Spinal Stenosis
Pinching spinal cord
The spinal cord is a cylindrical bundle of nerve fibers and associated tissue that is enclosed in the spine and connects nearly all parts of the body to the brain. Your spine, or backbone, protects your spinal cord and allows you to stand or bend. Spinal stenosis is a common condition that occurs when the small spinal canal, which contains the nerve roots and spinal cord, becomes compressed. This causes a “pinching” of the spinal cord and or nerve roots, which leads to pain, cramping, weakness or numbness. Depending on where the narrowing takes place, you may feel these symptoms in the lower back and legs, neck, shoulder or arms. The pain may come on more quickly when walking up or down a hill or steps. The impact of the disease varies from person to person. Spinal stenosis is most common in men and women over 50 years old but younger people who were born with a narrow spinal canal or who hurt their spines may also get it.
Small spinal canal
Spinal stenosis can be caused by a number of things. Some people are born with a small spinal canal. This is called “congenital stenosis”. However, spinal narrowing is most often due to age-related changes that take place over time. This is called “acquired spinal stenosis.” An overgrowth of bone in the spine can cause this kind of stenosis. Damage from osteoarthritis on your spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal. Paget’s disease, a bone disease that usually affects adults, can cause bone overgrowth in the spine. Though degenerative changes can cause spinal stenosis in younger people, other causes need to be considered. Car accidents and other trauma can cause dislocations or fractures of one or more vertebrae. Displaced bone from a spinal fracture may damage the contents of the spinal canal. Swelling of nearby tissue after back surgery can also put pressure on the spinal cord or nerves.
Seen in a scan
Evidence of spinal stenosis usually shows up when someone gets an MRI or CT scan. In some cases, the patient may not have any symptoms but when they do occur, they usually start gradually and get worse over time. The symptoms will vary depending on the location of the stenosis and which nerves are affected. If it’s in the neck, the patient typically experiences neck pain, weakness in a hand or foot and problems with their balance. In severe cases, bowel or bladder dysfunction may occur. If the stenosis is in the lower back, numbness, tingling or weakness in a foot or leg is usually the first symptom. Pain or cramping in one or both of the legs will occur after standing for long periods of time. Such pain usually eases when the patient bends forward or sits. Left untreated, severe spinal stenosis can cause permanent weakness and even paralysis. That’s why it’s a good idea to see a physician if you have any of these symptoms.
Improving your balance
There is no cure for spinal stenosis but there are certain steps you can take to provide relief from the pain and swelling the disease causes. Regular exercise can help you build and maintain strength in the muscles of your arms and upper legs. This will improve your balance, ability to walk, bend and move about, as well as control pain. Over-the-counter medications such as acetaminophen or nonsteroidal anti-inflammatories such as ibuprofen or naproxen may also relieve pain. Cortisone injections directly into the spinal cord can provide temporary relief and are done on an outpatient basis. Those patients who don’t respond to these therapies may be candidates for a decompression laminectomy. This surgery removes the bony spurs and buildup of bone in the spinal canal, freeing space for the nerves and spinal cord. Afterwards, doctors often perform a spinal fusion to connect two or more vertebrae and better support for the spine.
Slow progression
Spinal stenosis can lead to the slow but steady loss of strength in the legs. The severe pain caused by this condition can be quite disabling, even if you have no muscle weakness, since it greatly affects your ability to work and enjoy life. The natural course of the disease is one of slow progression over time. One thing you can do to deal with the illness is get moving. Regular exercise is very important, so do it often, at least three times a week for about 30 minutes. Start slowly with forward-bending exercises. As you begin to feel stronger, add walking or swimming to your plan. Don’t do anything that can trigger or worsen pain and disability such as lifting heavy objects or walking long distances. Talk to your physician about pain medications, as well as alternative therapies such as acupuncture or massage that can ease the pain. And be sure explore non-surgical options except in rare cases when pain, weakness and numbness comes on quickly.
Trusted by thousands of listeners every week, T. Glenn Pait, M.D., began offering expert advice as the host of UAMS’ “Here’s to Your Health” program in 1996. Dr. Pait began working at UAMS in 1994 and has been practicing medicine for over 20 years.