Learning "What is Spinal Stenosis?" will help you understand and recognize what is causing your pain. It will help you know when your symptoms can be treated at home and when you need to see the doctor.
If you do need to be seen by a doctor, understanding Spinal Stenosis will help you understand what he is talking about, what your treatment options are, and which treatments are best for you. Being informed will help you be an active member of your health care team.
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What is Spinal Stenosis?
Spinal stenosis is a narrowing of the space for the nerves in the spinal canal. Most often it is a degenerative condition of the spine that causes pressure on nerves. Spinal stenosis occurs most commonly in the lumbar or cervical spine. It is much less common in the thoracic spine.
What Causes Spinal Stenosis?
In general, the most common causes of spinal stenosis is a lifetime of bending and lifting which leads to arthritis and other degenerative changes in the lumbar or cervical spine. These changes cause a narrowing of the space for the nerves.
There are also traumatic and congenital causes of spinal stenosis, but by far the most common cause is degenerative and arthritic changes in the spine. There is normally three different things that contribute to this narrowing of the space for the nerves:
Facet Joint Arthritis
The facet joints are the small joints that connect your vertebra together. When they get arthritis they get big and overgrown with bone spurs growing into the space for the nerves.
The interspinous ligaments are wide flat ligaments that run along the inside of the spinal canal connecting all of the vertebra together. A lifetime of bending and lifting causes these ligaments to become thick and overgrown; this takes away from space available for the nerves.
Intervertebral Disc Bulges
Between each pair of vertebrae are the intervertebral discs. These discs act as shock absorbers between the vertebrae. Similar to a jelly roll, around the outside they are a tough ligamentous type material called the annulus, and on the inside is a softer center called the nucleus pulposis. When the annulus becomes weakened it may bulge into the spinal canal causing pressure on the nerves.
It Is All About The Nerves
When you have spinal stenosis it is usually some combination of these three things that come together causing pressure on the nerves and resulting in your symptoms.
When the nerves in your neck or low back are being squeezed it will cause pain, numbness, or other problems in the area that that nerve serves. Over years, as the arthritis progresses, pressure on the nerves will increase and your symptoms will grow more severe.
What are Spinal Stenosis Symptoms?
The most common Spinal Stenosis Symptoms are low back pain radiating into one or both buttocks. Other common symptoms include lower extremity numbness and/or weakness. Cervical spinal stenosis will cause similar symptoms in your neck and upper extremities.
The symptoms of spinal stenosis can be very variable. Some people with lumbar spinal stenosis may have only buttock and thigh pain, known as Sciatica,without back pain. Someone else may have only weakness or numbness, in one or both legs.
More Severe Symptoms
Problems controlling your bowels or bladder can also be a symptom of spinal stenosis, and these problems also can be very variable. Some people may have incontinence, while others have difficulty starting their urine stream or completely emptying their bladder. Severe symptoms may lead to Cauda Equina Syndrome and require immediate surgery.
Numbness in the perirectal or genital area can also be a sign of spinal stenosis. You may notice a lack of sensation when you are wiping after a bowel movement, or you may not be able to sense the need to have a bowel movement or empty your bladder, or you may not be able to tell when you are going.
The symptoms of spinal stenosis are caused by pressure on the nerves. Which symptoms you develop will depend on exactly which nerves are being squeezed, how tightly they are being squeezed, and for how long they have been squeezed.
What are the treatments for spinal stenosis?
Spinal Stenosis Treatment involves taking steps to remove pressure from the nerves. When you decompress the nerves your pain and other symptoms should improve. How much improvement you get will depend on how tightly the nerves were compressed and how long the nerves were compressed.
The best treatment for spinal stenosis will be the treatment that is the least invasive and requires the least amount of medication. Responsible doctors will always trial the most conservative treatments first. If your pain and symptoms do not improve to where you can go about your normal activities, then you can consider more aggressive treatment.
In the Beginning
Initial treatments can consist of weight loss, postural correction, and activity modification. When you are overweight it puts an additional stress on the discs and facet joints in your back. Additional weight will cause swelling and inflammation of these small joints leading to increased pressure on the nerves.
Correcting your posture can help to remove disc bulges and relieve pressure on the nerves. Your spine was designed to stand upright with your head up, not slouched in a chair or hunched over a computer.
Activities that involve a significant amount of bending and lifting will also aggravate the arthritis in your back. Avoiding these activities will allow the swelling and inflammation to subside, making more room for the nerves.
Additional Conservative Therapy
When your pain and other symptoms do not improve you may consider over the counter medications. Acetaminophen and nonprescription anti-inflammatory drugs are generally considered safe and can be helpful for relieving the swelling and inflammation of arthritis.
Topical treatments that you apply directly to the skin, such as creams or patches, may help to relieve symptoms. Some may use a sensation of warmth that can be soothing and help to relax tight muscles. Others may use mild chemical irritation or stimulation to block or confuse the pain signal.
More Aggressive Treatments
When moderate treatments do not relieve your pain, and allow you to return to living your life, you should consider seeing your doctor. He can examine you and order the appropriate tests to find out more about exactly what is the cause of your spinal stenosis.
If your pain is severe your doctor may prescribe strong prescription anti-inflammatories or narcotic pain medications. If your range of motion is limited, and you are unable to get around, he may send you to physical therapy for aggressive stretching and strengthening exercises.
If the evaluation indicates that you may have severe arthritis causing pressure on the nerves in your back he may send you for epidural steroid injections. Steroid medications are strong anti-inflammatories that can be injected in around the nerves. They can relieve pain and other symptoms by relieving swelling and inflammation.
If conservative treatments fail to relieve your spinal stenosis symptoms your doctor may talk to you about spinal stenosis surgery. This could involve a variety of different surgical treatments depending on the exact situation. The goal would be to decompress or remove the pressure from the nerves.
Your surgeon would have to determine the best approach and surgical plan. Everybody with spinal stenosis has a different situation that must be considered. Your surgeon would have to consider your general health and any other medical problems you may have.
He must consider the severity of your spinal stenosis symptoms and how much surgery will be required to relieve your symptoms. If there is instability or abnormal motion in your spine he may talk to you about a spinal fusion.
This surgeon will discuss the risks and benefits of surgery. With any surgery there are risks, more extensive surgeries involve bigger risks. Your surgeon will develop a surgical plan that uses the least amount of surgery that your doctors think will effectively relieve your symptoms.
Recognize Your Symptoms
Anybody over the age of 50 who is experiencing low back pain radiating into your buttocks or thighs should at least consider the possibility of spinal stenosis. The symptoms develop very gradually over many years. Sometimes people do not even realize that they can no longer stand up straight or walk very far.
When you recognize your symptoms early you have a better chance that conservative treatments will be effective. If you think you may be having symptoms of spinal stenosis but you do not feel limited in your activities you could try some of the more moderate steps to see if they make a difference.
If your symptoms are severe enough that they limit your everyday activities, or prevent you from doing the things that you want to do, you should get in to see your doctor. An early evaluation and getting started with a conservative treatment program can prevent severe symptoms and the need for surgery in the future.