Spinal Stenosis

Spine Treatment Center

Spinal stenosis is a common cause of back and leg pain caused by the gradual compression of the spine, usually in the lower back (lumbar) or neck (cervical). “Stenosis” means “narrowing,” referring to the narrowing of the spinal canal, or compression. For some, spinal stenosis can be so debilitating it causes pain around the clock, and some patients even become partly or fully paralyzed from long-term spinal nerve compression. While some people are born with a smaller spinal canal and experience stenosis from birth, the vast majority of people who have spinal stenosis are over the age of 50. Untreated spinal stenosis can have dire health consequences, such as chronic pain, as well as permanent numbness, weakness, incontinence, and paraplegia or quadriplegia.

Our Brain, Spine, & Neuromuscular Care Center at The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health offers treatment of all kinds of spinal stenosis, including cervical stenosis, cervical stenosis with myelopathy, lumbar stenosis, and thoracic stenosis. From diagnosis through aftercare and rehabilitation, our team of spinal care specialists, including board-certified neurologists, neurosurgeons, orthopedic surgeons, and support staff, are here to deliver the highest quality care to give you the relief you crave, and get you back on your feet through nonsurgical and/or surgical treatment.

Normal Anatomy of the Spine vs. Spinal Stenosis

To better understand spinal stenosis, it’s helpful to learn more about the anatomy of a normal, healthy human spine. The spine is naturally “S” shaped and has 3 connected “C” shaped curves. The curve of the neck is the cervical spine, the reverse “C” shape of the mid-back attached to the ribs is the thoracic spine, and the lumbar spine is the final “C” shaped curve of the lower back.

The spinal column protects the spinal cord, a critical part of the central nervous system which sends messages from the brain to the rest of your body. The spinal column is made up of small bones called vertebrae, stacked one on top of the other. The spinal cord is a nerve bundle running from the base of the brain to the lower back. The nerves of the spinal column provide sensation to various areas of the body. The spine is also made up of intervertebral disks, which sit between the vertebrae, to cushion the bones. Ligaments connect the vertebrae and help keep the spinal column in place. Finally, the spine is made up of facet joints, which help your spine move.

A normal spine has ample space in the spinal canal for the spinal cord, but in spinal stenosis patients, the nerves and sometimes the spinal cord itself become compressed. The vertebrae (spinal bones) have less of a cushion from the disks over time, which can can cause unnatural, painful rubbing of the bones against one another, ultimately forming bony growths called bone spurs.

Symptoms of Spinal Stenosis

Depending on the location of the spinal compression, and the degree of spinal canal narrowing, symptoms vary. Symptoms can go undetected even by experienced healthcare providers, because often the symptoms are subtle and appear very gradually. Also, many other conditions may mimic the symptoms of spinal stenosis.

The two main kinds of spinal stenosis are lumbar stenosis, which is the most common, and cervical stenosis. The names indicate which part of the spine is affected. Lumbar stenosis occurs when a nerve is pinched in the lowest part of the spine. Cervical stenosis, which occurs when a nerve is pinched in the neck area of the spine, is dangerous because there is a possibility of myelopathy, which is compression of the spinal cord in addition to the nerves. If the spinal cord is compressed, the complications can be severe, and paralysis may result if left untreated.

Another rare form of spinal stenosis is thoracic stenosis, which occurs when the spinal nerve is compressed in the middle/upper portion of the spine attached to the ribcage. Thoracic disk pain is less common, partly because the nerve of the thoracic spine has much more space, reducing the chance of nerve pinching.

Lumbar Stenosis Symptoms

  • Back pain: This pain may or may not be present, depending on the patient’s degree of arthritis.

  • Sciatica: This condition causes burning pain, numbness or tingling in legs, feet, or buttocks. It results from pressure on the spinal nerves causing pain in the areas that control these nerves. Increasing pressure on the nerve causes numbness and tingling along with pain. Not all patients experience both pain and numbness.

  • Weakness in the legs (“foot drop”): Extreme pressure on the spinal nerve causes weakness in one or both legs. Foot drop is a sensation of the foot slapping the ground when walking.

  • Less pain when sitting or leaning forward: Sometimes, leaning forward relieves pressure from the nerves.

Cervical Stenosis with Myelopathy Symptoms

  • Neck pain: This may or may not be present, and neck pain alone is often not indicative of cervical stenosis.

  • Numbness and/or tingling in the hands, arms, feet or legs: This is caused by a pinched nerve.

  • Difficulty balancing, walking, or coordination: The impaired function of the spinal cord can create clumsiness.

  • Loss of bowel or bladder function: Because the spinal cord cannot relay messages from the brain properly, some patients lose control of their bowel or bladder functions.

  • Paralysis, if the compression is chronic: The spinal cord is an extension of the brain, and any spinal cord injury will be irreversible and cause permanent damage.

Thoracic Stenosis Symptoms

  • Pain in the back and legs

  • Problems with balance and/or coordination

  • Incontinence, urgency to urinate

Causes of Spinal Stenosis

Most people with spinal stenosis do not have a congenital disorder causing the narrowing of the spine. Instead, the spinal canal narrows when something happens to the spine, such as trauma or bone overgrowth.

Some of the most common causes of spinal stenosis include:

  • Age: Spinal stenosis is most common in adults over the age of 50, due to wear and tear of the spine over the years, and degeneration of the disks.

