FAQ’s on Spinal Stenosis
What is Spinal Stenosis?
Spinal stenosis is a condition that causes narrowing in the spinal cord. The condition is quite problematic as painful symptoms caused by nerve compression can arise. Spinal stenosis can occur in many locations up and down the spine, and often affects multiple spinal levels simultaneously. The condition affects millions of people on a daily basis.
What Causes Spinal Stenosis?
Spinal stenosis occurs when arthritis sets in, and the body attempts to correct the degenerating joint(s) through the growth of more bone and soft tissue. The facet joints of the spine begin to rapidly lose cartilage, which can cause the onset of painful symptoms and limited mobility. To make matters worse, the body begins to create extra soft tissue and bone in an attempt to correct the stenosis, which causes a negative effect (you don’t want or need the extra tissue). The already cramped area of the spine becomes overgrown with tissue and bone leading to nerve compression.
Older individuals ages 50 and above are most at risk for developing spinal stenosis. The aging process causes wear and tear on the spine increasing the chances of developing spinal stenosis as each decade passes. There are other reasons for developing the condition including arthritis caused by an acute back injury and congenital issues such as dwarfism, but the vast majority of causes are wear and tear arthritis of the spine.
What are the Symptoms of Spinal Stenosis?
The most common symptom of spinal stenosis is an aching feeling radiating down into the buttocks and hip areas. It is common for individuals to believe they have problems with their hip because of the location of the pain. In some instances the pain may be worse at certain parts of the day and as the weather shifts. In extreme cases the pain may extend down into the legs, often both at the same time.
It is important to have a correct diagnosis as the symptoms of spinal stenosis are similar to other health issues. For example, stenosis that causes pain the in the lower body is referred to as neurogenic claudication. This type of spinal stenosis results from the lack of oxygen due to the nerves being compressed. It is similar in symptoms to a condition known as vascular claudication, which is a result of problems with the blood vessels. But the treatment is very different.
It is important to note that not all individuals with evidence of spinal stenosis experience symptoms. Typically they start out gradually and grow progressively worse over time. Symptoms can vary depending on the location of the stenosis. Spinal stenosis in the cervical spine, located in the upper neck, can cause tingling andweakness in the legs, foot, arms and even hands. But if no symptoms are present and severe stenosis is seen on an MRI, it does not mean treatment is necessary.
Spinal stenosis in the lumbar spine (lower spine) can lead to pain, numbness and cramping in the legs. These symptoms can be exacerbated when standing, sitting or engaged in intense physical activity for long periods of time.
How is Spinal Stenosis Diagnosed?
There are a variety of imaging tests used to diagnose spinal stenosis. Because the condition’s signs and symptoms closely mirror other health issues, it is necessary to use these types of tests to get an accurate diagnosis. Imaging tests include:
- X-rays: X-rays may or may not confirm the presence of spinal stenosis, but they are helpful in terms of ruling out other health issues.
- Magnetic resonance imaging (MRI): MRI is the most widely used test to diagnose spinal stenosis. This powerful test creates cross-sectional images of the spine to detect damage to the ligaments, disks, and how much pressure is on the spine.
- CT Myelogram: This test is a computerized tomography in combination with an x-ray. The test includes taking several images of the body including the spinal area. A dye is first injected to outline the spinal cord and surrounding nerves. A CT Meyleogram often reveals bone spurs, tumors and damages disks.
What are the Treatments for Spinal Stenosis?
There are a variety of treatment options for spinal stenosis including NSAIDs, prescription drugs, therapy and surgery. Medications vary from over the counter pain relievers and anti-inflammatory drugs such as ibuprofen, naproxen and acetaminophen to prescription drugs such as muscle relaxants, antidepressants, anti-seizure medication and opioids. Membrane stabilizing agents such as Neurontin and Lyrica are commonly used as well to help moderate the nerve pain.
There are a number of non-surgical treatment options that have proved effective including physical therapy to build strength and flexibility as well as steroid injections into the spine to relieve pressure to the nerves. Research shows that injection therapy is a very effective non-surgical method for relieving pain (Delport et al, 2004, Arch Phys Med Rehab). In particular, epidural injections are effective approximately 75% of the time, and can be performed in an outpatient setting. A series of three injections over six weeks may be necessary for optimal pain relief, which can be repeated every few months.
Spinal decompression therapy may relieve pain for months at a time. It is a low risk, FDA cleared treatment that involves intermittent traction through the cervical or lumbar spine. It does not fix the problem of spinal stenosis, but may be great at relieving pain. A TENS unit may also help alter the way the brain perceives pain signals by supplying a small electrical impulse through the skin.
For individuals who do not respond to less invasive treatment, surgery is usually performed where the physician will remove the elements that are compressing the nerves of the spine with a procedure called a laminectomy. It is important to speak with a healthcare provider if you are experiencing any of the above signs and symptoms.
The US Pain Network connects those in pain with pain management clinics nationwide. Surgery for spinal stenosis is an elective last resort option, conservative treatment at a pain clinic often provides relief without the risk!