Spinal stenosis, a narrowing of the spaces in your spine, can compress your spinal cord and nerve roots exiting each vertebrae. Age-related changes in your spine is a common cause. Symptoms include back and/or neck pain, and numbness, tingling and weakness in your arms and legs. Treatments are self-care remedies, physical therapy, medications, injections and surgery.
Spinal stenosis is the narrowing of one or more spaces within your spine. Less space within your spine reduces the amount of space available for your spinal cord and nerves that branch off your spinal cord. A tightened space can cause the spinal cord or nerves to become irritated, compressed or pinched, which can lead to back pain and sciatica.
Spinal stenosis usually develops slowly over time. It is most commonly caused by osteoarthritis or “wear-and-tear” changes that naturally occur in your spine as you age. For this reason, you may not have any symptoms for a long time even though some changes might be seen on X-rays or other imaging tests if taken for another reason. Depending on where and how severe your spinal stenosis is, you might feel pain, numbing, tingling and/or weakness in your neck, back, arms, legs, hands or feet.
Spinal stenosis can occur anywhere along the spine but most commonly occurs in two areas:
Lumbar canal stenosis is the narrowing of the spinal canal or the tunnels through which nerves and other structures communicate with that canal. Narrowing of the spinal canal usually occurs due to changes associated with aging that decrease the size of the canal, including the movement of one of the vertebrae out of alignment.
The narrowing of the spinal canal or the side canals that protect the nerves often results in a pinching of the nerve root of the spinal cord. The nerves become increasingly irritated as the diameter of the canal becomes narrower.
Symptoms of lumbar canal stenosis include pain, numbness or weakness in the legs, groin, hips, buttocks, and lower back. Symptoms usually worsen when walking or standing and might decrease when lying down, sitting, or leaning slightly forward.
Spinal stenosis can develop in anyone but is most common in men and women over the age of 50. Younger people who are born with a narrow spinal canal can also have spinal stenosis. Other conditions that affect the spine, such as scoliosis, or injury to the spine can put you at risk for developing spinal stenosis.
Your spine, (or backbone) is a stack or column of 24 bones (vertebrae) plus the fused bones of the sacrum and coccyx. It begins at the base of your skull and ends at your pelvis. Your spine supports your body’s weight and protects your spinal cord. Each vertebrae has a round front portion (the body), a central ring-shaped opening (the spinal canal), flat bony areas (facet joints) where one vertebrae comes into contact with others above and below it, and bone sections along the sides (transverse processes) and back (laminae). Part of the lamina called the spinous process is the ridge you feel when you run your hand down your back. Between each vertebrae body is a flat, round pad called an intervertebral disk that serves as a cushion or shock absorber. Ligaments are strong fiber bands that hold the vertebrae together, keep the spine stable and protect the disks.
The spinal cord – the body’s “master cable cord” that sends and receives messages between the body (including muscles and organs) and the brain – runs through the center of the spinal canal. It is completely surrounded by the bony parts of the spine. Nerves roots are the initial segment of a bundle of nerve fibers that come off the spinal cord and exit the spinal column through side spaces between the vertebrae called the neural foramen. The nerve fibers or “nerves” (the “mini cable network”) then go out to all parts of the body.
Spinal stenosis has many causes. What they share in common is that they change the structure of the spine, causing a narrowing of the space around your spinal cord and nerves roots that exit through the spine. The spinal cord and/or nerve roots become compressed or pinched, which causes symptoms, such as low back pain and sciatica.
The causes of spinal stenosis include:
You may or may not have symptoms when spinal stenosis first develops. The narrowing of the spinal canal is usually a slow process and worsens over time. Although spinal stenosis can happen anywhere along the spinal column, the lower back (number one most common area) and neck are common areas. Symptoms vary from person to person and may come and go.
While the narrowing of the spine can cause pain, it usually doesn’t cause paralysis. However, if a spinal nerve or the spinal cord is compressed for a long period of time, permanent numbness and/or paralysis is possible. This is why it is especially important to see your healthcare provider right away if you experience numbness or weakness in your arms or legs.
Your healthcare provider will review your medical history, ask about your symptoms and conduct a physical exam. During your physical exam, your healthcare provider may feel your spine, pressing on different area to see if this causes pain. Your provider will likely ask you to bend in different directions to see if different spine positions bring on pain or other symptoms. Your provider will check your balance, watch how you move and walk and check your arm and leg strength.
You will have imaging tests to examine your spine and determine the exact location, type and extent of the problem. Imaging studies may include:
Choice of stenosis treatments depend on what is causing your symptoms, the location of the problem and the severity of your symptoms. If your symptoms are mild, your healthcare provider may recommend some self-care remedies first. If these don’t work and as symptoms worsen, your provider may recommend physical therapy, medication and finally surgery.
Because of the complexity of spinal stenosis and the delicate nature of the spine, surgery is usually considered when all other treatment options have failed. Fortunately, most people who have spinal stenosis don’t need surgery. However, talk with your healthcare provider about surgical options when:
Surgery options involve removing portions of bone, bony growths on facet joints or disks that are crowding the spinal canal and pinching spinal nerves.
