Spinal stenosis

What is Spinal Stenosis and How is It Caused?

Spinal stenosis is a condition that occurs when the space surrounding the spinal cord becomes narrowed. It’s mostly commonly caused by ‘wear and tear’ arthritis (osteoarthritis). Treatment and therapy options include pain medication, exercise to alleviate symptoms and, in more severe cases, surgical intervention.

Medical conditions that affect the spine aren’t always the result of a traumatic injury. Conditions such as cervical degenerative disc disease can occur because of simple wear and tear.

A herniated disc is caused by a tear and prolapse of an area of the spinal cord. It can be very painful but is certainly a condition which is treatable.

Other spinal cord problems such as spina bifida arise because of congenital conditions where the spine doesn’t develop properly in the womb.

Here we take a closer look at spinal stenosis, a condition which can be caused for a variety of reasons but affects mainly people over the age of 50.

What is Spinal Stenosis?

Spinal stenosis infographic

The spinal column provides a canal through which the spinal cord and the nerves can pass. In diagnosed cases of spinal stenosis, this important space becomes narrowed for one reason or another, placing pressure on the nerves and damaging their ability to transmit information properly.

It is most often caused by wear and tear with conditions such as osteoarthritis that usually present in older age.

Some people may exhibit very few symptoms, others will find things like pain, tingling and muscle weakness gradually getting worse over time.

Spinal stenosis comes in two forms based on where the condition occurs:

  • Cervical stenosis affects the neck area.
  • Lumbar stenosis affects the lower back and is the most common type.

Spinal Stenosis Symptoms

Symptoms generally appear gradually over time as the condition worsens. It’s not unusual, however, for someone to experience no symptoms at all. Instead, stenosis will show up on a medical test like a CT or MRI scan.

For cervical stenosis, the most obvious symptoms include a numbness, tingling or weakness in areas like the hands, arms, feet or legs. There may be some neck pain and in some patients there can be difficulty walking properly. If the stenosis is advanced and severe, it can cause issues with bowel and bladder control.

For lumbar stenosis, the numbness and weakness is restricted to the legs and feet, mainly because of the location of the damage. People might lower feel back pain and suffer from cramping in the muscles of the legs.

Spinal Stenosis Causes

Some people are born with a narrow spinal canal that can cause issues. Spinal stenosis following a spinal cord injury is also a possibility but can be masked by other symptoms depending on the level of damage. 

Spinal stenosis is caused when something happens to narrow the space within the spine. This can include:

  • Conditions such as osteoarthritis where formation of bone spurs impinge on the spinal cord.
  • Bone conditions such as Paget’s disease which may lead to growths in the spinal cord.
  • A herniated disc where some of the compressed material pushes into the spinal cord.
  • Tumors that impact on the spinal cord are another obvious cause of spinal stenosis.
  • Thickened ligaments due to age may bulge into the spinal cord and cause issues.

The majority of people who are diagnosed with having spinal stenosis are over 50 years old and most cases are attributed to ‘wear and tear’ arthritis. It can also occur in younger people but this is usually down to a traumatic event like a spinal injury or because of a genetic or congenital deformity like scoliosis. 

Treatment of Spinal Stenosis

MRI scan showing spinal stenosis
MRI scan showing spinal stenosis

While spinal stenosis can be diagnosed from symptoms, it is usually confirmed using an imaging technique like CT or MRI scanning. Treatment will depend on where the damage has occurred and the severity of the problem.

If the symptoms are mild, a doctor may well just monitor the situation to make sure it doesn’t get any worse.

For pain relief, medications may be prescribed. These can include standard pain relievers such as ibuprofen or Tylenol. Antidepressants and anti-seizure drugs can also be used effectively to treat pain caused by nerve damage. For short-term pain relief, opiates may be used.

If there is a lot of pain being experienced, the individual with spinal stenosis may be less active than previously. It’s actually important to have at least some physical therapy to maintain flexibility and build up the strength of the muscles around the spine. A doctor will advise some exercise to improve the condition.

Nerves that have been pinched because of the narrowing of the spinal canal can become irritated and steroid injections may be used to combat this in certain cases.

In more severe types of spinal stenosis, a medical intervention may be used. This can include:

  • Decompression procedure: This is used for lumbar stenosis and involves removing a part of a thickened ligament.
  • Laminectomy: This removes part of the back of the vertebrae to relieve pressure.

Other surgical interventions include a laminotomy and laminoplasty on the area of the neck. These are generally a last resort after pain management, not least because not all patients find their symptoms improving following surgery.