Explore spinal stenosis symptoms, treatment options, and types, including spinal canal stenosis and lumbar spinal stenosis. Find effective ways to manage the condition.

Spinal Stenosis

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Ismail Munir

Overview

Spinal stenosis is defined as a narrowing of the spinal canal which can compress the spinal cord and nerves.&nbsp; 
Most people above the age of 60 years have some degree of spinal stenosis. However, it is not always possible to predict who will develop symptoms.

&nbsp;

Progressive narrowing of the spinal canal is a part of the normal aging process.&nbsp;The narrowing can occur at any point along the spine, but most commonly affects the lumbar and cervical spine. Thus, causing neck and back pain in people. 
&nbsp;

According to studies, 1 in 1000 persons over the age of 65 years and 5 in 1000 persons over the age of 50 years are at risk of developing spinal stenosis<a href="#accordion">[2]</a>. With an increase in the geriatric population, the prevalence of the disease is expected to increase to 18 million in the next 10 years<a href="#accordion">[2]</a>. While the condition is more common in the elderly, younger people can also present with spinal stenosis, especially after an injury to the spine or due to congenital causes. 
&nbsp;

Spinal stenosis can occur anywhere along the spine. Depending on the location, it can be classified into multiple types<a href="#accordion">[3]</a>.

These include:

Cervical Spinal Stenosis - This occurs in the neck

Lumbar Spinal Stenosis - This type of spinal stenosis affects the lower back and is the most common location for spinal stenosis to occur.

Foraminal Stenosis: Narrowing of the openings where the nerves exit the spinal column, causing compression of the nerves.

Tandem Spinal Stenosis - At least two areas of the spine are affected. 
&nbsp;

Signs and Symptoms

The signs and symptoms of spinal stenosis can vary depending on the location and severity of the narrowing. The following are common signs and symptoms associated with spinal stenosis:

<ol>
	<li>Pain or numbness in the back, legs, arms, or shoulders</li>
	<li>Weakness or difficulty walking</li>
	<li>Loss of bladder or bowel control</li>
	<li>Tingling or a pins-and-needles sensation in the affected area</li>
	<li>Difficulty standing or walking for extended periods</li>
	<li>Balance problems or falls 
	&nbsp;</li>
</ol>

Symptoms may worsen over time, and they may be intermittent or constant. In some cases, people with spinal stenosis may not experience any symptoms at all. 
&nbsp;

Causes

Spinal stenosis can be caused by a variety of factors, including:

<ol>
	<li>Age-Related Changes: As people age, the tissues that make up the spine can degenerate and wear down, leading to spinal stenosis. 
	&nbsp;</li>
	<li>Congenital Conditions: Some people are born with a smaller-than-normal spinal canal or with other abnormalities that can lead to spinal stenosis. 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/arthritis">Arthritis</a>: Osteoarthritis and rheumatoid arthritis can cause the growth of bone spurs, which can narrow the spinal canal. Ankylosing spondylitis is another type of arthritis that can result in chronic inflammation in the spine, leading to bone spurs. 
	&nbsp;</li>
	<li>Achondroplasia: This is a type of dwarfism that disrupts bone formation in the spine and other parts of the body. 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/herniated-disc">Herniated Discs</a>: When a spinal disc&#39;s fragile inner layer pushes through its outer ring and into the spinal canal, it can compress the nerves and spinal cord. 
	&nbsp;</li>
	<li>Osteophyte Formation: Osteophytes, commonly referred to as bone spurs, are bony outgrowths that may develop along the margins of vertebral bones. These growths into the spinal canal may result in compression and constriction. 
	&nbsp;</li>
	<li>Ligament Hypertrophy: Hypertrophy, or thickening, of the ligaments that run down the spine, can also cause spinal stenosis by pushing into the spinal canal and compressing the spinal cord and nerves. 
	&nbsp;</li>
	<li>Spondylolisthesis: This occurs when one vertebra slides forward over another vertebra below. This may result in the spinal canal being more restricted and the spinal cord and nerves becoming compressed. 
	&nbsp;</li>
	<li>Trauma: Spinal stenosis can occur as a result of a traumatic injury to the spine, such as bone fractures. 
	&nbsp;</li>
	<li>Spinal Tumors: Tumors that grow in or near the spinal canal can cause spinal stenosis. 
	&nbsp;</li>
</ol>

There are currently no screening tests available for spinal stenosis. A person&#39;s symptoms and functional limits may also be assessed by healthcare professionals through physical examinations and questionnaires. This can help them determine if a patient might benefit from imaging scans and additional assessment. 
&nbsp;

Diagnosis

A detailed medical history and a physical exam help doctors diagnose spinal stenosis and rule out other conditions. During the history, the doctor will inquire about the patient&rsquo;s symptoms, history of injury, and any underlying condition. While conducting the physical exam, the patient&rsquo;s mobility, balance, gait, and neurological function are assessed. Moreover, the doctor will check whether the pain or symptoms are relieved by bending forward. 
&nbsp;

The diagnosis of spinal stenosis may be confirmed in patients who are exhibiting symptoms using imaging tests including X-rays, Magnetic Resonance Imaging (MRIs), and Computed Tomography (CT) Scans.

