The narrowing of the space where the spinal cord runs in the spine is called spinal stenosis. Read about its causes, symptoms, and treatment options.
The spine is the column of bones known as vertebrae, which provides stability and support to the body’s upper part. It is useful in turning and twisting actions. The spinal nerves pass through the openings of vertebrae and help in the conduction of signals from the central nervous system or brain to the periphery or the other parts of the body. Any condition affecting these nerves or bones can lead to malfunctioning of walking, balancing, and/or sensation.
A condition where there is a narrowing of spaces within the spine is known as spinal stenosis. This can put pressure on the spinal cord and spinal nerves that have the route through the spine. It is usually seen in the lower back portion of the body in the lumbosacral region and in the neck known as the cervical region.
It can be either symptomatic or asymptomatic. When it is symptomatic, it can be experienced as pain, numb feeling, weakness in the muscle, and/or tingling sensation. It is also possible that the symptoms can worsen in the future. The other names for spinal stenosis are neurogenic claudication, central spinal stenosis, and foraminal spinal stenosis.
Depending on the affected location on the spine, it can be classified into the following (sometimes a person may experience more than one type):
1. Cervical stenosis: In this type, the narrowing is seen in the part of the spine situated in the neck.
2. Lumbar stenosis: In this type, the narrowing is witnessed in the spine portion located in the lower back. It has to be noted that, this is the most common type.
Most of the people remain asymptomatic and the diagnosis is done only after imaging like X-rays, CT, etc. But, when a person has symptoms, it usually starts as mild, and then with time, it worsens.
The symptoms seen in the cervical spine or neck are as follows:
1. A sensation of numbness or tingling in the hands, feet, arms, or legs.
2. Weakness in the limbs.
3. Walking and balancing issues.
4. Pain in the neck.
5. When it is severe, dysfunctioning of bowel or bladder can be seen as urinary urgency and incontinence.
The symptoms seen in the lower back or lumbar spine are as follows:
1. Numbness or tingling sensation in lower limbs.
2. Weakness felt in lower limbs.
3. Presence of pain or cramps in the legs while standing for a long duration or while walking. This discomfort eases while bending forward or sitting.
4. Pain in the back.
The extension of the spine also called the backbone runs from the neck to the lower back. The bones of the spine form the spinal canal, which acts as a protective layer for the spinal cord (the nerve passing through the spinal canal).
The causes of spinal stenosis are as follows:
1. Bone overgrowth due to damage caused by wear and tear in osteoarthritis patients.
2. Disk herniation.
3. Thickening of the ligaments.
4. Tumors within the spinal cord.
5. Injuries to the spine due to vehicle accidents, etc.
6. Abnormal curvature of the spine also called scoliosis.
7. Bone disease like Paget’s disease.
8. Achondroplasia: this is a type of dwarfism.
The following are the risk factors of spinal stenosis:
1. People who are above 50 years of age.
2. In young people, trauma, certain genetic defects, congenital abnormalities, etc., may increase the risk.
If severe spinal stenosis is not treated, it can lead to the following complications:
1. Numbness in the affected part.
2. A weakness of limbs.
3. Problems in balancing the body.
Initially, when you visit your physician, he or she will ask your personal history, medical history, and complete details about the signs and symptoms being experienced by you. Following that, a physical examination will be conducted along with many imaging tests to assist in confirming the diagnosis.
The imaging tests may include the following:
1. X-rays of the back or neck.
2. MRI of the spine.
3. CT or CT myelogram.
The imaging studies help to read the spine and pathologies associated with it. An electromyogram can be useful in checking the spine health.
The treatment is mainly dependant on the location and severity of stenosis. Initially, medications can be given to manage the symptoms, they are as follows:
1. Painkillers or analgesics like Ibuprofen, Paracetamol, etc.
2. Muscle relaxants like Chlorzoxazone, Thiocolchicoside, etc.
3. Certain antidepressants like Amitriptyline.
4. Anti-epileptic or anti-seizure drugs like Gabapentin, Pregabalin, etc.
5. Opioid analgesics in refractory pain.
It is very important to consult your physician before taking any of these medications.
Next, physical therapy can be done like doing exercises that can improve the balance and strengthen the muscles. Steroid injections and decompression of the nerve are other procedures that can be done.
In severe cases, surgery is advisable which can be laminectomy (this includes removal of part of vertebrae so that the nerves can get more space and is the most common procedure), laminotomy, laminoplasty, and bone or lamina removal using minimally invasive surgery. Another procedure carried out are diskectomy and foraminotomy which helps in widening the part of the spine where the nerve exits.
In very severe cases, spinal fusion is carried out in which spines are involved in multiple levels and thus helps in preventing instability. Also, bone grafts and/or metal implants can be used to attach the affected bones together.
Pain is the most severe problem faced by individuals in such situations. Hence, other options available apart from surgery include ice or heat packs, acupuncture, massaging. Also, cognitive behavioral therapy will prove to be helpful in managing pain as it provides education and coping mechanisms.
Spinal stenosis can affect the daily routine if not treated at the right time. Consult a physician to get all your details cleared regarding spinal stenosis which can also be done using online medical platforms.
Last reviewed at:
11 May 2020 - 4 min read
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