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Spinal stenosis is a narrowing of the spinal canal that often puts pressure on the spinal cord or the spinal nerves. It can occur in any part of the spine from the neck down, but is most common in the low back or lumbar area and lower neck.
There are multiple causes of stenosis. Some of them are:
• Trauma
• Degenerative changes
• Unstable spine
• Congenital
• Diseases such as Paget’s disease
The most common cause of lumbar stenosis is degeneration of discs and bony elements. Arthritis can cause bone spurs that impinge on the spinal cord. Symptoms of stenosis are often gradual and worsen over a span of years. Pain, a feeling of heaviness, and neurological symptoms such as numbness, tingling, and burning may be present in the legs.
A classic symptom of lumbar stenosis is the person who always leans over on the shopping cart at the store because it takes pressure of the spine, opens the canal up a bit and relieves symptoms. Often we would ask about this in the spine clinic and the patient’s face would light up as she realized she did that all the time but hadn’t realized why.
Treatment depends partially on the cause of the problem and partially on how progressive the symptoms are. If there are any symptoms of cauda equina syndrome, emergency surgery is required. Cauda equina syndrome is named after the bottom of the spinal cord where the lower nerves come out and look like the tail of a horse. Pressure on this area causes bowel and bladder dysfunction that may become permanent if not treated immediately.
Most often stenosis comes on gradually and can be treated conservatively, at least at first. Treatment may begin with physical therapy to strengthen the muscles of the core and support the spine, chiropractic adjustments, acupuncture, or lumbar traction. Medications may be prescribed; these often include anti-inflammatories, pain medications, and medicines to relieve nerve pain.
If these non-invasive therapies do not give relief, the next step may be epidural steroid injections. Steroids and anesthetics are injected to bathe the spinal cord or spinal nerves to reduce irritation and pain. These injections sound scary but can be a huge relief, and can postpone the need for surgery even indefinitely.
Surgery is only indicated when cauda equina syndrome is present, or if neurological dysfunction progresses. Untreated severe stenosis can cause foot drop and the inability to walk. Surgery can be minimally invasive and very effective.
Sources:
American Academy of Orthopaedic Surgeons: Lumbar Spinal Stenosis
http://orthoinfo.aaos.org/topic.cfm?topic=a00329#Treatment
Scheon, D. C. (2001). NAON Core Curriculum for Orthopaedic Nursing. (4th Ed.). Pittman, NJ. Anthony J. Janetti, Inc.
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