Spinal Stenosis

Spinal stenosis refers to the narrowing of the passageway for nerves. This can occur in the central part of the spine wherein the cord and nerve root bundles lie. It can also occur in the sides of the spine at the neuroforamina therefore compressing the nerve roots . Stenosis subsequently results in neurological pain and dysfunction.

Signs & Symptoms

When spinal stenosis results in nerve pressure, symptoms include radiating pain, tingling, numbness, and weakness in the extremities. The more commonly affected areas are in the low back therefore resulting in shooting pain and numbness down into the legs and feet. Radiating pain typically gets worse when bending backwards which approximates the bones and further narrows the nerve canals. Pain is typically relieved by bending forwards. In general most people with significant cases will actually stand and walk with a forward lean as a consequence this phenomenon. In more extreme cases, both sides may be involved thereby producing pain in both arms or both legs. There can even be damage to the nerves controlling bowel, bladder, and sexual function.

Causes of Spinal Stenosis

The classic cause for spinal stenosis is degenerative changes as mentioned in spondylosis section. Loss of disc and joint space along with arthritic changes like bone spurs, joint thickening, and calcification lead to encroachment upon nerves. Degenerative changes are often driven by poor spinal mechanics which is often the result of trauma and bad habits (injury, poor posture, improper lifting, etc).

Treatment of Spinal Stenosis

Just as with degenerative changes, treatment is focused on improving spinal mechanics, segmental motion and improving joint/disc space. Therapies such as manipulation of joints and soft tissue along with exercises and stretches targeting increased pain free movement is usually the key. More advanced cases may need simple gentle therapies as stronger or more aggressive approaches may not be tolerated and may actually cause more nerve damage. Modifying behaviors that would drive degenerative changes is also indicated (poor lifting and bending habits). Should conservative approaches fail, surgery or pain management need be considered.

Prognosis

Prognosis depends on severity of symptoms and the length of time the problem has persisted. Because this condition develops over years, it likely requires lengthy treatment. Patients who do not stick to their treatment plan will continue to deteriorate and require surgery. Surgery should be a last resort and it’s efficacy has been brought into question recently.