Spinal stenosis (or narrowing) is a common condition that occurs when the small spinal canal that contains the nerve roots and spinal cord becomes restricted.
This narrowing can squeeze the nerves and the spinal cord causing lower back and leg pain. In general, spinal narrowing is caused by osteoarthritis, or “wear and tear” arthritis of the spinal column. This results in a “pinching” of the spinal cord and/or nerve roots.
Typically, a person with spinal stenosis complains about developing tremendous pain in the legs or calves and lower back after walking. Pain comes on more quickly when walking up inclines. This is relieved by sitting down, or leaning over. When the spine is bent forward, more space is available for the spinal cord, causing a reduction in symptoms.
What causes it?
Unless the individual is born with a small spinal canal (congenital stenosis), spinal narrowing most commonly results from progressive degenerative changes.
This “acquired spinal stenosis” can occur from the narrowing of the space around the spinal cord due to bony overgrowth from osteoarthritis combined with thickening of one of the ligaments in the back, and a bulge of the intervertebral discs.
Who gets it?
The risk of developing spinal stenosis increases in those who:
- Are born with a narrow spinal canal
- Are female
- Are 50 years of age or older
- Have had previous injury or surgery of the spine
Conditions that can cause
spinal stenosis include:
- Osteoarthritis and osteophytes (bony spurs) associated with aging
- Inflammatory spondyloarthritis
- Spinal tumours
- Trauma
- Paget’s disease of the bone
- Previous surgery
How is it diagnosed?
Your doctor will ask about your symptoms and medical history, and perform a physical exam if spinal stenosis is suspected. Your symptoms may include: numbness, weakness, cramping, or pain in the legs and thighs; radiating pain down the leg; abnormal bowel and/or bladder function; decreased sensation in the feet causing difficulty placing the feet when walking; loss of sexual function; and/or partial or complete leg paralysis.
Additional tests conducted to confirm and assess the diagnosis may include:
- An X-ray of the spine to check for abnormalities in the bones of the back including osteoarthritis, bone spurs and obvious narrowing of the spinal canal.
- A computed tomography (CT) scan to take images of the bony architecture of the back. This helps to evaluate the spinal canal.
- A magnetic resonance imaging (MRI) scan of the spine to make pictures of soft tissues such as the spinal cord and the spinal nerves inside the back.
- An EMG which may show active and chronic neurological changes.
How is it treated?
Although there is no cure for spinal stenosis, various therapies are available, one of the most important being exercise. Keeping the hip adductors and abductors, quadriceps and hamstrings from developing atrophy helps increase stability and the ability to walk.
Medications such as nonsteroidal anti-inflammatories (NSAIDs) also may be appropriate and helpful in pain relief. Cortisone injections into the epidural space, the area around the spinal cord, can afford tremendous temporary or permanent relief to people suffering this disorder.
Under severe circumstances, surgery to correct this disorder may be appropriate.
Living with it
- Exercise regularly. Regular exercise, which focuses on flexion-based exercise, often reduces pain symptoms. Add in some walking, swimming and stretch exercises for even better results.
- Modify activity. Avoid activities that can cause or worsen pain and disability.
- Talk to your physician about pain medications.
- Explore non-surgical options first except in rare cases of rapid neurologic progression or cauda equina syndrome.
(The writer is a Consultant Rheumatologist) |
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