Spinal Stenosis

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Introduction

What is spinal stenosis?

Spinal stenosis is a condition in which the spinal cord is compressed because of a narrowing of either the spinal canal within the spinal column, or the openings through which nerves extend away from the spinal column.

The spinal column refers to the column created by your vertebrae. This column is hollow at its core, creating a spinal canal to house and protect the spinal cord, which is a long, tube-shaped bundle of nerves that extends from the brain. Nerves exit this column and extend to all parts of your body, leaving the spinal column through openings in the backbone called the neural foramina. When these hollow spaces narrow (a process called stenosis), pressure is put on nearby nerves.

Spinal stenosis can be caused by arthritis, as well as degeneration of your bones and discs through the aging process. It can also be caused by a congenital defect (present at birth), by injury, spinal tumors, or bone diseases. In some cases, any kind of surgery on the spine can also lead to spinal stenosis.

You can have spinal stenosis and still lead an active life for years. However, in some cases you may need surgery to relieve pressure or partial pressure on your spinal cord. Because surgery has adverse effects of its own, you and your physician will need to weigh your options carefully.

Spinal cord compression from spinal stenosis can lead to a serious injury of various nerves in your body and this damage can become permanent, even after relieving that pressure. Seek immediate medical care (call 911) for serious symptoms of nerve compression, such as loss of sensation in the limbs or shoulders; a complete loss of balance; or loss of bladder or bowel control, especially in combination with weakness in your legs. Also seek immediate care for serious symptoms, such as abnormal sensations or sudden weakness or numbness on one side of your body, paralysis, and changes in level of consciousness.

Seek prompt medical care if you are being treated for spinal stenosis but symptoms recur or are persistent.

Symptoms

What are the symptoms of spinal stenosis?

Symptoms of spinal stenosis may develop gradually and increase over time. Sometimes they occur on only one side of the body, depending on which nerves are being compressed or stressed.

Common symptoms of spinal stenosis

You may experience spinal stenosis symptoms constantly or on and off during the day. At times any of these symptoms can be severe:

  • Bilateral numbness on the soles of the feet
  • “Foot drop” (feeling of the foot slapping the ground; caused by leg weakness)
  • Lower back pain
  • Muscle spasms
  • Muscle weakness in one or more limbs
  • Pain, numbness or tingling in one leg or buttock
  • Pain, numbness or tingling in the neck, shoulder or arm
  • Pain on standing
  • Sciatica (shooting pain down the full extent of the back of one leg)
  • Urinary symptoms

Symptoms that might indicate a serious condition

In some cases, spinal stenosis can be a serious condition that should be immediately evaluated in an emergency setting. Its symptoms may also mimic those of stroke or other serious conditions. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms including:

  • Abnormal sensations, numbness, or weakness on one side of the body
  • Impaired balance and coordination
  • Loss of bladder or bowel control
  • Loss of sensation in a limb or limbs
  • Muscle weakness in the arms or legs
Causes

What causes spinal stenosis?

Spinal stenosis can be caused by arthritis, as well as degeneration of the bones and discs through the aging process. It can also be caused by a congenital defect (present at birth), by injury, chronic infection or inflammation, spinal tumors, or bone diseases. In some cases, any kind of surgery on the spine can also lead to spinal stenosis.

Causes of spinal stenosis

The following conditions can all cause spinal stenosis:

  • Ankylosing spondylitis (inflammation of joints between the vertebrae of the spine)

  • Arthritis

  • Bone disease, such as osteoporosis, Paget’s disease (abnormal bone tissue loss and reformation) or achondroplasia (inherited disorder that causes defective bone growth)

  • Chronic spinal infection or inflammation

  • Congenital (birth) defect

  • Degenerative disc disease

  • Herniated disc

  • Injury leading to pressure on nerve roots or spinal cord

  • Osteophyte formation

  • Postsurgical changes

  • Scoliosis (abnormal curvature of the spine)

  • Spinal tumors and cysts

    What are the risk factors for spinal stenosis?

