Spinal Stenosis

Spinal stenosis narrows the space in your spinal canal which puts pressure on your spinal cord and nerve roots. The compression of the nerves in and around your spinal cord gives rise to pain, numbness and weakness in your back, legs, neck, arms and hands. 

Most often, spinal stenosis symptoms are managed with non-surgical treatments, but if your condition is more severe, surgery may be recommended. It’s important to seek an early diagnosis and treatment to maintain a good quality of life.

What is spinal stenosis?

Spinal stenosis is a condition where the spaces in your spinal canal narrow which can put pressure on your spinal cord and spinal nerve roots. Understanding the Greek words can help you to remember what spinal stenosis is. ‘’Spinal’ refers to the spinal tunnel and ‘stenosis’ means narrowing. 

The narrowing of space around your spinal cord and nerve roots can lead to pain, numbness and weakness in your back, legs, neck, arms and hands, depending on where the compression is located.

Spinal stenosis can affect any part of your spine. It is most common in your lower back and neck. 

Lower Back (lumbar stenosis)

Lumbar spinal stenosis (LSS) is a narrowing of your spinal canal in the lower part of your back. Lumbar refers to your lower back and your lumbar spine is made up of five vertebrae (L1 to L5). LSS is used to describe pain in your legs caused by a problem in the lower back. 

Neck (cervical stenosis)

Cervical stenosis is a narrowing of your spinal canal in your neck. Cervical refers to your neck and your cervical spine is made up of the first seven vertebrae (C1–C7). 

Is spinal stenosis common?

Spinal stenosis is a relatively common condition, particularly in older people. 

Lumbar spinal stenosis affects about 11% of the general population but it is very uncommon under the age of 50 with the average age being 62 to 69 years old.1

The incidence of cervical stenosis in the general population is between 4.9% and 21.5% with the prevalence increasing with age.2

What causes spinal stenosis?

Spinal stenosis is caused by many different changes or injuries to your spine that cause your spinal canal to narrow. 

Spinal stenosis causes are divided into two main categories:

Acquired causes

Acquired causes of spinal stenosis are developed after birth and most often after age 50. They are the more common causes and usually happen due to age-related degenerative changes or an injury in your spine. They include:

• Bone overgrowth - osteoarthritis wears down joint cartilage, leading to your bones rubbing against each other. Your body responds by forming bone spurs, which can extend into your spinal canal and pinch nerves. Paget’s disease can also cause excessive bone growth in the spine.  
• Bulging or herniated disks - aging causes these round shock-absorbing cushioning pads to bulge or herniate and press on nearby nerves.  
• Thickened ligaments - arthritis can cause your spinal ligaments to thicken and bulge into your spinal canal and reduce space.  
• Spinal fractures and injuries - broken or dislocated vertebrae (spinal bones), as well as inflammation from spinal injuries, can reduce the space in the spinal canal. 
• Spinal cysts or tumours - abnormal growths in or near your spinal cord can compress the canal and nerves. 

Congenital causes

Congenital spinal stenosis is much less common and affects babies and children. It can happen due to spine formation issues in the fetus (achondroplasia, spinal dysraphism, congenital kyphosis, congenital short pedicles) and genetics (osteopetrosis, Morquio syndrome and hereditary multiple exostoses).

Can I prevent spinal stenosis?

You cannot technically prevent spinal stenosis – it is often a wear and tear condition. However, there are steps you can take to assist in maintaining a healthy spine that may help lower your risk or slow down the progression of spinal stenosis. These include:

• Maintaining a healthy weight
• Eating healthy foods with plenty of calcium to keep your bones strong
• Not smoking 
• Practicing good posture
• Regularly exercising to keep your back and core muscles strong.

Symptoms of spinal stenosis

Often spinal stenosis causes no symptoms. When spinal stenosis symptoms do happen, they vary depending on the severity of your spinal stenosis and which part of your spine is affected.  In general, symptoms start slowly and worsen with time. They include pain, numbness and weakness in your neck, back, arms, legs, hands or feet.

Lumbar spinal stenosis

Lumbar spinal canal stenosis symptoms include:

• Low back pain 
• Pain starting in your buttocks and extending down your leg and sometimes into your foot (sciatica)
• Weak and heavy legs, foot drop (difficulty lifting the front part of the foot) and cramping in one or both legs at nighttime
• Numbness or tingling in your buttocks, leg or foot
• Pain that is worsened when you stand for long periods of time, walk, or walk downhill
• Pain that is eased when you lean forward, walk uphill or sit.

Cervical spinal stenosis

Cervical spinal stenosis symptoms include:

• Neck pain
• Numbness or tingling in your arm, leg, hand or foot
• Weakness or clumsiness in your arm, leg, hand or foot
• Balance issues
• Decreased hand function such as difficulty writing or buttoning shirts.

Complications

In severe cases, complications of spinal stenosis can include:

• Incontinence - loss of bladder or bowel control 
• Sexual dysfunction - nerve issues can cause erectile dysfunction or anorgasmia 
• Cauda equina syndrome - pressure on nerves in the lower back can cause loss of bladder or bowel control, severe pain, weakness, and numbness in your legs 
• Leg paralysis – in rare cases, spinal stenosis can cause partial or complete paralysis in the legs.

Spinal stenosis diagnosis

Initial assessment

Your healthcare provider will review your medical history, ask about your symptoms, and perform a physical exam.

The physical exam may involve pressing on your spine to identify painful areas and asking you to bend in various directions to assess symptom triggers.

Imaging tests

To pinpoint the location, type, and extent of your spinal stenosis, your doctor may order the following:

• Spine X-ray – to detect changes in bone structure, such as bone spurs or loss of disk height.
• MRI - to create detailed images of your nerves, disks, and spinal cord, and to identify tumours.
• CT scan/CT myelogram – to produce cross-sectional images of your spine. A CT myelogram uses contrast dye for clearer views of your spinal cord and nerves.

Spinal stenosis treatment

There are a number of non-surgical treatments to help manage spinal stenosis. However, if  they are not successful in managing your symptoms then surgery may be recommended.

At-home treatment

At-home treatment may be recommended if you have mild spinal stenosis symptoms. These include:

• Apply heat – to increase your blood flow, which relaxes your muscles and relieves aching joints. It is often beneficial for osteoarthritis pain. 
• Apply ice - to reduce swelling, tenderness and inflammation. Use an ice pack, frozen gel pack or a frozen bag of peas. Apply for 20 minutes then 20 minutes off and repeat as advised. 
• Exercise - to help relieve your pain, strengthen your muscles which support your spine, and improve your balance and flexibility.

Nonsurgical treatment

Nonsurgical treatments help to manage your spinal stenosis symptoms. They include:

• Over-the-counter nonsteroidal anti-inflammatory medications (NSAIDs) - to help relieve inflammation and pain. 
• Prescription pain-relieving medications – to relieve pain and relax muscles.
• Physiotherapy exercises – to strengthen your back and abdominal muscles and help build spinal strength, stability and flexibility, and improve your balance. You might also be shown a way of walking that opens up your spinal canal and relieves pressure on your nerves.
• Alternative medicines – can help you to cope with spinal stenosis pain. They include massage therapy, chiropractic treatment, and acupuncture.
• Corticosteroid injections - to help reduce inflammation and pain.

Spinal stenosis surgery

Spinal stenosis surgery may be recommended if other treatments have not worked. These surgeries are often termed decompression surgeries and aim to create more space within your spinal canal. 

Types of spinal stenosis surgery include:

• Laminectomy (decompression surgery) – this is the most common type of spinal stenosis surgery. It removes part or all of your vertebral bone, called the lamina, and other tissue to relieve excess pressure on your spinal nerve(s). Types of laminectomies include:

• Laminotomy - is a partial laminectomy, where only a small part of your lamina is removed.

• Laminoplasty - is only for cervical spinal stenosis. Lamina bone is reshaped to expand your spinal canal. Metal plates and screws may be used to create a hinged bridge to open up your spinal canal through the lamina bone.

• Discectomy – removes just enough of a prolapsed or bulging disc to prevent pressure on your spinal nerves.

• Foraminotomy – removes bone or tissue in the foramen area (the opening of your spine where your nerve roots exit) to make more space for your nerve roots.

• Interspinous process spacers - inserts spacers between the bones that extend off the back of each vertebra, called spinous processes, to help keep your vertebrae apart and create more nerve space.

• Spinal fusion - permanently joins (fuses) 2 or more vertebrae together to help prevent excessive movements between 2 adjacent vertebrae and lower the risk of further compression of nearby nerves.

Prognosis

The outlook if you have spinal stenosis can vary depending on factors such as where it is, your symptom severity, and your overall health.

For most people with spinal stenosis, the prognosis is good and they can live their lives fully with nonsurgical treatment. However, each patient is different and not all treatments works for everyone. 

Spinal Stenosis treatment at Ramsay Health Care UK

At Ramsay Health Care, we offer fast and convenient appointments with our expert consultants who will listen to your symptoms of spinal stenosis and recommend treatments. 

We have a multi-disciplinary team who understand the pain of spinal stenosis and provide the best treatment options.

Contact us today to speak to our friendly team for more information, or to book an appointment.