Types of spine surgery include:
Laminectomy (decompression surgery): The most common type of surgery for this condition, laminectomy involves removing the lamina, which is a portion of the vertebra. Some ligaments and bone spurs may also be removed. The procedure makes room for the spinal cord and nerves, relieving your symptoms.
Laminotomy: This is a partial laminectomy. In this procedure, only a small part of the lamina is removed – the area causing the most pressure on the nerve.
Laminoplasty: In this procedure, performed in the neck (cervical) area only, part of the lamina is removed to provide more canal space and metal plates and screws create a hinged bridge across the area where bone was removed.
Foraminotomy: The foramen is the area in the vertebrae where the nerve roots exit. The procedure involves removing bone or tissue this area to provide more space for the nerve roots.
Interspinous process spaces: This is a minimally invasive surgery for some people with lumbar spinal stenosis. Spacers are inserted between the bones that extends off the back of each vertebrae called the spinous processes. The spacers help keep the vertebrae apart creating more space for nerves. The procedure is performed under local anesthesia and involves removing part of the lamina.
Spinal fusion: This procedure is considered if you have radiating nerve pain from spinal stenosis, your spine is not stable and you have not been helped with other methods. Spinal fusion surgery permanently joins (fuses) two vertebrae together. A laminectomy is usually performed first and bone removed during this procedure is used to create a bridge between two vertebrae, which stimulates new bone growth. The vertebrae are held together with screws, rods, hooks or wires until the vertebrae heal and grow together. The healing process takes six months to one year.
All surgeries have the risks of infection, bleeding, blood clots and reaction to anesthesia. Additional risks from surgery for spinal stenosis include:
To prepare for spine surgery, quit smoking if you smoke and exercise on a regular basis (after checking with your healthcare provider first) to speed your recovery time. Ask your provider if you need to stop taking any non-essential medications, supplements or herbal remedies that you may be taking that could react with anesthesia. Also, never hesitate to ask your healthcare team any questions you may have or discuss any concerns.
If you’ve had a laminectomy, you may be in the hospital for a day or two. If you’ve had spinal fusion, you may have a three- to five-day hospital stay. If you’re older, you may be transferred to a rehabilitation facility to receive additional care before going home.
You will be given pain medications and/or NSAIDs to reduce pain and swelling. You may be given a brace or corset to wear for comfort. You will likely be encouraged to get up and walk as soon as possible. Your healthcare provider or physical therapist will recommend a light form of exercise right after spinal surgery to insure that your back does not stiffen and to reduce swelling. Your physical therapist will develop an individualized exercise plan to stretch and strengthen muscles to support your back and stabilize your spine.
Taking hot showers and using hot compresses may help alleviate pain. Additionally, using an ice pack may ease pain before and after exercise.
Full recovery after surgery for spinal stenosis and return to normal activities typically takes three months and possibly longer for spinal fusion, depending partially on the complexity of your surgery and your progress in rehabilitation.
If you’ve had a laminectomy, you will likely be able to go back to work at a desk job within a few days of returning home. If you’ve had spinal fusion, you’ll likely be able to return to work a few weeks after your surgery.
Since most causes of spinal stenosis are normal age-related “wear and tear” conditions, such as osteoarthritis and loss of bone and muscle mass, you can’t 100% prevent spinal stenosis. However, you can take certain measures to lower your risk or slow the progression, including:
Also keep in mind that although there is no “cure” for spinal stenosis, its symptoms can be successfully managed with the nonsurgical or surgical options discussed in this article.
First, spinal stenosis develops slowly over time, so you may not have symptoms even though changes are occurring in your spine. Your first noticeable symptoms may be pain, numbness, tingling or weakness in your back or neck or arms and legs depending on the location of the stenosis. Conservative treatments – such as pain-relieving and anti-inflammatory medicines, ice or heat, and physical therapy – may be enough to relieve pain for a period of time. As stenosis worsens and your quality of life is no longer acceptable to you, talk with your healthcare provider. Most people who undergo spinal stenosis surgery achieve good to excellent results with pain relief. Surgery results depend on your general health and presence of other medical conditions, severity and location of your spinal stenosis, experience and skills of your surgeon and your commitment to your recovery plan.
No, spinal stenosis can’t be reversed but the process might be able to be slowed if you take good care of yourself by maintaining a healthy weight, eating healthy foods, exercising regularly to keep your bones and muscles strong, and following your healthcare provider’s instructions to best manage any existing medical conditions you may have. If you do develop symptoms, there are many options – up to and including surgery – that can be considered to relieve your pain and other symptoms so you feel better.
Generally no because the most common causes of spinal stenosis is normal age-related “wear and tear” on the bones and structures of the spine. However, if the cause of your spinal stenosis is a herniated disk, it can sometimes get better on its own with a short amount of rest or with treatments such as physical therapy, anti-inflammatory medications or spinal injections.
Yes. Spinal stenosis can happen in multiple locations at the same time, such as in both the lower back (lumbar spine) and neck (cervical spine).