    Several factors increase the risk of developing spinal stenosis. Not all people with risk factors will get spinal stenosis. Risk factors for spinal stenosis include:

    • Advanced age

    • Arthritis

    Treatments

    How is spinal stenosis treated?

    The preferred treatment for cases of persistent back pain from spinal stenosis is a combination of physical therapy, prescribed exercise, and medications for chronic pain. In some cases, you may benefit from steroid injections for temporary pain relief. Only if you have persistent pain, or if your pain does not respond to these efforts, will your physician consider surgery to relieve the pressure on the affected nerves or on your spinal cord.

    Nonsteroidal anti-inflammatory analgesics for chronic pain in spinal stenosis

    The most common treatment for chronic pain in spinal stenosis is nonsteroidal anti-inflammatory drugs (NSAIDs). These include:

    • Celecoxib (Celebrex)

    • Diclofenac (Voltaren)

    • Ibuprofen (Advil, Motrin)

    • Indomethacin (Indocin, Indocin SR)

    • Naproxen (Aleve, Naprosyn)

    • Oxaprozin (Daypro)

    Other pain medications that may be helpful:

    • Acetaminophen (Tylenol)

    • Tramadol (Ultram) a narcotic-like pain reliever

    Nerve pain medications

    Some medications focus specifically on nerve pain and include:

    • Duloxetine (Cymbalta)

    • Gabapentin (Neurontin)

    • Pregabalin (Lyrica)

    Anticonvulsants to control pain in spinal stenosis

    Two anticonvulsant agents in particular have been found to help with pain control in spinal stenosis by decreasing abnormal electrical activity. These include:

    • Carbamazepine (Carbatrol, Equetro, Tegretol)

    • Phenytoin (Dilantin, Phenytek, Di-Phen)

    Tricyclic antidepressants for chronic pain in spinal stenosis

    A tricyclic antidepressant can be helpful in pain management for spinal stenosis, in particular amitriptyline (Elavil, Endep, Vanatrip).

    Steroid injections

    In some cases, you may benefit from steroid injections for temporary pain relief. These include:

    • Cortisone (Celestone, Kenalog)

    • Methylprednisolone acetate (Depo-Medrol, Medrol)

    Surgical Treatments

    In some cases you may need surgery to relieve spinal stenosis, particularly if a disc fragment is lodged in your spinal canal and is pressing on a nerve, which can cause significant loss of function.

    What you can do to improve your spinal stenosis

    In addition to using medications to reduce chronic back pain, you can also maximize your mobility and minimize stiffness by:

    • Attending physical therapy as prescribed by your medical practitioner

    • Consulting a chiropractor for pain relief from lumbar stenosis (warn your practitioner if you have osteoporosis or herniated disc)

    • Exercising and remaining physically active

    • Practicing exercises and lifestyle changes as directed by your medical practitioner or physical therapist

    Complementary treatments

    Some complementary treatments may help some people to better deal with spinal stenosis and its treatments. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

    Complementary treatments may include:

    • Acupuncture

    • Biofeedback

    • Massage therapy

    • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products

    • Yoga

    What are the potential complications of spinal stenosis?

    Complications of untreated or poorly controlled spinal stenosis can be serious. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of spinal stenosis include:

    • Adverse effects of treatments

    • Dependence on pain medications

    • Diminished overall quality of life

    • Disability

    • Immobility

    • Injury to the legs or feet due to loss of sensation

    • Permanent loss of sensation

    • Permanent nerve damage or disability

    • Permanent or chronic pain

    • Progression of symptoms

    • Worsening of infections due to loss of sensation

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    Medical Reviewer: William C. Lloyd III, MD, FACS
    Last Review Date: 2018 Nov 18
    1. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
    2. Lumbar spinal stenosis. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00329
    3. Spinal stenosis. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001477/
    4. Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med 2008; 358:818.
    5. Atlas SJ, Delitto A. Spinal stenosis: surgical versus nonsurgical treatment. Clin Orthop Relat Res 2006; 443:198.
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