Spinal Stenosis | PainDoctor.com

What Is Spinal Stenosis?

Do you suffer from back pain that typically worsens while standing up, or radiates out into your arms and legs? You may be suffering from spinal stenosis.

Occurring most frequently among adults over the age of 50, the condition involves the narrowing of the spinal canal, leading to compression of the spinal cord and nearby nerves. The spine is comprised of 26 stacked bones, known as vertebra. These bones provide structure for the body and serve to protect the spinal cord. Despite this protection, the spinal cord can be vulnerable to compression in several areas, including:

  • The hollow area in the middle of the spine (i.e., the spinal canal)
  • The areas where peripheral nerves branch off of the spinal cord
  • The space between vertebrae

When the spinal cord compresses at these areas, it can lead to symptoms of chronic pain and discomfort, as well as reduced mobility of the lower extremities.

Spinal Stenosis | PainDoctor.com

In some instances of spinal stenosis, the patient may report no symptoms. Typically, though, symptoms do tend to emerge slowly and progressively worsen over time. Some of the most common spinal stenosis symptoms include:

  • Neck pain, related to cervical spinal stenosis
  • Lower back pain, related to lumbar spinal stenosis
  • Limb pain (i.e., pain in the legs and arms)
  • Limited mobility
  • Muscle cramping
  • Numbing sensations
  • Muscle weakness
  • Foot problems
  • Pain that radiates down the leg
  • Pain that increases when standing, rather than sitting or lying down

These symptoms of spinal stenosis can begin to cause impairments in the patient’s daily functioning. For instance, patients may begin to have difficulty standing for extended periods or trouble walking. Further, they may be unable to tolerate being active on a day-to-day basis.Spinal Stenosis | PainDoctor.com

Causes Of Spinal Stenosis

While spinal stenosis occurs most frequently among older adults, the condition can also be congenital.

Most cases of spinal stenosis emerge as the result of degenerative arthritis. Degenerative arthritis develops from typical daily wear and tear placed on the spine. This daily stress over time leads to a breakdown in the connective tissue that normally provides cushioning between the individual bones of the spinal column. Once the connective tissue begins to break down, the risk for developing a bulged intervertebral disc, bone spurs (i.e., osteophytes), or even thickened soft tissue between the vertebrae within the lower back, neck, and upper back is increased. These conditions carry with them risk for nerve compression within the spine.

Some instances of spinal stenosis are not the result of damage or injury later in life. Indeed, some cases of spinal stenosis are present at birth, though it is relatively rare for individuals to be born with a narrowed spinal canal. Individuals who have a family history of either spinal stenosis or chronic lower back pain are considered to be at increased risk for developing complications related to the condition.

Some cases of spinal stenosis may be related to a more serious condition, known as cauda equine syndrome. This condition arises as the result of compressed nerves within the lower back. It is recommended that you contact your doctor immediately if you have any of the following symptoms:

  • Loss of bladder or bowel control
  • Sexual difficulties
  • Weakness, numbing, or pain in one or both legs

Spinal Stenosis Risk Factors

Older individuals with degenerative disease are considered most at risk for developing this condition. Other risk factors that are believed to increase your risk for developing this condition include:

  • Hypertension
  • Scoliosis
  • Poor posture
  • Frequent overextension of the back and spine
  • Being overweight
  • An unbalanced alignment
  • A medical history of back pain or injury

Spinal Stenosis Treatment

The most important aspect of treating spinal stenosis correctly is getting an accurate diagnosis. Some of the more common symptoms of this condition can also occur in other related conditions. Treating spinal stenosis, however, requires a different set of tools than treatment for most types of back pain. Your pain doctor will generally want to review your medical history, as well as perform an in-depth physical exam in order to diagnose this condition.

Physical examination includes inspection of the spine and lower extremities. The physician will assess for degree of mobility, joint stiffness, and reported pain or other sensations. Additional imaging techniques may be utilized in order to get a more accurate assessment of the severity of the condition. These techniques include magnetic resonance imaging (MRI), X-rays, computerized axial tomography (CAT), myelogram, ultrasounds, or bone scans.

Once the physician has determined that spinal stenosis is the cause for your symptoms, they will review appropriate treatment techniques. In some cases, over-the-counter (OTC) medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), have proven effective for reducing the pain associated with spinal stenosis. However, some instances of the condition are characterized by more severe degrees of pain that are not responsive to these types of medication. Opioid medications may then be recommended, as they are more effective for providing relief from severe cases of refractory pain. However, other treatment options are available to patients, as opioids come with a host of side effects and risks.

Spinal Stenosis | PainDoctor.com

Alternative treatments for spinal stenosis

Individuals may also wish to consider alternative treatment methods. These methods do not require the use of medications and can (and should!) be used in conjunction with other treatments to provide added benefit. These techniques include:

In some instances, alternative methods may be preferred, as they are safe and do not require the use of drugs. At-home spinal stenosis exercises you can do if you suffer from mild cases of spinal stenosis include core strengthening exercises, short and frequent bouts of walking, or simple stretches. Find all of our exercise suggestions here.

Interventional treatments for spinal stenosis

Other options are available for treating refractory instances of spinal stenosis pain. In the majority of cases, patients should consider using alternative therapies in conjunction with more interventional treatment options. For example, epidural steroid injections can help a patient reduce pain so they can more fully participate in physical therapy. Likewise, dietary and fitness changes can improve overall well-being and reduce stress and tension in the body.

Interventional methods target the transfer of pain signals between the peripheral nerves and the spinal cord and brain. Some examples that have received support in reducing pain include:

Working with a pain doctor can help you decide which of these options could work for you.

Surgery for spinal stenosis

While many of these treatment techniques are effective for spinal stenosis pain, a small portion of cases may not be responsive to intervention. These patients suffer from severe and unremitting pain that interferes with daily functioning. In these cases, surgery may be the only option. If you believe you may need surgery for your pain, make sure that you have tried other options first, as surgery is an invasive process with its own risks.

Conclusion

This pain condition develops as the result of spinal canal narrowing. When the connective tissue of the spinal column becomes compromised, the spinal cord and spinal nerves are at risk for injury or damage. Thus, the pain and discomfort experienced as a result of spinal stenosis may be related to compression of the spinal cord and spinal nerves. In many instances, symptoms of spinal stenosis can begin to interfere with an individual’s daily functioning.

If you suffer from spinal stenosis, there are a range of treatment options available, from at-home remedies to surgical options. Treatment options available include non-steroidal anti-inflammatory drugs (NSAIDs), opioid medications, epidural steroid injections, chiropractic care, acupuncture, or other relaxation practices. In cases of unremitting pain, despite previous treatment attempts, surgery may be the only option for relieving symptoms related to spinal stenosis.

If you need help diagnosing your pain, talk to a pain doctor today.

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References

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  2. Atlas SJ, Delitto A. Spinal stenosis: surgical versus nonsurgical treatment. Clin Orthop Relat Res. 2006;443:198–207.
  3. Ciol MA, Deyo RA, Howell E, et al. An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. J Am Geriatr Soc. 1996;44:285–90.
  4. Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI. United States trends in lumbar fusion surgery for degenerative conditions. Spine. 2005;30:1441-1445.
  5. Kapural L, Mekhail N, Bena J, et al. Value of the magnetic resonance imaging in patients with painful lumbar spinal stenosis (LSS) undergoing lumbar epidural steroid injections. Clin J Pain. 2007;23:571–5.
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