Spinal Stenosis

The spine is a column of bones called vertebrae that extends from the base of the skull to the pelvis. The vertebrae form a channel known as the spinal canal, which contains and protects the spinal cord, the bundle of nerves that runs through the spine. In spinal stenosis, the spinal canal narrows. If the spinal canal narrows enough, it begins to put pressure on the spinal cord or nearby nerve roots, which may cause symptoms.

WHAT ARE THE SYMPTOMS?

Spinal stenosis does not always cause symptoms. When symptoms do occur, they depend on the area of the spine affected by stenosis and can include:

Pain in the neck or shoulder that may radiate down the arm;
Numbness or tingling in the affected arm;
Clumsiness, loss of balance, and/or weakness;
Pain in the lower back, which may radiate down one or both legs;
Numbness or tingling in the affected leg;
Pain, cramping, weakness, or fatigue of the legs that starts slowly when a person walks and improves with rest; and
Problems with bladder or bowel control.

CAUSES AND RISK FACTORS

Most cases of spinal stenosis are acquired and usually develop after age 50. Age-related degenerative changes, such as osteoarthritis, are the most common cause of acquired spinal stenosis. Other causes of acquired spinal stenosis include:

Spinal tumors;
Trauma or injury to the spine;
Paget's disease;
Fluorosis; and
Calcium deposits inside the spinal canal.

DIAGNOSIS

Several tests may be used to diagnose spinal stenosis, such as:

X rays;
Magnetic resonance imaging (MRI);
Computed tomography (CT) scan; and
Myelogram.

TREATMENT APPROACH

Unless spinal stenosis is causing severe pain or bladder or bowel incontinence, most physicians try to first treat it conservatively with nonsurgical measures such as:

Medications;
Epidural steroid injections;
Nerve blocks;
Rest or restricted activity;
Physical therapy or exercise therapy; and
A back brace or corset to support the spine.

When nonsurgical treatments are no longer effective at easing pain or if spinal stenosis is causing numbness that interferes with walking or impaired bladder or bowel function, a type of surgery called decompressive laminectomy may be recommended. In this procedure, a surgeon removes the lamina (back portion) of one or more of a patient's vertebrae to relieve the pressure on and the spinal cord and nerves.

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