Many people have evidence of spinal and cervical stenosis on X-rays, but have no signs or symptoms. When symptoms do occur they often start gradually and worsen over time. The most common parts of the spine affected are the neck and lower back. Spinal Stenosis is most common in men and women over 50 years old. Symptoms vary depending on the location of the stenosis.
Lumbar Spinal Stenosis
Lumbar Spinal Stenosis is one of the most common causes of low back pain. It is caused by the narrowing of the spinal canal, which houses the spinal cord and nerve roots. This occurs as part of the natural aging process. The symptoms include back pain, burning or aching type of pain in buttocks that radiates to the legs (sciatica), weakness in the legs or “foot drop.”
Spinal Stenosis in the neck (cervical)
Spinal Stenosis in your upper (cervical) spine can cause numbness, tingling or weakness in the leg, foot, arm or hand. Also, gait and balance disturbances can occur.
Causes of Spinal Stenosis
Some patients are born with this narrowing, but most often spinal stenosis is seen in patients over the age of 50. In these patients, stenosis is the gradual result of aging and “wear and tear” on the spine during everyday activities.
Other causes can include:
- Osteoarthritis (wear and tear arthritis)
- Rheumatoid arthritis
Non-surgical Treatment of Spinal Stenosis
There are a number of ways a doctor can treat spinal stenosis without surgery. These include:
- Medications, including non-steroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and pain, and analgesics to relieve pain.
- Corticosteroid injections (epidural steroids) can help reduce swelling and treat acute pain that radiates to the hips or down the leg. This pain relief may only be temporary and patients are usually not advised to get more than 3 injections per 6-month period.
- Rest or restricted activity (this may vary depending on extent of nerve involvement).
- Physical therapy and/or prescribed exercises to help stabilize the spine, build endurance and increase flexibility.
Surgical Treatment of Spinal Stenosis
In many cases, non-surgical treatments do not treat the conditions that cause spinal stenosis; however, they might temporarily relieve pain. Severe cases of stenosis often require surgery. The goal of surgery is to relieve pressure on the spinal cord or spinal nerve by widening the spinal canal. This is done by removing, trimming, or realigning involved parts that are contributing to the pressure.
The most common surgery in the lumbar spine is called decompressive laminectomy, which the laminae (roof) of the vertebrae are removed to create more space for the nerves. A surgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disc. Various devices (like screws or rods) may be used to enhance fusion and support unstable areas of the spine.
Other types of surgery to treat stenosis include the following:
- Laminotomy – when only a small portion of the lamina is removed to relieve pressure on the nerve roots;
- Foraminotomy – when the foramin (the area where the nerve roots exit the spinal canal) is removed to increase space over a nerve canal. This surgery can be done alone or along with a laminotomy;
- Medial Facetectomy – when part of the facet (a bony structure in the spinal canal) is removed to increase the space;
- Anterior Cervical Discectomy and Fusion – the cervical spine is reached through a small incision in the front of the neck. The intervertebral disc is removed and replaced with a small plug of bone, which in time will fuse the vertebrae.
- Cervical Corpectomy – when a portion of the vertebra and adjacent intervertebral discs are removed for decompression of the cervical spinal cord and spinal nerves. A bone graft, and in some cases a metal plate and screws, is used to stabilize the spine.
- Laminoplasty – a posterior approach in which the cervical spine is reached from the back of the neck and involves the surgical reconstruction of the posterior elements of the cervical spine to make more room for the spinal canal.
Common procedures that can be performed for spinal stenosis include:
- Lumbar Laminectomy
- Spinal Fusion Surgery
- TLIF – Transforaminal Lumbar Interbody Fusion
- Minimally Invasive Lumbar Fusion
- XLIF – Extreme Lumbar Interbody Fusion