What Is Spinal Stenosis and How Is It Treated?

Your spine is one of the most delicate parts of your body. Any injury, even a minor one, needs to be treated seriously since your spine is a bridge between your brain and the rest of your body. One such condition you may have heard of is spinal stenosis. 

What is spinal stenosis?

The spine consists of a series of ringed bones (vertebrae) which create a tunnel called the spinal canal. The spinal canal protects the spinal cord and spinal nerves as they travel from the brain to the rest of your body. When the spinal canal narrows, or becomes stenotic,  this may compress the spinal cord and/or exiting nerves manifesting in a variety of symptoms. This condition is called spinal stenosis. Here’s why it happens and how it’s treated.

What causes spinal stenosis?

There are quite a few things that can cause spinal stenosis, from osteoarthritis and herniated discs to thickened ligaments or spinal injuries. In some rare scenarios, compression secondary to tumors can cause it as well.

The key thing is to get checked out and figure out if any of these scenarios are true in your case. Needless to say, the cause is key to figuring out the best future course of action.

There are two major locations in which one can have spinal stenosis:

• Lumbar (lower back)

• Cervical (neck)

A third and far less common area is within the thoracic (mid-back) spine. 

Each of them gives different symptoms. Speaking of which…

What are the symptoms of spinal stenosis?

When it comes to lumbar spinal stenosis, the most common symptoms are - pain in the lower back or leg. You may also feel numb, have a burning sensation, or feel weak creating difficulty walking. In some severe scenarios, you may even suffer from bowel or bladder dysfunction. This, however, is quite rare.

As for cervical spinal stenosis, the most common symptoms are neck pain, arm pain/numbness/tingling sensation, and arm coordination issues(trouble buttoning shirt buttons, zipping zippers, and handwriting difficulties). Also, in some advanced cases, a person may experience difficulties with balance and coordination. 

In other words, as you would have expected, neck and upper extremities vs lower back and lower extremities. 

The biggest problem with this is that, since the spine distributes your nerves, the pain can manifest uniquely in each individual and be one or a combination of the above symptoms.

What are the final stages of spinal stenosis?

If left untreated, spinal stenosis may potentially worsen. The most severe complication is irreversible nerve damage. While paralysis is a major concern to patients when one hears they have compression within the spine, in all actuality, paralysis is rarely a result of spinal stenosis as a result of arthritis over time. Spinal stenosis in the cervical spine can eventually create irreversible symptoms such as difficulty with hand coordination, balance issues, and permanent bowel and bladder incontinence.  The major concern is if a patient sustains an injury to the head or neck the compression can result in a much more serious deficit. 

Within the lower lumbar spine, there is less concern for paralysis. This is because of the common misconception that the spinal cord traverses the body from head to toe but it actually ends in the upper lumbar spine about the vertebrae L1-2.  Spinal stenosis most commonly happens much lower in the spine and total paralysis is less of a concern at that point as issues here usually only compromise specific nerves.  

How is spinal stenosis treated?

There are several ways to treat spinal stenosis, depending on the cause. For instance, you won’t treat tumors, thickened ligaments, and spinal injuries in the same way. Still, there are two paths that you can take - conservative and operative. Here’s what each of these spinal stenosis treatment options has to offer.

Conservative treatment for spinal stenosis

The first thing you want to try in this scenario is physical therapy. By strengthening core and paraspinal muscles, you’ll provide better support to the spine. This will keep it in a much better position, and a good posture can help reduce the pressure on nerves. Staying active is also one of your best shots at preventing spinal stenosis.

If the symptoms become unbearable, you can try your luck with over-the-counter medications. Nonsteroidal anti-inflammatory drugs can help reduce inflammation and the size of any swollen material in the spinal cord, which would, therefore decrease the stenosis and hopefully alleviate your symptoms. However, if these don’t work, talk to your doctor to see if corticosteroid injections are an option. This is a more powerful and localized anti-inflammatory medication. Usually, it is injected near the spinal nerves and may provide relief from pain by reducing inflammation.

One more (less reliable) way to reduce inflammation is to try a heat and cold therapy. 

You also want to modify your lifestyle and avoid activities that will put too much pressure on your spine. At the same time, lowering your body weight will put less pressure on your spine.

Exercises for spinal stenosis

What exercises can someone with spinal stenosis do? First of all, what is a spinal stenosis exercise? Simply put, these are low-intensity exercises that will allow you to improve flexibility and strengthen your core and paraspinal muscles.

• Low-impact cardio, like walking and swimming, should be your go-to.

• Other than this, you might want to consider core exercises like planks or bridges. Just make sure not to push it too far, especially if you’re already struggling. 

• Balancing exercises like single-leg stands, heel-toe walks, and similar are also things you have to try
• Finally, you cannot afford to skip warm-up and stretching.

Ultimately, it might be best to talk to your healthcare professional before taking up any of these exercises.

Spinal stenosis surgery

If conservative treatment fails, surgery is the next best step. Still, what is spinal stenosis surgery, and is there more than one type? Generally speaking, there are two common surgical approaches in the absence of spinal instability:

• Decompressive laminectomy: This is a procedure where the surgeon removes the back part of the vertebral ring, called the lamina, to give the spinal canal more space and relieve pressure on the nerves. This turns the closed ring into an open “C”. This is usually done when there’s growth of bone or thickening of ligaments.

• Laminotomy: This procedure is simpler but removes a smaller portion of the lamina.

• Fusion: In the neck, the above two options, while exist, are typically not routinely done for technical and anatomical reasons.  This will likely require fusion to relieve the compression on the spinal cord 

• In the lower back, fusion is considered when INSTABILITY is present. This is determined upon review of x-rays and MRIs. 

The majority of patients take a while to recover, but they commonly leave the hospital within 24 hours to two days after surgery. In certain instances, patients may benefit from doing this surgery as an outpatient and are sent home the same day. Post-surgery, patients often resume a normal life within the first 6 weeks but sometimes patients may undergo rehabilitation and require pain management strategies for full recovery. 

Does spinal stenosis go away?

As a chronic condition, spinal stenosis does not go away on its own. Pain will be sporadic, and symptoms will change intermittently. While conservative treatments may provide some help with pain management and mobility, they usually treat symptoms, not the underlying cause.  Sometimes this will mitigate the symptoms for an undetermined amount of time which may be short or long-term.  

Generally speaking, surgical procedures give the best, long-term results, but they are also the riskiest. This is also never the first response but only after all other conservative options have failed and you no longer are comfortable with your symptoms as you feel them. 

Wrap up

In the end, spinal stenosis can drastically affect patients and proper management can increase quality of life. This way, you can lead a less painful and more mobile life. More importantly, if untreated, things will only get worse, which is why taking a proactive stance might be your safest bet.

You can learn more about spinal stenosis and the treatment options available at the Orthopedic Institute of New Jersey.