SPINAL STENOSIS: WHAT IT IS AND HOW TO TREAT IT
Spinal stenosis occurs when the spaces between spine discs narrow and pressure is placed on the nerves and the spinal cord. Spinal stenosis causes numbness, pain, and tingling in the lower back or along the back side of the legs. Some people may have trouble walking. It can be caused by spinal injuries, old age, arthritis, genetics, or tumors. Resting the back, changes in posture, and nonsteroidal anti-inflammatory painkillers can help to manage symptoms, but in severe cases, surgery may be necessary.
The need for spinal stenosis treatments is growing more common and pressing today for a number of reasons. The most prominent reason is simple aging. As the lifespan of the general population continues to increase, spinal stenosis becomes a more likely diagnosis. In this post, learn more about spinal stenosis, including what it is, how it develops and the best ways to treat it.
Spinal Stenosis Defined
When you receive a diagnosis of spinal stenosis, what your doctor is telling you is that the spaces between the vertebrae in your spine have started to narrow. The more these spaces narrow and compress, the more likely the vertebrae are to encounter the central spinal cord and the sensitive nerves that run up and down the center of each vertebrae, connecting the brain to the rest of your body.
When the spaces become narrow enough, this can cause pressure on the nerve root itself. This is the point at which you may start to experience back pain and even pain in the back of your leg(s). Most but not all cases of spinal stenosis seem to correlate with low back or lumbar pain and some cases also report pain along the back of the leg(s).
Causes for Spinal Stenosis
Physicians have identified a number of factors that can lead to a diagnosis of spinal stenosis and the need for spinal stenosis treatments.
Here are some of the most common reasons why you might develop spinal stenosis now or in the future:
As mentioned in the introduction, aging and the ever-increasing human life expectancy is a significant contributing factor to the increase in cases of spinal stenosis. When the body begins to age, ligaments thicken and become less flexible, tissue pads lose the moisture that helps them cushion bones and keep them from rubbing together, joints lose their resilience and bone spurs can begin to form. All of these can work against the body to begin to create pressure on the spinal cord and nerves in the back and legs.
As joints break down, osteoarthritis can occur. The weakening and stiffening of the joints mean they are no longer able to absorb the shocks the spine endures and may begin to cause pressure on the central nerve. Rheumatoid arthritis is also linked to spinal stenosis and can have much the same effect on joints, ligaments, bone and nerves, albeit for different reasons.
Heredity can definitely play a part in who develops spinal stenosis. If you had a natural childbirth through a very narrow birth canal, this may have caused early compression on your vertebrae that can contribute to early onset of spinal stenosis.
Accidents or injuries
Certain kinds of accidents or injuries or trauma to the body can hasten the onset of spinal stenosis by inflicting damage on related areas.
Spinal tumors can create their own source of compression on the vertebrae, which can lead to pressure on the spinal column and central nerve.
Spinal Stenosis Symptoms
The symptoms of spinal stenosis tend to be more subtle at first and build in intensity over time.
Here are some of the most common symptoms to look for if you suspect you or a loved one may be developing spinal stenosis:
The number one symptom of spinal stenosis is simply pain. Lower back (lumbar) pain and pain along the back of the leg(s) specifically are the most common reported areas where pain occurs. But pain can occur along the spine at any point so it is important not to overlook pain the upper back as well.
Difficulty walking and moving
As spinal stenosis worsens, it can cause even a formerly athletic and coordinated person to begin stumbling and walking more clumsily. Falls also become more common.
Tingling, numbness, hot/cold
If you start to feel tingling, numbness or a hot/cold sensation in your legs, this is a common sign of spinal stenosis. All four symptoms don’t have to be present to indicate it may be spinal stenosis.
Diagnosing Spinal Stenosis
Spinal stenosis shares its most common symptoms with a host of other ailments, which can make it difficult to diagnose, especially in the early stages. But there are some things that physicians especially look for to determine if the symptoms are coming from spinal stenosis or another cause.
Here are some of those markers:
- The symptoms first appear in the legs, not the back.
- There is no prior history of back trouble or pain.
- There is no recent injury that could be causing the symptoms.
But further investigation will be needed to pinpoint the diagnosis. Typically, doctors take a progressive approach to diagnosis. First, it may be recommended to take a course of anti-inflammatory medication (not steroids) to see if that eases the symptoms. The patient may also receive physical therapy to improve posture.
If the symptoms remain, the next step is typically to have a MRI (magnetic resonance imaging) or CT (computed tomography) scan to identify if there is anything going on in the spine that may be causing the symptoms. A further step is often to do a dye-aided CT scan, called a myelogram, because the dye will help to show greater detail about what is happening in the spinal area and with the vertebrae.
Spinal Stenosis Treatments
Once a diagnosis of spinal stenosis is confirmed, it is time to begin treatments to get relief from pain and other symptoms. Unfortunately, at this time spinal stenosis treatments will largely relieve symptoms rather than eradicate the underlying issue.
The most common treatments offered include these:
Anti-inflammatory medications can ease the pressure the vertebrae are placing on the central nerve. This treatment is most effective when it is certain that swelling is the reason why there is pressure on the nerve. Other drugs that may be prescribed to ease pain, swelling and other symptoms include opioids, anti-seizure medications (effective for damaged nerve sites), muscle relaxants and anti-depressants, which are now known to ease pain in some treatments.
If other medications do not work or there isn’t the option to take them, an injection of steroids can sometimes be effective to relief pain and reduce the inflammation. Some patients respond very well to steroid injections and results last a long time while other patients experience only minimal temporary relief.
Posture improvement can definitely ease symptoms of spinal stenosis. By learning how to flex the spine and adopt positions that can elongate the spine and ease any pressure caused by the vertebrae pressing against the nerves, symptoms may be greatly eased. A big part of the goal of physical therapy is always to help you become stronger and more balanced and flexible to guard against the clumsiness and falls that characterize spinal stenosis.
An initial period of rest
Sometimes when you are really suffering from spinal stenosis symptoms and have been for some time before an accurate diagnosis is made, a period of rest can contribute to the body’s ability to heal. This period of rest can give you a break from the pain and other symptoms before you take other treatments.
Exercises such as bicycling that encourage you to lean forward and flex the spine can be very helpful in easing the symptoms of spinal stenosis. There are many exercises that can achieve this same goal including yoga, pilates and swimming, so if you have a favorite, you may ask your doctor about that.
Sometimes spinal stenosis treatments include surgery to ease points where the vertebrae are placing undue pressure on the nerves. Since surgery is typically viewed as a last resort option, it is always a good idea to try the other treatments before moving on to surgery.
Types of Surgery for Spinal Stenosis
There are three different types of surgery that are typically recommended for spinal stenosis treatments.
The word lamina means “back part of the vertebra.” In a laminectomy this back part is removed and vertebrae may then be linked or fused with metal parts to keep pressure off the nerves.
A laminotomy’s goal is to remove only the lamina of the affected vertebrae to directly relieve nerve pressure.
This procedure is performed on the neck vertebrae to remove the lamina and place a metal hinge to keep pressure off the nerve.
By examining all of the options for spinal stenosis treatments, you can get a complete picture of what is available. Typically it is recommended to begin with less invasive treatments and work your way through each option until you find the best fit for your specific needs.