Spinal Stenosis

Description

Spinal stenosis is a narrowing of the spinal canal or the foramen (openings) where spinal nerves exit and branch out to innervate the body. The stenosis creates pressure on either the spinal cord in central canal stenosis, or on the spinal nerves in trans-foraminal stenosis. Spinal stenosis is more common in the lower back than other parts of the back.

Causes

  • Degenerative changes associated with aging
  • Herniated disks
  • Osteoarthritis
  • Rheumatoid arthritis
  • Scoliosis
  • Paget’s Disease
  • Thickened, bulging ligaments
  • Bony overgrowths
  • Tumors
  • Spinal Injuries
  • Achondroplasia
  • Congenital spine defects

Symptoms

Spinal stenosis is a progressive disease and symptoms worsen over time. Patients may feel leg or arm weakness, lower back pain with standing and walking, numbness in the legs and buttocks and balance problems.

Diagnosis

The diagnosis of spinal stenosis begins with a history and physical exam with includes a detailed neurologic exam. The medical history will likely include questions about your family’s medical problems as some spine disorders are hereditary. Your physician may ask you if you have diabetes or cardiovascular disease and which medications, if any, you take. Lifestyle questions such as if you smoke, drink and exercise are routinely asked as well. The doctor will ask about your symptoms. She/he will ask you if you have any numbness or tingling. They will ask you how long you have had symptoms, the location of your pain and if it radiates. They may also ask you to quantify your pain and ask about instigating and alleviating factors. The physician is likely to ask what treatments you have attempted and if they helped.

During the physical exam, the physician will inspect the spine for deformities and assess you for pain and tenderness. They will examine your posture and observe your walking pattern. She/he may ask you to bend forward and side to side to assess your range of motion. The neurologic exam is aimed at assessing nerve related symptoms such as numbness, tingling and burning. Your reflexes, muscle strength and balance are assessed.

Electrodiagnostic tests such as electromyography and nerve conduction studies may be ordered.

Imaging includes X-rays to detect alignment problems such as scoliosis, bone spurs, arthritis, and narrow disk spaces that can cause nerve compression. A CT scan or an MRI provides more detailed images.

A bone scan involves an intravenous radioactive tracer. After it is absorbed by the bones, imaging is used to highlight any bony defects. This study is used to detect metabolic abnormities of the bone including cancer, arthritis, Paget’s disease, fractures, and infections.

A myelogram involves injection of contrast dye into the spinal canal followed by an X-ray or CT scan. It is used to visualize compression of the spinal cord or nerve roots.

Management

Conservative treatment with physical therapy and medication is appropriate for patients who are mildly symptomatic. Physical therapy provides relief by gently stretching the joints of the spine and surrounding muscles. If symptoms persist despite medication and physical therapy, steroid injections performed by an interventional pain management physician or other appropriately qualified physician can help. Physical therapy should be used after/between injections. Intractable pain despite these measures or other severe symptoms such as loss of bowel and bladder control or paraplegia are indications for surgery.