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Spinal stenosis

Spinal stenosis is 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 discs become drier and start to bulge. At the same time, the bones and ligaments of the spine thicken or grow larger due to arthritis or long-term swelling (inflammation).

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 and achondroplasia
  • A defect or growth in the spine that was present from birth
  • A herniated disc
  • Injury that causes pressure on the nerve roots or the spinal cord
  • Tumors in the spine


Symptoms

Often, symptoms worsen slowly over time. Most often, symptoms will be on one side of the body or the other, but may involve both legs. They include:

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


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 cannot walk for a long period of time.

Diagnosis

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

  • Sit, stand and walk
  • 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 and tingling in one of your legs)


Your doctor will also move your legs in different positions, including bending and straightening your knees. To test nerve function, the 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 capability for 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 spinal CT scan
  • X-ray of the spine


Treatment

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

You may be referred for physical therapy. The physical therapist will help you try to reduce your pain, using stretches, and will show you how to do exercises to strengthen your muscles. Cold packs and heat therapy may help your pain during flare-ups, and a number of different medications can help with your back pain.

A type of talk therapy called cognitive behavioral therapy may be helpful if the pain is having a serious impact on your life. This technique helps you better understand your pain and teaches you how to manage back pain.

If the pain does not respond to these treatments, or you lose movement or feeling, you may need surgery. Surgery is done to relieve pressure on the nerves or spinal cord.

You and your doctor can decide if and when you need to have surgery. Spinal stenosis symptoms often worsen over time, but the worsening may occur very slowly. Surgical procedures include:

Foraminotomy, which may be performed on any level of the spine, takes pressure off of a nerve in your spinal column and allows it to move more freely without pain.

Laminectomy is surgery to remove the lamina, part of the bone that makes up a vertebra, or bone spurs in your back. The procedure can take pressure off your spinal nerves or spinal canal.

Spinal fusion is surgery to permanently join two bones together so there is no longer movement between them. Spinal fusion is usually done along with other surgical procedures of the spine.

Spine surgery will often partly or fully relieve symptoms. People who had long-term back pain before their surgery are likely to still have some pain afterwards. Spinal fusion probably will not take away all the pain and other symptoms.

Many people with spinal stenosis are able to be active for many years with the condition, although they may need to make some changes in their activities or work.

Spine problems are possible after spine surgery. The area of the spinal column above and below a spinal fusion is more likely to be stressed when the spine moves. Also, if you needed more than one kind of back surgery (such as laminectomy and spinal fusion), you may be more likely to have future problems.

Source: National Institute of Neurological Disorders and Stroke

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