Without treatment, spinal stenosis can significantly impact your mobility and quality of life. It is important to have an experienced spinal specialist perform a proper workup including a physical examination and diagnostic imaging to determine if you have spinal stenosis. At the Virginia Spine Institute in Reston, Virginia, the neurological surgery team provides evidence-based solutions for spinal stenosis, including but not limited to surgery to address your spinal stenosis.
The spinal cord is a long, tubular structure that connects the brain to the peripheral nervous system, allowing you to move your body, feel your surroundings, and experience pain.
The spinal column protects our spinal cord and is made up of bones, joints, discs, soft tissues, and nerves. The spinal cord is housed in the cervical and thoracic spine and normally terminates at the upper lumbar spine, where the nerves then spread out and travel freely through the canal. Think about the spinal cord and nerves as a spaghetti noodle traveling through a straw. Think about spinal stenosis as the straw getting smaller and smaller, providing little room for the spaghetti noodle to fit.
Cervical spinal stenosis causes pressure on the spinal cord and exiting spinal nerves. Lumbar spinal stenosis causes pressure on the freely traveling and exiting lumbar spinal nerves. This can be caused by several factors including degenerative changes such as disc herniations, disc height collapse, enlargement of facet joints, arthritis, or thickening of the ligamentous structures.
Spinal stenosis is diagnosed when medical imaging demonstrates narrowing of the spinal canal or foramen where the spinal nerves exit.
Spinal stenosis is a narrowing of the spinal canal to a degree where the spinal cord or nerve roots become compromised. Spinal stenosis may occur in any area of the spine, but it is most common in the lumbar spine. However, spinal stenosis is most dangerous in the cervical and thoracic spine due to its proximity to the spinal cord.
There are several causes of spinal stenosis; however, degenerative changes are typically the most common. These changes include:
Finally, bone spur formation, called spondylosis, is also a common cause.
Symptoms depend on the location, and whether it affects the spinal cord or spinal nerves.
If the spinal cord is compressed in the cervical or thoracic spine, you may or may not experience pain or symptoms of radiculopathy. Often, spinal cord stenosis presents with symptoms of myelopathy. Myelopathy is a term used to describe neurologic symptoms related to the spinal cord that may cause permanent spinal cord injury. Without spinal stenosis treatment, damage may lead to paralysis or death. Symptoms of myelopathy include:
If only the spinal nerve roots are involved, you may experience pain, numbness, tingling, or weakness in the arms or legs, called radiculopathy.
Lumbar spinal stenosis may cause pain and radiculopathy or symptoms of neurogenic claudication. Symptoms of neurogenic claudication include pain, numbness, weakness, tingling, or heaviness in the legs that often worsen with prolonged standing or walking.
Pain often is improved with sitting or bending forward. If lumbar spinal stenosis is severe enough, it can result in cauda equina syndrome. That is when the bundle of nerves below the spinal cord is compromised, causing loss of sensation in the genital area, bowel or bladder incontinence, urinary urgency, leg pain or weakness, numbness, or heaviness in the legs.
Cauda equina syndrome is a spinal emergency and requires emergent evaluation as it can lead to permanent paralysis and incontinence.
If you experience any of the symptoms above or suspect you may be experiencing spinal stenosis, make an appointment to be evaluated by a spinal specialist at the Virginia Spine Institute in Reston, VA.
Your initial evaluation will involve discussing your full medical history, explanation of your symptom severity and onset, a comprehensive physical exam, and diagnostic imaging such as x-rays, MRI, or CT scan. The most sensitive test to properly diagnose spinal stenosis is Magnetic Resonance Imaging (MRI).
For people with mild spinal stenosis and not at risk for permanent neurologic deficit, conservative treatments often are the initial treatment of choice. These non-surgical treatments include spine specialized physical therapy in conjunction with medications.
Physical therapy gently stretches the joints and muscles in the spine to provide relief. PT should also help you develop an effective home exercise program to build your core and cardiovascular endurance. Chiropractic manipulation should never be performed with spinal stenosis. When medications and therapy fail to improve symptoms, steroid injections may be recommended to reduce inflammation. However, if your symptoms progress despite the above remedies or if you develop neurologic symptoms/deficit, then it is important to discuss surgical options.
The goal of spinal stenosis treatment with surgery is to improve pain and stop progressive neurologic damage.
Multiple surgical procedures and approaches exist to treat spinal stenosis. Our spinal specialists at the Virginia Spine Institute will review these options with you. Each surgical plan is specifically tailored to the patient and their spinal needs to provide the best care possible and optimal recovery.
Spine-Specialized Physical Therapy →
Anterior Cervical Discectomy & Fusion (ACDF) →
Anterior Cervical Disc Replacement (ACDR) →
Hybrid Cervical Spine Surgery →
Dr. Niteesh Bharara
Director of Regenerative Medicine
Orthopedic Specialist - Non-Surgical Sports Medicine
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Reviewed by: Dr. Christopher Good, MD, FACS.