Spinal Stenosis
Compression of the Spinal Canal
Spinal stenosis is a relatively common orthopedic condition that simply
means narrowing of the spinal canal. This narrowing is typically the result
of a gradual process. Most causes of spinal stenosis are associated with
age-related wear and tear. Spinal stenosis may or may not cause symptoms.
In some cases, it can result in compression of nerves causing persistent
back pain and leg pain, making it a debilitating disease for those who have it.
Some people are born with a smaller spinal canal and therefore may be more likely to develop symptoms from stenosis earlier in life. The vast majority of people with symptomatic spinal stenosis are over the age of 50. Untreated spinal stenosis can have critical health consequences, such as chronic pain, weakness, numbness, peripheral neuropathy, incontinence, and paraplegia or quadriplegia.
Multidisciplinary Spinal Stenosis Treatment in New Jersey
RWJBarnabas Health is the largest health care system in New Jersey. Together with the Departments of Orthopedic Surgery and Neurosurgery at Rutgers Health, we offer state-of-the-art options for pain relief and recovery. Identifying the causes of spinal stenosis and addressing spinal stenosis symptoms requires a multidisciplinary approach involving expertise from the orthopedics and neuroscience fields.
Our Brain, Spine and Neuromuscular Care Center offers leading-edge spinal stenosis treatment for those who suffer from cervical stenosis, cervical stenosis with myelopathy, lumbar stenosis, thoracic stenosis, and other spinal conditions.
We treat thousands of patients per year, and have dedicated spine specialists at locations throughout New Jersey. Our team includes board-certified neurologists, neurosurgeons, fellowship-trained orthopedic spinal surgeons and support staff who are here to deliver the highest quality spine care and restorative relief for your back pain.
If you need a leading orthopedic surgeon or neurosurgeon, RWJBarnabas Health is here to guide you.
Normal Anatomy of the Spine vs. Spinal Stenosis
To better understand spinal stenosis, it’s helpful to learn more about the anatomy of a typical, healthy human spine. The spine is naturally shaped like the letter S and is and made up of three interconnected C-shaped curves. The curve of the neck is the cervical spine, the reverse C shape of the mid-back attached to the ribs is the thoracic spine, and the lumbar spine is the final C-shaped curve of the lower back.
The role of the spinal column is to protect the spinal cord, which is a nerve bundle running from the base of the brain to the lower back. This critical part of the central nervous system sends messages from the brain to the rest of your body, while also receiving sensations from various parts of your body.
The spinal column is made up of small bones called vertebrae that are stacked one on top of the other. In between each vertebra sits an intervertebral disc whose job is to provide cushion between the bones. Ligaments are fibrous tissues that connect the vertebrae and help keep the spinal column in place.
A healthy spine has ample space in the spinal canal for the spinal cord, but in cases of spinal stenosis, the nerves and sometimes the spinal cord itself become compressed. When this occurs, the cushion between the discs wears down, causing an unnatural rubbing of the bones against one another. They can ultimately form bony growths called bone spurs, resulting in a painful condition requiring spinal stenosis treatment or surgery.
Types of Spinal Stenosis
The narrowing of your spinal canal can occur at any place in your back, however, it is most common in the cervical and lumbar regions. As such, they make up the two main types of spinal stenosis. A third type is also detailed below.
- Cervical stenosis. This occurs when a nerve is pinched in the neck area of the spine. It is dangerous because there is a possibility of a person developing myelopathy, which is the compression of not only the nerves but the spinal cord itself. If the spinal cord is compressed, the complications can be severe, and without spinal stenosis treatment, permanent weakness and other difficulties may result.
- Lumbar stenosis. Often caused by osteoarthritis, this painful condition occurs when a nerve is pinched in the lowest part of the spine.
- Thoracic stenosis. This less common form of spinal stenosis involves disc compression in the middle or upper portion of the spine that is attached to the ribcage.
Spinal Stenosis Symptoms
Your spinal stenosis symptoms may vary depending on where your spine is compressed, and the degree that your spinal canal is narrowed. Signs can go undetected even by an experienced health care provider because oftentimes, the spinal stenosis symptoms are subtle and appear very gradually. There are also various conditions such as a herniated disc, a tumor, multiple sclerosis or peripheral arterial disease that may mimic the symptoms of spinal stenosis.
Cervical Stenosis with Myelopathy Symptoms
- Neck pain. This symptom may or may not be present, and neck pain alone is generally not a sign of cervical stenosis.
- Numbness and/or tingling in the hands, arms, feet or legs. Reduced feeling or the sensation of pins and needles is caused by a pinched nerve.
- Difficulty balancing, walking or coordination. The impaired function of the spinal cord that comes with cervical stenosis can create clumsiness.
- Paralysis, if the compression is chronic. In some cases cervical stenosis can cause changes in the spinal cord that are similar to what one might see with a spinal cord injury. A spinal cord injury could cause some degree of permanent damage.
Thoracic Stenosis Symptoms
- Pain in the back and legs. Stenosis of the thoracic region can start in the back and radiate down one or both legs.
- Problems with balance, walking or coordination. The impaired function of the thoracic region can create clumsiness.
Lumbar Stenosis Symptoms
- Back pain. Pain from lumbar stenosis may or may not be present, depending on the patient’s degree of arthritis.
- Sciatica. This condition may result from lumbar stenosis, causing burning pain, numbness or tingling in the legs, feet or buttocks. It results from pressure on the spinal nerves causing pain in the areas that control them. Increasing pressure on the nerve causes numbness and tingling along with pain, however, not all patients experience both pain and numbness.
- Weakness in the legs (“foot drop”). Extreme pressure on the spinal nerve from lumbar stenosis causes weakness in one or both legs. “Foot drop” is a term for when the foot slaps the ground when walking, and it can sometimes occur.
- Lessened pain when sitting or leaning forward. People with lumbar stenosis symptoms may find that leaning forward brings them relief, as it opens up the joint space, reducing pressure.
- Loss of bladder function. Pain radiating from back to front under a rib may suggest pinching of nerves in the thoracic spine. Difficulty with bowel and bladder starting with the inability to urinate or have a bower movement and leading to incontinence accompanied by numbness and tingling in the genital regions may require urgent surgery.
Causes of Spinal Stenosis
Most cases of spinal stenosis are not caused by congenital disorders that narrow the spaces within the spine. Instead, trauma to the spine, such as an auto accident or sports injury, an acute change in the size of the spinal canal or over a prolonged time lead to bone overgrowth and narrowing of the spinal canal. Some of the most common causes of spinal stenosis include:
- Age. Spinal stenosis is most common in adults over the age of 50, due to wear and tear of the spine and the degeneration of discs over the years.
- Herniated discs. Herniated discs can cause stenosis by occupying space in the canal and directly pushing on nerves.
- Degenerated discs. Degenerated discs can lead to stenosis because as they “shrink” and decrease in height the exiting nerve tunnels get tighter.
- Bone overgrowth. There are small joints at every level of the spine which help create the spinal canal. When these joints become arthritic, spurs form than can cause stenosis and pinch nerves.
- Tumors. Tumors are one of the uncommon causes of spinal stenosis that develop as abnormal growths inside the spinal cord, causing narrowing and compression of the nerves.
- Trauma. Injury to the spinal cord can create dislocations or fractures of one or more of the vertebrae, which can lead to spinal stenosis.
Why Is Spinal Stenosis More Common in Older Adults?
Spinal stenosis is strongly associated with older adults because the spine changes as we age. It is one of a number of conditions that may require treatment from an orthopedic surgeon or neurosurgeon because it can lead to degeneration of the spine’s discs and joints. As many as 95 percent of people will experience some degenerative condition by the age of 50, according to the American Academy of Orthopaedic Surgeons.
Arthritis, for example, is a common orthopedic spine disease that mostly affects older adults. It involves the joints in the spine wearing down over time. While the majority of adults experiencing arthritis can achieve relief by reaching a healthy weight, eliminating tobacco use or through other lifestyle practices, others may benefit from consultation with an RWJBarnabas Health specialist to feel improvement.
How Is Spinal Stenosis Diagnosed?
If you encounter sudden or gradual back pain symptoms, you should seek medical attention to obtain a proper diagnosis and treatment. In your appointment, your family physician, orthopedist, neurosurgeon or neurologist may conduct the following:
- Physical exam. Your doctor will take a complete medical history, including asking about your back pain symptoms and how long they have lasted. Your range of spinal motion will be tested, as well as your balance and coordination. Through testing, your neurologist can determine if you are exhibiting a loss of reflexes, abnormal reflexes or any unusual muscle weakness or loss of sensation.
- X-ray imaging. Obtaining an image of your spine is crucial for your doctor to form a diagnosis for spinal stenosis or other condition. They may begin with an X-ray, which shows your bone formation and other dense structures in your body. This imagery can identify orthopedic conditions such as osteoarthritis, which may require further testing if signs point to spinal stenosis.
- Magnetic resonance imaging (MRI). An MRI can provide detailed images of the soft tissues inside the body as well as signs of inflammation. This is valuable to your orthopedic surgeon or neurosurgeon in identifying spinal stenosis as well as other signs of neurologic compression.
- Computerized axial tomography (CT scans). In some situations, an MRI is not possible because the patient has a metallic device in the body, such as a cardiac pacemaker. When this is the case, a CT scan is a beneficial tool in providing an image to aid your orthopedic surgeon or neurosurgeon in making a diagnosis.
- Myelogram. This procedure is performed by a radiologist who injects a liquid dye into the spinal column to show whether there is pressure on the spinal cord, or if you have other issues like herniated discs, bone spurs or tumors. From there, your orthopedic surgeon or neurosurgeon can assess your condition.
- Lab tests. Although there are no lab tests that specifically diagnose spinal stenosis, blood and urine tests may help reveal systemic illnesses that can mimic spinal stenosis.
Spinal Stenosis Treatment Options
Treatment options for spinal stenosis vary depending on the location and severity of your spinal compression, your other symptoms, and your lifestyle factors.
Some patients with milder spinal stenosis symptoms respond well to conservative therapies and nonsurgical spine treatments or in some cases, may require no further treatment. Patients with severe spinal cord compression are often good candidates for surgical spine treatment which may involve traditional open spinal stenosis surgery or minimally invasive spinal stenosis surgery performed by a skilled orthopedic surgeon or neurosurgeon.
Either spinal stenosis treatment option serves to remove compression of the spinal cord to improve the patient’s pain level and ability to function, as well as to prevent deterioration or worsening of pain.
Nonsurgical Spinal Stenosis Treatment
The purpose of nonsurgical spinal stenosis treatment is to restore function and relieve pain. While these treatment options do not improve the narrowing of the spinal canal, they can help with associated symptoms. Some of the most commonly used nonsurgical therapies for spinal stenosis include:
- Physical therapy. Aided by a trained physical therapist, exercises such as walking, swimming, stretching, core strengthening, and light weightlifting are particularly useful forms of spinal stenosis treatment for those who only have minor spinal stenosis symptoms.
- Epidural steroid injections. Aided by a needle inserted into the lower back, injections can reduce arthritis symptoms and pain, as well as provide an effective spinal stenosis treatment to lessen irritation and swelling from spinal stenosis symptoms.
- Medication. Anti-inflammatory medication, muscle relaxants or nerve pain medication such as gabapentin or pregabalin may be useful in providing relief from spinal stenosis symptoms.
Spinal Stenosis Surgery
The purpose of spinal stenosis surgery is to permanently decompress the spinal canal, which can be performed in several ways. While surgery may be a first-line treatment for many, nonsurgical spinal stenosis treatment options are a reasonable initial approach to spinal stenosis.
Some types of spinal stenosis treatment options include:
- Laminectomy (decompression). This surgery removes bone, bone spurs and ligaments which are compressing the nerves. It can be performed either through the traditional “open” method or through a minimally-invasive method with smaller incisions, where your orthopedic surgeon or neurosurgeon will be guided through through special tubes, retractors or endoscopic cameras.
- Foraminotomy. This is another type of spinal stenosis decompression surgery in which your orthopedic surgeon or neurosurgeon enlarges the spinal canal’s passageway where the spinal nerve is compressed in the exiting tunnel or neuroforamen. During the surgery, the piece of bone or tissue obstructing the passageway is removed.
- Spinal fusion. If a patient’s spine is particularly unstable from arthritis or other spine conditions, their spinal stenosis treatment may include combination therapy of spinal fusion and laminectomy. A spinal fusion is also often indicated for spinal stenosis surgery if the amount of bone removed to alleviate the stenosis causes an instability.
Risks of Spinal Stenosis Surgery
Undergoing any surgical procedure comes with risks. Spinal stenosis surgery risks include adverse reactions to anesthesia, bleeding, infection and blood clots. Risks are higher for elderly patients, as well as patients who smoke, are overweight, have diabetes or have multiple medical problems.
Specific risks of spinal stenosis surgery include failure of the bones to heal, nerve injuries, tearing of the sac covering the nerves, failure to relieve symptoms, return of symptoms or the need for further surgery.