Many of my clients have reported the diagnosis spinal stenosis. Many think this is a death sentence. Questions arise like will I be able to walk? Do I have to get surgery? Although spinal stenosis seems serious, it is pretty common. Degenerative spinal changes affect up to 95% of people by the age of 50. Spinal stenosis is one of those changes. Half of people age 60 and over have spinal stenosis.
What is spinal stenosis?
Spinal stenosis is the narrowing of one or more spaces within your spinal canal. Your spinal canal is the tunnel that runs through each of the vertebrae in your spine. It contains your spinal cord. Less space within your spinal canal cramps your spinal cord and the nerves that branch off it (nerve roots).
A tightened space can cause your spinal cord or nerves to become irritated, compressed or pinched. This can lead to back pain and other nerve issues, like sciatica. Several conditions and injuries can lead to a narrowed spinal canal.
Spinal stenosis can affect anyone, but it’s most common in people over the age of 50.
The condition most commonly affects two areas of your spine:
Lower back (lumbar spinal stenosis): Your lumbar spine consists of five bones (vertebrae) in your lower back. Your lumbar vertebrae, known as L1 to L5, are the largest of your entire spine.
Neck (cervical spinal stenosis): Your cervical spine consists of seven vertebrae in your neck. These vertebrae are labeled C1 to C7.
Signs of lumbar spinal stenosis
Symptoms of lumbar (low back) spinal stenosis include:
Pain in your low back.
This is pain that begins in your buttocks and extends down your leg. It may continue into your foot.
A heavy feeling in your legs, which may lead to cramping in one or both legs.
Numbness or tingling (“pins and needles”) in your buttocks, leg or foot.
Pain that worsens when you stand for long periods of time, walk or walk downhill.
Pain that lessens when you lean forward, walk uphill or sit.
What causes spinal stenosis?
Spinal stenosis has several causes. Many different changes or injuries in your spine can cause a narrowing of your spinal canal. The causes are split into two main groups:
Acquired (developing after birth).
Congenital (from birth).
Acquired spinal stenosis is more common. It usually happens from “wear and tear” changes that naturally occur in your spine as you age. Only 9% of cases result from congenital causes.
Acquired causes of spinal stenosis
Causes of acquired spinal stenosis include:
Bone overgrowth: Osteoarthritis is the “wear and tear” condition that breaks down the cartilage in your joints, including your spine. Cartilage is the protective covering of joints. As your cartilage wears away, your bones begin to rub against each other. Your body responds by growing new bone. Bone spurs, or an overgrowth of bone, commonly form. Bone spurs on your vertebrae extend into your spinal canal, narrowing the space and pinching nerves in your spine. Paget’s disease of the bone can also cause an overgrowth of bone in your spine.
Bulging or herniated disks: Between each vertebra is a flat, round cushioning pad (vertebral disk) that acts as a shock absorber. As you age, the disks can dry out and flatten. Cracking in the outer edge of the disks can cause the gel-like center to break through. The bulging disk then presses on the nerves near the disk.
Thickened ligaments: Ligaments are the fiber bands that hold your spine together. Arthritis can cause ligaments to thicken over time and bulge into your spinal canal.
Spinal fractures and injuries: Broken or dislocated bones in your vertebrae or near your spine can narrow your canal space. Inflammation from injuries near your spine can also cause issues.
Spinal cysts or tumors: Growths within your spinal cord or between your spinal cord and vertebrae can narrow your spinal canal.
2. Congenital spinal stenosis affects babies and children. It can happen due to:
Issues with spine formation during fetal development.
Genetic (inherited) conditions that affect bone growth. These are due to genetic mutations(changes).
At-home care may include:
Applying heat: Heat usually is the better choice for osteoarthritis pain. Heat increases blood flow, which relaxes your muscles and relieves aching joints. Be careful when using heat — a high heat setting can burn you.
Applying cold: If heat isn’t easing your symptoms, try ice, like an ice pack, frozen gel pack or a frozen bag of peas. Apply the ice for 20 minutes on and 20 minutes off. Ice reduces swelling, tenderness and inflammation.
Exercising: Check with your healthcare provider first, but exercise can help relieve pain. It also strengthens your muscles to support your spine and improves your flexibility and balance.
Nonsurgical treatment for spinal stenosis
Oral medications: Over-the-counter nonsteroidal anti-inflammatory medications (NSAIDs) can help relieve inflammation and provide pain relief from spinal stenosis. Be sure to talk with your provider to learn about the possible long-term problems of taking these medicines. Your provider may also recommend prescription medications with pain-relieving properties. These may include the antiseizure medication called gabapentin or tricyclic antidepressants, like amitriptyline. If you have muscle cramps or spasms, muscle relaxants may help.
Physical therapy: Physical therapists will work with you to develop a back-healthy exercise program to help you gain strength and improve your balance, flexibility and spine stability. Strengthening your back and abdominal muscles (your core) will make your spine more resilient. Physical therapists can teach you how to walk in a way that opens up your spinal canal, which can help ease pressure on your nerves.
Steroid injections: Getting corticosteroid injections in the space around pinched spinal nerves may help reduce inflammation, pain and irritation.
Surgery for spinal stenosis
Spinal stenosis is complex, and your spine is a delicate area. Because of this, providers consider surgery only if all other treatment options haven’t worked. Fortunately, most people who have spinal stenosis don’t need surgery.
How is spinal stenosis diagnosed?
Your healthcare provider will review your medical history, ask about your symptoms and do a physical exam. Your provider may feel your spine, pressing on different areas to see if it causes pain. They’ll likely ask you to bend in different directions to see if certain spine positions bring on symptoms.
You’ll also have imaging tests so your provider can “see” your spine and determine the exact location, type and extent of the problem. These tests may include:
Spine X-ray: X-rays use a small amount of radiation and can show changes in bone structure. For example, they can show a loss of disk height or bone spurs.
MRI: Magnetic resonance imaging (MRI) uses radio waves and a powerful magnet to create cross-sectional images of your spine. MRI provides detailed images of your nerves, disks and spinal cord. It can reveal any tumors as well.
CT scan or CT myelogram: A computed tomography (CT) scan is a combination of X-rays that creates cross-sectional images of your spine. A CT myelogram uses a contrast dye so your provider can more clearly see your spinal cord and nerves.
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