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Spinal Stenosis: Neck and Back Nerve Compression

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What is Spinal Stenosis?
A clue to answering this question is found in the meaning of each word. Spinal refers to the spine. Stenosis is a medical term used to describe a condition where a normal-size opening has become narrow. Spinal stenosis may affect the cervical (neck), thoracic (chest), or lumbar (low back) spine. The most common area affected is the lumbar spine followed by the cervical spine.

Are there particular spinal structures that are affected?
Yes. To help you to visualize what happens in spinal stenosis, we will consider a water pipe. Over time rust and debris builds up on the walls of the pipe thereby narrowing the passageway that normally allows water to freely flow. In the spine, the passageways are the spinal canal and the neuroforamen. The spinal canal is a hollow vertical hole that contains the spinal cord. The neuroforamen are the passageways that are naturally created between the vertebrae through which spinal nerve roots exit the spinal canal. See Figure 1.

vertebral body, labeled structures, color drawing

Figure 1.
The spine's bony structures encase and protect the spinal cord. Small nerve roots shoot off from the spinal cord and exit the spinal canal through passageways called neuroforamen.

Figure 2 is an artist's illustration of lumbar spinal stenosis. Notice the narrowed areas in the spinal canal (reddish-colored areas). As the canal space narrows, the spinal cord and nearby nerve roots are squeezed causing different types of symptoms. The medical term is nerve compression.

lumbar spinal stenosis

Figure 2. Lumbar spinal stenosis.

Updated on: 09/07/12
Howard S. An, MD

I had a great pleasure reading Dr. Stewart Eidelson's 5-part article on spinal stenosis. The information included in this article is accurate and informative. I would like add a few comments for the benefit of the readers or potential patients. First, spinal stenosis is indeed most common in the lumbar spine, followed by the cervical spine. However, occasionally, the thoracic spine is affected as well. Spinal stenosis in the thoracic spine can present with pain radiating around the rib (thoracic radiculopathy) or numbness, spasm, and weakness of the legs (myelopathy). Sometimes, lumbar stenosis and cervical stenosis co-exist, and the astute doctor will pickup both diagnoses and render appropriate treatment for both conditions. Also, leg symptoms and walking difficulty may be due to clogging of the leg vessels (vascular claudication) rather than due to lumbar spinal stenosis (neurogenic claudication). Sometimes, both vascular and neurogenic claudication conditions may co-exist. Again, making the correct diagnosis is important for subsequent treatment.

As Dr. Eidelson mentioned, lumbar stenosis is largely due to "wear and tear" or degenerative changes in the joints and intervertebral discs in the spine over many years, but some patients are born with smaller spinal canal (congenital stenosis). Congenital stenosis patients typically show symptoms in their 40s and 50s rather than in their 60s and beyond. Because of smaller canals at birth, minor bulging discs and degenerated joints tend to affect the nerves earlier in life in these patients. Some patients with congenital stenosis may undergo discectomy alone without decompressive procedures for the narrowed canal, and surgical outcomes may be compromised. Again, correct and precise diagnosis leads to correct treatment.

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