X-Rays: These help diagnose fractures, calcification, disc degeneration, and spondylolisthesis.

MRI: An MRI scan provides a detailed image of the back and surrounding structures. It can help detect any damage or disease of the disks, ligaments, and nerves around the spine, and the presence of any tumors.

CT: CT scans are usually used in individuals who cannot undergo MRI scans. They are useful in detecting arthritis-related changes in the back or fractures. 
&nbsp;

These examinations can assist in pinpointing the location and degree of the spinal canal&#39;s narrowing as well as any potential nerve compression.

Electromyography (EMG) and nerve conduction studies (NCS) are two additional examinations that may be done to assist in the diagnosis of spinal stenosis. These tests can aid in assessing the health of the nerves in the afflicted area and locating any places where they have been damaged or compressed.

A healthcare professional may occasionally administer a diagnostic injection of a local anesthetic or steroid into the injured region. If the injection results in significant pain relief, it may help confirm a diagnosis of spinal stenosis. 
&nbsp;

Treatment

The treatment of spinal stenosis depends on the severity of the symptoms and the underlying cause of the condition. Here are some of the commonly used treatments for spinal stenosis: 
&nbsp;

Non-Surgical Treatments: These may be recommended initially and may include the following:

<ul>
	<li>Medications: Pain medications, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), may be prescribed to alleviate pain and inflammation. Prescription medications, such as opioids may be prescribed for short-term pain relief. Moreover, muscle relaxants or tricyclic antidepressants may also be used. 
	&nbsp;</li>
	<li>Heat/Cold Therapy: Heat packs can help relieve pain due to osteoarthritis as it increases blood flow and relaxes muscles. However, if the heat does not improve symptoms, ice packs can be applied for 20 minutes at a time, a few times in the day. 
	&nbsp;</li>
	<li>Physical Therapy: A physical therapist can teach exercises to strengthen the muscles in the back, abdomen, and legs. This can help to improve posture, increase flexibility, and reduce pain. 
	&nbsp;</li>
	<li>Steroid Injections: Steroid injections may be used to reduce inflammation and swelling around the nerves in the affected area. 
	&nbsp;</li>
	<li>Percutaneous Image-Guided Lumbar Decompression (PILD): This is an outpatient procedure used specifically to help treat lumbar spinal stenosis due to the thickening of the ligamentum flavum. A contrast agent is injected during the procedure, guided by an X-ray, and a section of the thickened ligament is removed. This creates space in the spinal canal and reduces compression on the nerve roots. People can go home a few hours after the procedure and require physical therapy after. 
	&nbsp;</li>
</ul>

Surgery: Surgery may be recommended for severe cases of spinal stenosis that do not respond to conservative treatments. 
 
The following procedures may be performed:

<ul>
	<li>Laminectomy: This is a surgical procedure that involves removing a portion of the vertebrae (lamina) to relieve pressure on the spinal cord or nerves. 
	&nbsp;</li>
	<li>Laminotomy: Only a small part of the lamina is removed; therefore, this is called a partial laminectomy. 
	&nbsp;</li>
	<li>Laminoplasty: This procedure is only conducted in the cervical area and involves removing part of the lamina. Metal plates and screws are then used to create a hinged bridge in the area where the bone was removed. 
	&nbsp;</li>
	<li>Foraminotomy: This is a surgical procedure that involves removing a portion of the bone around the nerve root to relieve pressure. 
	&nbsp;</li>
	<li>Spinal Fusion: This is a surgical procedure that involves permanently fusing two or more vertebrae together to stabilize the spine. It is conducted in patients who have radiating nerve pain due to spinal stenosis, an unstable spine, or those that have not experienced relief from other methods. 
	&nbsp;</li>
</ul>

In conclusion, spinal stenosis therapy is unique and dependent on the degree of the condition&#39;s symptoms and its underlying causes. Initially, conservative therapies can be advised; however, if severe instances don&#39;t improve, surgery might be required. 
&nbsp;

If left untreated, spinal stenosis can lead to a range of complications.

