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Spinal stenosis

Spinal stenosis is a narrowing of the spinal column that causes pressure on the spinal cord, or narrowing of the openings, called neural foramina, where spinal nerves leave the spinal column. Spinal stenosis usually occurs as a person ages and the disks become drier and start to bulge. At the same time, the bones and ligaments of the spine thicken and grow larger due to arthritis or long-term swelling.

Spinal stenosis may also be caused by:

  • Arthritis of the spine, usually in middle-aged or elderly people
  • Bone diseases, such as Paget’s disease of the bone and achondroplasia
  • Defect or growth in the spine that was present from birth
  • Herniated or slipped disc
  • Injury that causes pressure on the nerve roots or the spinal cord
  • Tumors in the spine


Common Symptoms

  • Numbness, cramping or pain in the back, buttocks, thighs or calves, or in the neck, shoulders or arms
  • Weakness of part of a leg or arm


Symptoms often grow worse slowly over time. Most often, symptoms will be on one side of the body or the other, but may involve both legs. Symptoms are more likely to be present or get worse when you stand or walk. They will often lessen or disappear when you sit down or lean forward. Most people with spinal stenosis are unable to walk for a long period of time.

More serious symptoms include:

  • Difficulty or poor balance when walking
  • Problems controlling urine or bowel movements


Diagnosis

During a physical exam, your doctor will try to find the location of the pain and determine how it affects your movement. You’ll be asked to:

  • Sit, stand and walk. While you walk, your doctor may ask you to try walking on your toes and then your heels.
  • Bend forward, backward and sideways
  • Lift your legs straight up while lying down. If the pain is worse when you do this, you may have sciatica, especially if you also feel numbness or tingling in one of your legs.


Your doctor will also move your legs in different positions, including bending and straightening your knees, to check your strength and ability to move.

To test nerve function, your doctor will use a rubber hammer to check your reflexes. Touching your legs in many places with a pin, cotton swab or feather tests your ability to feel sensation.

A brain and nervous system (neurological examination can confirm leg weakness and decreased sensation in the legs. The following tests may be done:

  • Electromyography (EMG)
  • Spinal MRI or CT scan
  • X-ray of the spine


Treatment

If your back pain does not improve or becomes more painful, learning to take care of your back at home may prevent repeat episodes of pain and help you avoid surgery. Your doctor and other health professionals will help you manage your pain and keep you as active as possible.

Your doctor may refer you for physical therapy to strengthen your muscles and increase flexibility. Massage therapy may also be recommended. Cold packs and heat therapy may help during pain flare-ups. A number of medications can help with your back pain.

If the pain is having a serious impact on your life, your doctor may recommend a type of talk therapy called cognitive behavioral therapy to help you better understand your pain and manage it.

Neuromodulating medications such as gabapentin or pregabalin, or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or Aleve may be recommended. Interventions available include:

  • Caudal or lumbar epidural steroid injections
  • Spinal selective nerve blocks


If your pain doesn’t respond to these treatments, or if you lose movement or feeling, you may need surgery to relieve pressure on the nerves or spinal cord. Our neurosurgeons perform the following procedures:

  • Foraminotomy to relieve pressure on nerves compressed by the intervertebral foramina, the passages through the bones of the vertebrae of the spine that pass nerve bundles to the body from the spinal cord
  • Laminectomy to remove the portion of the vertebral bone called the lamina
  • Spinal fusion, also know as spondylodesis, which joins two or more vertebrae. Supplemental bone tissue, either from the patient (autograft) or a donor (allograft), is used in conjunction with the body’s natural bone growth processes to fuse the vertebrae.


Source: National Institutes of Health

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