The spinal cord is a long tubular structure that connects the brain to the peripheral nervous system through spinal nerves, allowing us to move our body, feel our 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. Cervical and thoracic spinal stenosis can cause pressure on the spinal cord and exiting spinal nerves. Lumbar spinal stenosis can cause 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. If the central spinal canal or the foramen through which the spinal nerves exit becomes narrowed, you are considered to have spinal stenosis.
Spinal stenosis is a narrowing of the spinal canal to a degree where the spinal cord or nerve roots may be compromised. Spinal stenosis may occur throughout the spine but is typically more common in the lumbar spine however more dangerous in the cervical spine due to the proximity to the spinal cord. There are several different causes of spinal stenosis, however, degenerative changes are typically the most common cause. These changes include disc height collapse, disc herniations, thickening of ligaments, or arthritic changes causing bone spur formation called spondylosis.
Symptoms depend on whether narrowing affects the spinal nerves, spinal cord, or both. If only spinal nerve roots are involved, you may experience pain, numbness, tingling, or weakness in the arms or legs called radiculopathy.
In cervical or thoracic spinal stenosis patients may or may not experience pain or symptoms of radiculopathy. Often, they present with symptoms of myelopathy which is the term used to describe neurologic symptoms related to the spinal cord. Myelopathy may cause permanent spinal cord injury and if left untreated damage may lead to paralysis or death. Symptoms of myelopathy include difficulty with balance, heaviness in the arms or legs, abnormal gait, dropping objects, clumsiness or difficulty with fine motor skills such as typing or writing.
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. This is when the bundle of nerves below the spinal cord, in the lumbar spine, is compromised causing symptoms of loss of sensation over 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 suffering with spinal stenosis, you should make an appointment to be evaluated by a spinal specialist. Your initial evaluation would involve discussing your full medical history, a comprehensive physical exam, and determining the need for diagnostic imaging such as x-rays and MRI. Spinal stenosis is formally diagnosed by MRI.
For patients with mild spinal stenosis who are 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. Chiropractic manipulation should never be performed with spinal stenosis. When medications and therapy fail to improve symptoms steroid injections are a possibility to reduce inflammation but surgery may also be discussed.
If non-surgical treatments fail to improve symptoms of spinal stenosis or the degree of stenosis is too severe surgery is often discussed. The goal of surgery is to improve intractable pain and stop progressive neurologic damage. Multiple different surgical procedures and approaches exist to treat stenosis. Our spinal specialists will review these options with you. Each surgical plan is specifically tailored to the patient and their spinal needs to provide the safest and best care possible.
Dr. Thomas Schuler
Founder of Virginia Spine Institute
Chief Executive Officer
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Reviewed by: Dr. Christopher Good.