You have been experiencing back pain for a few weeks or months, or maybe you’ve had an acute episode that forces you to seek medical care quicker than usual. The physician examines all of your symptoms, addresses your pain, and sends you to have an x-ray or MRI. The results come back and you see the words spinal stenosis typed throughout the report. Immediate panic sets in because truthfully who knows what exactly this means? Do I need surgery, or will it ever get better are just a couple of the first questions that run through your mind. Though each person will present uniquely, this article should help answer some of those questions and give insight into what may come next.
Spinal stenosis is a term that describes narrowing of the spine, almost always due to degenerative changes. Often symptoms present insidiously over a period of time, but acute exacerbations can set off a cascade of events leading to severe pain in a short of amount of time. When the spine breaks down as we age the space where the spinal cord and the exiting nerve roots becomes smaller. This narrowing can put pressure on our nervous system, and as a result will cause serious pain. Central stenosis is a term used to describe narrowing of the canal where the spinal cord itself rests. Lateral foraminal stenosis is similar, except the narrowing occurs on either the left or right (or in some cases both) sides where the nerves exit the spinal cord and begin their course toward the legs or arms. The arms will become affected by stenosis is the cervical spine, the area closest to your head, and the legs will become affected by stenosis in the lumbar spine, or in serious cases even the cervical spine. Through degenerative processes the discs between the vertebrae lose some of their height which narrows the space for the nerves. The same occurs when the facet joints, where the vertebrae adjoin at the back side of the spine, grow larger. This is called hypertrophy and is a result of wear and tear at a specific level of the spine. Another structure that may enlarge overtime, which will cause narrowing around the nerves is the long ligaments that run vertically on the front and back side of the spinal cord to keep the vertebrae in place.
So what does all of this mean exactly? What you will be experiencing is symptoms as a result of this degenerative process that causes narrowing. The nerves or spinal cord itself will become impinged. The first symptoms may be a generalized aching pain across either side of the spine, typically in the low back. You may also experience more severe nerve symptoms that will present in the legs or arms. Typically nerve pain is referred to sensations of burning, numbness, or tingling in specific areas of the extremities. Each nerve as it exits a specific level of the spinal cord is responsible for innervating specific muscles and providing sensation in specific locations, termed myotomes and dermatomes respectively. It is hard for many patients to understand that pain in their feet is actually caused by a problem in their low back. It is fairly common to experience leg or arm symptoms without actual pain in the low back or neck due to the referral pattern of the nerves. Patients with the most severe stenosis will experience weakness in their arms or legs due to greater impingement of the nerve which does not allow efficient nerve signals to pass to the muscle. Think of this as a problem with the messenger to your body’s muscular system. Most frequently people with stenosis in their lower back will have increased pain or leg symptoms when standing or walking for long periods of time, and feel some relief upon sitting.
Once the problem is identified there are a number of treatment options available. Your physician will determine the most appropriate course of action to address why the stenosis has occurred and how to most effectively manage the condition. The first course of action is to relieve the immediate acute pain. Some physicians may prescribe medication to address pain or inflammation. The second course of action is typically a bout of physical therapy. The physical therapist will assess your spine and surrounding joints to address areas of muscle imbalance, such as shortened and tight muscles or weak muscles that may be contributing additional stress on the spine. They will also likely prescribe stretches to unload the spine, or attempt to create additional space around the nerves to alleviate your symptoms. For many this will provide considerable relief and you will have a number of exercises or postural changes kept handy in case an episode pops up in the future, which is likely to happen. However, next time you will understand how to best manage your back and quickly address the problem before it becomes too painful to function.
If physical therapy or medication does not solve your problems you may need to consult a surgeon or pain specialist. The pain specialist will use a number of more advanced methods of pain control, whether that is more effective medication, psychotherapy, or a joint injection. The surgeon may also propose a joint injection, which will bathe the nerve that is causing pain in an anti-inflammatory. Some may require up to three injections for relief, which will last for six months to a year, or in more successful cases may provide pain relief for longer. One of the final options to relieve symptoms of spinal stenosis may be surgery. There are a number of very successful surgical options, including minimally invasive spine surgery. The surgeon only needs a small incision into the back where they place a small camera and tools to clean out the area of impingement which in turn creates more space around the spinal cord or nerve roots. If the surgeon determines that there is an instability that is causing your pain, or damage is too severe for minimally invasive surgery, they may opt for an open spine surgery called a fusion. This procedure creates stability between two or more vertebrae in order to prevent movement and pinching of the nearby nerves.
As you can see spinal stenosis is no joking matter. Seeking care is the first step in pain relief and learning long term management strategies so that you can continue to live life normally. Advanced medicine has given the patient a number of options to treat symptoms caused by spinal stenosis.