Spinal Stenosis- Symptoms, Causes and Treatment

Spinal Stenosis Symptoms

Spinal stenosis happens when the areas inside your spine get narrower, compressing the spinal cord and nerves. Depending on where the narrowing occurs (cervical, thoracic, or lumbar spine) and the severity, symptoms can differ, but general symptoms include:

General Symptoms

• Back or neck pain
• Numbness or tingling in the arms or hands, or legs or feet
• Leg weakness
• Difficulty with balance or coordination
• Crampling of one or both legs, especially on standing or walking

Lumbar (Lower Back) Spinal Stenosis Symptoms

• Lower back ache
• Legs or feet numbness, weakness, or pain
• Pain that gets better when bending forward or sitting down
• Difficulty in walking or standing for extended periods (neurogenic claudication)
• Problems with bladder or bowel control (rare, but life-threatening—could indicate cauda equina syndrome, a medical emergency)

Cervical (Neck) Spinal Stenosis Symptoms

• Neck ache
• Weakness, numbness, or tingling of the arms or hands
• Having trouble with fine motor skills (e.g., buttoning shirt)
• Balance difficulties or difficulty walking
• In extreme circumstances, bladder or bowel dysfunction

Spinal Stenosis Treatment

Treatment of spinal stenosis varies with the degree of symptoms and site of narrowing. Treatment varies from non-surgical to surgical.

Non-Surgical Treatment (First-line for Mild to Moderate Cases)

Medications

• NSAIDs (e.g., ibuprofen, naproxen): Decrease pain and inflammation.
• Painkillers (e.g., acetaminophen): For mild pain.
• Muscle relaxants: If there are muscle spasms.
• Antidepressants (such as amitriptyline): For ongoing pain.
• Anti-seizure medications (e.g., gabapentin, pregabalin): Ease nerve pain.

Physical Therapy

• Strengthen back and abdominal muscles
• Enhances balance, flexibility, and mobility
• Decreases pressure on nerves

Epidural Steroid Injections

• Decrease inflammation around compressed nerves
• Temporary relief (weeks to months)

Activity Modification

• Avoid standing/walking for long periods
• Use of assistive devices such as a cane or walker if necessary

Weight Management

• Loss of excess weight relieves spinal stress

Surgical Treatment (For Severe or Progressive Symptoms)

Surgery is indicated when:

• Pain is severe and disabling
• Neurological deficits increase
• Non-surgical approaches fail

Common Procedures:

• Laminectomy (most common): Removes portion of the vertebra to provide more space.
• Laminotomy: Incomplete removal of the lamina.
• Foraminotomy: Expansion of the exit of the nerve root.
• Spinal fusion: Stabilizes the spine when there is instability.

Lumbar Spinal Stenosis

Lumbar spinal stenosis refers to a narrowing of the lower back (lumbar spine) spinal canal that puts pressure on the nerves going to the legs. It most frequently occurs in individuals over the age of 50 and typically results from wear and tear over time, although it can be caused by a variety of factors such as herniated discs, arthritis, or spinal trauma.

Cervical Spinal Stenosis

Cervical spinal stenosis is a narrowing of the spinal canal in the neck area (cervical spine), which can compress the spinal cord and nerve roots. This condition is more severe than lumbar stenosis since it can directly impact the spinal cord.

Spinal Stenosis Surgery

Spinal stenosis surgery is done to decompress the spinal cord or nerves due to the narrowing of the canal. It's typically reserved when conservative measures aren't effective or when nerve compression is severe, there is progressive weakness or loss of function.

Spinal Stenosis Surgery Types

Laminectomy (Decompression Surgery)

• Most frequently performed procedure
• Goes in and removes the lamina (rear portion of the vertebra) to expand space for nerves
• Performed with or without spinal fusion often

Laminotomy

• Partial laminectomy (only a small section)
• Conserves more of the structure of the spine

Foraminotomy

• Increases size of the foramina (nerve root exit points)
• Usually performed with laminectomy

Spinal Fusion

• Joins two or more vertebrae to stabilize the spine after decompression
• Usually used if spinal instability or spondylolisthesis is present
• Decreases flexibility but adds stability

Laminoplasty (for Cervical Spine)

• Opens and reformats the spinal canal by hinging the lamina open
• Conserves motion, unlike complete laminectomy with fusion

Minimally Invasive Surgery (MIS)

• Smaller cuts, less damage to muscles, quicker recovery
• Methods: Tubular retractors, endoscopic decompression
• Not appropriate for all patients or complicated cases

Spinal Stenosis Causes

Spinal stenosis is the result of narrowing of the intervertebral spaces, which compresses the spinal cord or nerve roots. It may be congenital (inborn) or acquired (progressive, as a result of aging or injury).

Frequent Causes of Spinal Stenosis

Degenerative Changes (Most Frequent Cause)

• Osteoarthritis: Wear-and-tear of spinal joint results in bone spurs that project into the spinal canal.
• Degenerative disc disease: Sinking discs decrease space between vertebrae.
• Thickened ligaments (ligamentum flavum): Ligaments become thick and protrude into spinal canal over time.

Herniated Discs

• The inner, soft part of a disc bulges or leaks out and compresses surrounding nerves or the spinal cord.

Spondylolisthesis

• A vertebra slips forward onto the vertebra below, which can decrease the canal size and potentially squeeze nerves.

Congenital Spinal Stenosis

• Some individuals are born with a genetically narrow spinal canal, so they are more susceptible to symptoms despite minimal degeneration.

Spinal Injuries

Trauma or accidents may produce:

• Fractures that can displace bone into the canal
• Swelling or bleeding compressing nerves

Tumors

• Growth abnormalities in or around the spinal cord can invade or compress the spinal canal.

Infections

• Spinal infection can produce inflammation or abscesses that reduce the size of the canal.

Paget's disease

• A bone disease resulting in irregular bone growth along the spine that reduces the canal.

Spinal Stenosis Diagnosis

Spinal stenosis diagnosis includes a combination of a thorough medical history, physical examination, and imaging studies to establish spinal canal narrowing and determine nerve compression.

Medical History

Your physician will inquire about:

• Type, location, and intensity of pain
• Onset and course of symptoms
• Worsening or relieving factors (e.g., walking vs sitting)
• Numbness, tingling, weakness, or bladder/bowel symptoms

Physical Examination

• Neurological examination: Test reflexes, muscle strength, and sensation
• Gait and balance: Evaluate walking capacity and coordination
• Posture and flexibility: Check for movement restriction or evidence of nerve irritation

Imaging Tests

• MRI (Magnetic Resonance Imaging) — Gold standard
• Best at demonstrating soft tissues (discs, nerves, ligaments)
• Demonstrates nerve compression, disc herniation, and canal narrowing

CT Scan

• Offers precise images of bones
• Usually combined with myelogram for improved nerve visualization

X-rays

• Demonstrates bone spurs, disc height loss, or vertebral misalignment
• Useless for visualizing nerves

CT Myelogram

• Involves injection of contrast dye into spinal fluid prior to CT
• Highlights spinal cord and nerves better if MRI is not possible

Electrophysiological Tests (Occasionally Utilized)

• EMG (Electromyography) and nerve conduction tests
• Detect nerve damage and distinguish stenosis from other nerve conditions such as peripheral neuropathy

Spinal Stenosis Prognosis

The prognosis of cervical or lumbar spinal stenosis, however, is quite variable and depends on a variety of factors: severity of the disease, site of the stenosis, etiology, neurological status, and modality of treatment utilized. In most instances, it is a chronic and progressive disease, yet early treatment and proper management may greatly change its course and quality-of-life affect.

Decompressive operations like laminectomy, foraminotomy, or laminoplasty, usually with or without fusion, provide good to excellent results in well-selected patients.

Success rates following postoperative success are around:

• 75–90% for symptomatic relief in leg pain from lumbar stenosis
• 70–85% improvement in cervical myelopathy following surgery

Spinal Stenosis Management

Management of spinal stenosis intends to alleviate pain, enhance function, and avoid neurological deterioration. It varies with the severity, position (cervical or lumbar), and etiology. Management varies from conservative treatment to surgery.

Non-Surgical Management (First-Line for Most)

Physical Therapy

• Strengthening core, back, and leg muscles
• Enhances posture and flexibility
• Decreases pressure on nerves
• Individualized programs involve stretching, aerobic conditioning, and balance training

Medications

• NSAIDs (ibuprofen, naproxen): Pain relief and reduce inflammation
• Acetaminophen: Mild pain relief
• Muscle relaxants: For associated spasms
• Gabapentin/Pregabalin: For nerve-related pain
• Short-term oral steroids: For flare-ups

Epidural Steroid Injections

• Anti-inflammatory corticosteroids injected into epidural space
• May decrease nerve inflammation and pain
• Relief is temporary (weeks to a few months)

Activity Modification & Aids

• Avoid extended standing/walking if it exacerbates symptoms
• Bending forward (e.g., with a walker or leaning over a shopping cart) may alleviate symptoms in lumbar stenosis
• Use of canes, braces, or ergonomic chairs if necessary

Alternative Therapies (with caution)

• Acupuncture, chiropractic manipulation (not recommended for cervical stenosis with myelopathy)
• Yoga or Tai Chi (gentle styles)

Surgical Management (For Moderate-Severe or Progressive Cases)

Indicated when:

• Conservative treatment fails after 3–6 months
• Neurological symptoms worsen (e.g., weakness, bowel/bladder dysfunction)
• Significant spinal cord compression (particularly in cervical stenosis)

Common Surgical Options:

• Laminectomy (with or without fusion)
• Laminotomy (partial)
• Foraminotomy
• Laminoplasty (primarily cervical spine)
• Spinal fusion (for instability)

Spinal Stenosis Recovery Time

Recovery time from spinal stenosis depends on the treatment type, severity of the condition, and if surgery was involved. Below is a breakdown:

Recovery with Non-Surgical Treatment

Timeframe:

• The majority of patients improve in 4 to 6 weeks with regular therapy and medication.
• Complete improvement may take 3 to 6 months depending on severity and compliance with therapy.

Recovery After Spinal Stenosis Surgery

Immediately After Surgery

Hospital stay:

• 1–3 days for minimally invasive surgery
• 3–5 days if traditional open surgery or if spinal fusion is necessary

At Home (First 6 Weeks)

• Light activities only (walking, light housework)
• No bending, lifting, or twisting
• Slow return to regular daily activities

6 Weeks to 3 Months

• Start formal physical therapy
• Noticeable relief from leg/arm symptoms often within short time
• Return to desk activity may be possible in 4–8 weeks; physical activity could take longer

Full Recovery Timeline

• 3 to 6 months for the majority
• Up to 12 months for complete healing of spinal fusion or in case of extensive surgery
• Quick with minimally invasive surgeries