These include:

<ol>
	<li>Chronic Pain: Spinal stenosis can cause chronic pain, particularly in the lower back and legs.</li>
	<li>Nerve Damage: Spinal stenosis can cause compression of the nerves in the spine, potentially leading to nerve damage. This can cause balance problems, numbness, weakness, and increase the risk of falls.</li>
	<li>Loss Of Mobility: Spinal stenosis can make it difficult to move around and perform daily activities, potentially leading to a loss of mobility.</li>
	<li>Urinary And Bowel Incontinence: In severe cases of spinal stenosis, the compression of the nerves in the spine can lead to urinary and bowel incontinence.</li>
	<li>Paralysis: In extremely rare cases, severe spinal stenosis can cause paralysis. 
	&nbsp;</li>
</ol>

Several risk factors have been identified that may increase the likelihood of developing spinal stenosis, including:

<ol>
	<li>Age: Spinal stenosis is more common in people over the age of 50.</li>
	<li>Gender: Men are more likely to develop spinal stenosis than women.</li>
	<li>Genetics: Certain inherited conditions, such as dwarfism, can increase the risk of developing spinal stenosis.</li>
	<li>Obesity: Being overweight or obese can put extra pressure on the spine, increasing the risk of developing spinal stenosis.</li>
	<li>Occupation: Jobs that require heavy lifting, twisting, or standing for long periods of time can increase the risk of developing spinal stenosis.</li>
	<li>Previous Spinal Injuries Or Surgeries: Previous injuries or surgeries to the spine can increase the risk of developing spinal stenosis. 
	&nbsp;</li>
</ol>

There is no known method to stop spinal stenosis from happening, but there are several measures that can reduce the risk or delay the advancement of the problem.

These consist of:

<ol>
	<li>Maintaining A&nbsp;Healthy Weight: Excess weight can put extra pressure on the spine, potentially contributing to spinal stenosis.</li>
	<li>Regular Exercise: Engaging in regular exercise can help keep the spine strong and flexible, potentially reducing the risk of developing spinal stenosis.</li>
	<li>Good Posture: Maintaining good posture can help reduce the amount of pressure on the spine, potentially reducing the risk of spinal stenosis.</li>
	<li>Avoiding Heavy Lifting: Heavy lifting can put significant strain on the spine, potentially contributing to spinal stenosis.</li>
	<li>Regular Check-Ups: Regular check-ups with a healthcare provider can help identify any early signs of spinal stenosis, potentially allowing for early intervention and treatment. 
	&nbsp;</li>
</ol>
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Key Points

<ul>
	<li>Spinal stenosis is defined as a narrowing of the spinal canal which can compress the spinal cord and nerves.</li>
	<li>As people age, the tissues that make up the spine can degenerate and wear down, leading to spinal stenosis.</li>
	<li>Osteoarthritis and rheumatoid arthritis can cause the growth of bone spurs, which can narrow the spinal canal.</li>
	<li>Spinal stenosis can also occur as a result of a traumatic injury to the spine.</li>
	<li>There are currently no screening tests available for spinal stenosis.</li>
	<li>Imaging investigations such as X-rays, MRIs, and CT scans are among the diagnostic procedures that can help confirm a diagnosis of spinal stenosis.</li>
	<li>Electromyography (EMG) and nerve conduction studies (NCS) are two additional examinations that may be done to assist in the diagnosis of spinal stenosis.</li>
	<li>The treatment of spinal stenosis depends on the severity of the symptoms and the underlying cause of the condition.</li>
	<li>Conservative treatments may be recommended initially which may include pain medication such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and injectable steroids.</li>
	<li>Surgery may be recommended for severe cases of spinal stenosis that do not respond to conservative treatments.</li>
	<li>In severe cases of spinal stenosis, the compression of the nerves in the spine can lead to urinary and bowel incontinence.</li>
	<li>Certain inherited conditions, such as dwarfism, can increase the risk of developing spinal stenosis.</li>
	<li>Jobs that require heavy lifting, twisting, or standing for long periods of time can increase the risk of developing spinal stenosis.</li>
	<li>Engaging in regular exercise can help keep the spine strong and flexible, potentially reducing the risk of developing spinal stenosis.</li>
	<li>Regular check-ups with a healthcare provider can help identify any early signs of spinal stenosis, potentially allowing for early intervention and treatment. 
	&nbsp;</li>
</ul>
<quillbot-extension-portal></quillbot-extension-portal>

[1] Mayo Clinic. (2022). Spinal stenosis.

[2] Raja A, Hoang S, Patel P, et al. Spinal Stenosis. [Updated 2022 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan