What is Spinal Stenosis?
The spinal cord travels through the bony spine to provided muscle sensory and motor signals. Spinal stenosis occurs when there is narrowing of this spinal canal which can put pressure on the nerves travelling through it. Spinal stenosis occurs most often in the neck (cervical spinal stenosis) and lower back (lumbar spinal stenosis). Spinal stenosis occurs most commonly over time with the wear and tear of osteoarthritis, but can sometimes occur with injury or trauma, the spine can narrow and press on nerves of the spinal cord. Spinal stenosis may be painless but can progress to a sharp or pain dull that can be chronic and worsens with activity. You may have numbness or tingling or even weakness of muscles as well. In severe cases, your neurosurgeon may recommend surgery to enlarge the spinal canal to reduce pressure on the spinal cord and nerves.
Pain is usually the first sign of a spinal stenosis. Symptoms will depend on the location of the stenosis. Lower back stenosis (lumbar stenosis) may have pain, weakness and numbness extending from your back to your buttocks, thighs, and down to your calves. If the stenosis is in your neck (cervical spine) then you may have the same symptoms but in the neck, upper back and arms. You may have aching, tingling or burning sensations in the affected area. In severe lumbar or cervical stenosis you may have bowel or urinary incontinence, sexual dysfunction, or numbness in the groin and buttocks area. The pain is usually only on one side of the body but may be both. Movement, walking sitting and certain bending or twisting movements may worsen the pain. When you are unable to perform your normal daily activities then it is time to see your doctor.
The spinal cord is surrounded by a protective by the bony spine. Although some patients may develop with a narrow spinal canal, other conditions will occur that can cause areas of the spinal canal to narrow over time.
- Bulging or Herniated Discs. The cushioning discs can extrude from between each spinal vertebrae and can press on the spine or spinal nerves.
- Osteoarthritis. The wear of aging can cause bony spurs of the spine that can narrow the canal. This usually occurs at age or 55 or greater but should be evaluated in younger patients as well.
- Tumors. The tissue of the spinal cord, bones, ligaments or membranes can grow abnormally and narrow the spinal canal.
- Trauma. Sporting injuries and motor vehicle accidents can fracture or dislocate spinal segments to narrow the spinal canal. Bleeding or tissue swelling can also cause symptoms.
Your doctor will take a complete history will give information on where your spinal stenosis is occurring and what other conditions may be present. A physical exam will evaluate you for your source of your pain and discomfort. Your nerve function will be evaluated along with and muscle strength and skin sensation. Imaging tests can help your doctor identify spinal stenosis.
X-rays may be used as a preliminary test to look for spinal stenosis or injury to the spine. Additional studies that may be used for diagnosis include a computed axial tomography (CAT) scan uses the electromagnetic energy of X-rays to provide a detailed look at the bony anatomy spine and tissue around it. A myelogram uses dye injected into your spinal fluid and an X-ray to show the location of pressure on the spinal cord. A magnetic resonance imaging (MRI) uses powerful magnets and radio waves to create a detailed picture of soft tissue of the spine, spinal cord and spinal nerves. Nerve conduction studies look for nerve damage by using electrodes to measure how quickly a nerve impulse is transmitted. An electromyogram uses needle electrodes to look for muscle damage.
The treatment of spinal stenosis is dependent on the severity of symptoms and the location of narrowing. If there are minimal symptoms then your doctor may recommend periodic monitoring. Resting can allow your back to heal. Ice or heat in the are of discomfort may help you feel better. Over-the-counter medications like ibuprofen (Advil, Motrin) or naproxen (Aleve) are NSAIDs (nonsteroidal anti-inflammatory drugs) that can decrease pain and swelling. Your doctor may prescribe opiates, muscle relaxants, nerve pain medications or antidepressants that can reduce pain. A physical therapist can show you which exercises you should perform to strengthen and increase spinal flexibility. Steroid injections can reduce swelling but will not decrease spinal stenosis.
Surgery may be needed to reduce pain or to prevent nerve damage or if conservative treatments do not relief pain. Surgery will also relieve pain much more rapidly than rest and medication. You may require one or a combination of the following procedures. Our neurosurgeons will use minimally invasive surgery whenever appropriate.
- PILD is a Percutaneous Image-guided Lumbar Decompression that is performed through the skin under local anesthesia to open the ligaments surrounding the spinal canal. This used to be called MILD or Minimally Invasive Lumbar Decompression.
- Laminectomy or laminotomy– your surgeon uses a microscope to make a small opening in the spinal bone (vertebral arch) to relieve pressure on the nerve roots.
Spinal fusion– two of more of the spinal vertebrae are permanently attached together using bone grafts with plastic or metal screws and rods. This permanently fuses the spine vertebrae in the attached segments. This also requires general anesthesia and a short hospital stay.
The pain of a spinal stenosis can be excruciating and debilitating. The neurosurgeons of Norelle Health are highly trained and skilled in the diagnosis, management, and treatment of spinal stenosis. Our neurosurgeons can provide the optimal treatment. Neurosurgery is considered essential by insurances and should be covered with your plan. As out-of-network providers, we will check your benefits for you and let you know what they are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us (link to contact page) or call our office (link to phone number).