually do not improve.1 In these cases, surgery is usually successful in relieving leg pain and allowing a person to resume his or her normal daily activities. |
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Cause |
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Spinal stenosis is caused by conditions that are either: |
- Acquired through the normal aging process that leads to the breakdown (degeneration) of tissues. These conditions may include.
- Degenerative disc disease of the spine.
- Arthritis of the spine.
- Certain bone diseases.
- Injury to the spine caused by trauma.
- Present at birth (congenital), such as defects in the formation of the spine.
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Degenerative disc disease and arthritis of the spine, both of which result from normal aging, are the most common causes of spinal stenosis. Changes in the shape of the spinal canal that are related to the breakdown of tissue (degeneration) include disc herniation, thickening of soft tissues, and degeneration of facet joints and joint capsules. Any of these conditions can cause squeezing pressure (compression) on the spinal cord or its nerve roots and can result in symptoms of spinal stenosis. |
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Symptoms |
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The classic symptom of spinal stenosis is leg pain when walking and standing that is relieved by sitting. Leg pain is often present when the spine is extended, as in a standing position, and is relieved when the spine is flexed, as in a sitting position.
Symptoms of spinal stenosis may include numbness or weakness of the legs. The lower back (lumbar spine) is affected by spinal stenosis more often than any other area of the spine. Since the nerve roots that pass through the lumbar spine extend to the legs, the legs are most affected by spinal stenosis.
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The main symptoms of spinal stenosis include: |
- Leg pain, usually in both legs (worse when walking or standing).
- Stiffness in legs and thighs.
- Leg numbness or weakness.
- Low back pain.
- A feeling of tiredness in the legs.
- Cramping pain in the leg that occurs during exercise (such as walking) and is relieved by rest (pseudoclaudication).
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Some people with severe spinal stenosis develop a habit of leaning forward in a stooped position to relieve symptoms.
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Spinal stenosis can occur in the neck (cervical spine), although this is not as common as stenosis in the lower back (lumbar spine). Symptoms of spinal stenosis of the cervical spine include: |
- Restricted range of neck movement, but usually no neck pain.
- Arm numbness or weakness.
- An irregular manner of walking (irregular gait).
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In some cases, the severity of symptoms may not relate to the degree of the narrowing of the spinal canal as seen on imaging tests. A person may have very severe symptoms, but tests show relatively little narrowing of the spinal canal. Or a person may have mild symptoms, but tests show a significant narrowing of the spinal canal. |
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Treatment |
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Therefore, treatment is based not only on imaging test results, but also on the severity of symptoms and their impact on a person's normal daily activities and quality of life.
Spinal stenosis usually starts gradually and develops over a long period of time. Pain, numbness, and weakness in the legs gradually get worse. A person may be able to relieve pain by changing positions. For example, leaning forward or sitting will relieve pain because it often reduces pressure on the spinal cord or the nerve roots. For mild to moderate cases, nonsurgical treatment (such as medications and exercise) can help relieve symptoms and allow a person to do normal daily activities.
Doctors agree that the course of spinal stenosis varies-it may stay the same, get better, or get worse. However, if symptoms become severe, they usually do not improve.1 Severe symptoms may restrict a person's normal daily activities and affect his or her quality of life. If symptoms are still severe after 3 or more months of nonsurgical treatment, surgery may be considered. However, surgery may not be an option for some older adults who have other serious health problems that make surgery too risky. |
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What Increases Your Risk? |
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The risk of spinal stenosis increases if a person: |
- Is over 60 years old.
- Has an injury to the spine or has other diseases that affect the spine, such as:
- Spondylosis (inflammation of the joints in the spine).
- Spondylolisthesis (a shift of one vertebra over another, due to a defect in the joint that binds them together).
- Achondroplastic dwarfism (a genetic disorder in which the bones of the arms and legs do not grow to normal size and the vertebrae of the spine do not grow normally).
- Osteoarthritis (a disease of joint cartilage).
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