  • Herniated disks: These are the soft cushions acting as shock absorbers between each vertebra. They become worn out as we age and can lead to stenosis.

  • Bone overgrowth: Bone spurs are caused when osteoarthritis of the spine becomes so severe that the disks deteriorate, and the vertebrae begin to rub together. To compensate for the loss of the cushioning tissue, the bones overgrow and fuse together.

  • Tumors: Although it is an uncommon cause of spinal stenosis, these abnormal growths can form inside the spinal cord, causing narrowing and compression of the nerves.

  • Trauma: Injury to the spinal cord can create dislocations or fractures of one or more vertebrae, damaging the spinal canal.

Why Is Spinal Stenosis More Common in Older Adults?

Spinal stenosis is strongly correlated with older adults, because the spine changes as we age. As many as 95% of people will experience some degenerative condition by the age of 50, according to the American Academy of Orthopaedic Surgeons. Aging can lead to degeneration of the spine’s disks, bones, and joints. Arthritis is a common spine problem associated with older adults, as the joints in the spine wear down over time. While the majority of adults experiencing arthritis only need to modify their lifestyles to lessen symptoms, such as getting down to a healthy weight and eliminating tobacco use, for others, more drastic steps need to be taken to achieve relief of stenosis symptoms.

How Is Spinal Stenosis Diagnosed?

  • Physical Exam: Your doctor will take a complete medical history, including asking about your symptoms and how long they have lasted. Your range of spinal motion will be tested, as well as balance and coordination testing. A neurologist can tell if you have experienced a loss of reflexes or abnormal reflexes, as well as unusual muscle weakness, or loss of sensation.

  • Imaging tests: X-rays show dense structures, mainly the bones, and these alone can reveal if a patient has osteoarthritis and indicate the need for further testing if there are correlative symptoms of stenosis. Magnetic resonance imaging (MRI) scans create images of the softer tissues inside the body, and can be more useful to the physician, as MRI scans show a clearly defined image of the extent of the patient’s stenosis and neurologic compression. If an MRI is not possible because the patient has a metallic device in the body, such as a cardiac pacemaker, other imaging tests such as computed tomography (CT) scans will be utilized.

  • Myelogram: This procedure involves injecting a liquid dye into the spinal column to show whether there is pressure on the spinal cord, herniated disks, bone spurs, or tumors.

  • Lab tests: Although there are no lab tests that specifically indicate spinal stenosis, it can be useful for the physician to rule out any other medical conditions.

Spinal Stenosis Treatment Options

Treatment options for spinal stenosis vary depending on the severity of the patient’s neurologic compression and their symptoms. Some patients with milder spinal stenosis respond well to conservative treatments, at first, or may require no further treatment. Patients with severe spinal cord compression are often good candidates for surgical treatment, which serves to remove compression of the spinal cord to improve the patient’s pain level and ability to function, as well as to prevent deterioration or worsening of pain.

Nonsurgical Treatment

The purpose of nonsurgical treatment for spinal stenosis is to restore function and relieve pain. While these do not improve the narrowing of the spinal canal, treatment can help with associated symptoms. Some of the most commonly used nonsurgical therapies for spinal stenosis include:

  • Physical therapy: This is particularly useful for those who only have a minor case of stenosis.

  • Lumbar traction: This program assists in calming inflammation and easing pain to improve mobility and strength. Traction therapy involves gentle stretching of the joints and muscles of the spine to provide relief of symptoms.

  • Epidural steroid injections: These can reduce arthritis symptoms and pain, and help with irritation and swelling where the spinal nerves are being pinched.

  • Medication: Anti-inflammatory pills, muscle relaxants, or painkillers may be useful for patients with spinal stenosis.

  • Alternative medicine: You may decide to try massage therapy, chiropractic treatment or acupuncture, but you should first seek the advice of your medical doctor before trying these additional therapies. Alternative medicine is not proven to work for provide long-term relief. Chiropractic care must be discussed with your medical doctor first, as it may be dangerous to attempt on patients with severe stenosis.

Surgical Treatment

The purpose of surgical treatment is to permanently decompress the spinal canal, which can be performed in several ways. While surgery may be a first-line treatment for many, nonsurgical treatments are sometimes exhausted before surgery is considered.

Types of surgery for spinal stenosis include:

  • Laminectomy (decompression): This surgery removes bone, bone spurs and ligaments which are compressing the nerves. It can be performed either through the traditional “open” method, or through a minimally-invasive method with smaller incisions, where your surgeon will be guided through an arthroscopic camera. Your surgeon will discuss the pros and cons of each type of surgery with you.

  • Foraminotomy: This is another type of decompression surgery which is performed to enlarge the spinal canal’s passageway where the spinal nerve is compressed. During the surgery, a piece of bone or tissue obstructing the passageway is removed.

  • Spinal fusion: If the spine is particularly unstable and the patient has arthritis, the patient may be treated with a combination therapy of spinal fusion and laminectomy.

Risks of Spinal Stenosis Surgery

Any surgical procedure has risks, and spinal stenosis risks include adverse reaction to anesthesia, bleeding, infection, and blood clots. Risks are higher for elderly patients, as well as patients who smoke, are overweight, have diabetes, or have multiple medical problems.

Specific risks of surgery for spinal stenosis include failure of the bones to heal, nerve injuries, tearing of the sac covering the nerves, failure to relieve symptoms, return of symptoms, or the need for further surgery.

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