Spinal Stenosis: Lumbar and Cervical

Written by Steven R. Garfin, MD

Spinal stenosis is a narrowing of the back and/or neck's nerve passageways, called neural foramen (or, neuroforamen) and/or the spinal canal. When this happens, nerve structures and/or the spinal cord can become compressed (eg, pinched nerve), which causes inflammation, irritation and pain. When the low back is affected the condition is called lumbar spinal stenosis, and if the neck is involved, cervical spinal stenosis. While spinal stenosis can be found in any part of the spine, the low back and neck areas are the most commonly affected. The foremost symptom is pain.

What Causes Spinal Stenosis?

Some patients are born with this narrowing, but most often spinal stenosis is seen in patients over the age of 50. In these patients, stenosis is the gradual result of aging and “wear and tear” on the spine during everyday activities.

There most likely is a genetic predisposition to this since only a minority of individuals develops advanced symptomatic changes. As people age, the ligaments of the spine can thicken and harden (called calcification). Bones and joints may also enlarge, and bone spurs (called osteophytes) may form.

Bulging or herniated discs are also common. Spondylolisthesis (the slipping of one vertebra onto another) also occurs and leads to compression.

When these conditions occur in the spinal area, they can cause the spinal canal to narrow, creating pressure on the spinal nerve.

Symptoms of Spinal Stenosis

The narrowing of the spinal canal itself does not usually cause any spinal stenosis symptoms. It is when inflammation of the nerves occurs at the level of increased pressure that patients begin to experience problems.

Patients with lumbar spinal stenosis may feel pain, weakness, or numbness in the legs, calves or buttocks. In the lumbar spine, symptoms often increase when walking short distances and decrease when the patient sits, bends forward or lies down.

Cervical spinal stenosis may cause similar symptoms in the shoulders, arms, and legs; hand clumsiness and gait and balance disturbances can also occur.

In some patients, the pain starts in the legs and moves upward to the buttocks; in other patients, the pain begins higher in the body and moves downward. This is referred to as a “sensory march.”

The pain may radiate like sciatica or may be a cramping pain. In severe cases, the pain can be constant.

Severe cases of stenosis can also cause bladder and bowel problems, but this rarely occurs. Also paraplegia or significant loss of function also rarely, if ever, occurs.

How Spinal Stenosis is Diagnosed

Before making a diagnosis of stenosis, it is important for the doctor to rule out other conditions that may have similar symptoms. In order to do this, most doctors use a combination of tools, including:

History: The doctor will begin by asking the patient to describe any symptoms he or she is having and how the symptoms have changed over time. The doctor will also need to know how the patient has been treating these symptoms including what medications the patient has tried.

Physical Examination: The doctor will then examine the patient by checking for any limitations of movement in the spine, problems with balance and signs of pain. The doctor will also look for any loss of extremity reflexes, muscle weakness, sensory loss, or abnormal reflexes which may suggest spinal cord involvement.

Imaging Tests: After examining the patient, the doctor can use a variety of tests to look at the inside of the body. Examples of these tests include:

Non-Surgical Treatment of Spinal Stenosis

There are a number of ways a doctor can treat spinal stenosis without surgery. These include:

Surgical Treatment of Spinal Stenosis

In many cases, non-surgical treatments do not treat the conditions that cause spinal stenosis; however, they might temporarily relieve pain. Severe cases of stenosis often require surgery.

The goal of the spinal stenosis surgery is to relieve pressure on the spinal cord or spinal nerve by widening the spinal canal. This is done by removing, trimming, or realigning involved parts that are contributing to the pressure.

The most common surgery in the lumbar spine is called decompressive laminectomy in which the laminae (roof) of the vertebrae are removed to create more space for the nerves. A surgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disc. Various devices (like screws or rods) may be used to enhance fusion and support unstable areas of the spine.

Other types of surgery to treat stenosis include the following:

If nerves were badly damaged before the surgery, the patient may still have some pain or numbness after the surgery. Or there may be no improvement at all. Also, the degenerative process will likely continue, and pain or limitation of activity may reappear 5 or more years after surgery.

Most doctors will not consider surgical treatment of spinal stenosis unless several months of non-surgical treatment methods have been tried. Since all surgical procedures carry a certain amount of risk, patients are advised to discuss all treatment options with their doctor before deciding which procedure is best.

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