Spinal stenosis (or narrowing) is a common condition that occurs when the small spinal canal, which contains the nerve roots and spinal cord, becomes compressed. This causes a “pinching” of the spinal cord and/or nerve roots, which leads to pain, cramping, weakness or numbness. Depending on where the narrowing takes place, you may feel these symptoms in the lower back and legs, neck, shoulder or arms.
Some people are born with a small spinal canal. This is called “congenital stenosis”. However, spinal narrowing is most often due to age-related changes that take place over time. This is called “acquired spinal stenosis.”
The risk of developing spinal stenosis increases if:
- You were born with a narrow spinal canal
- You are female
- You are 50 years old or older
- You’ve had a previous injury or surgery of the spine
Some medical conditions can cause spinal stenosis. These include:
- Osteoarthritis and bony spurs that form as we age
- Inflammatory spondyloarthritis (e.g., ankylosing spondylitis)
- Spinal fractures and injuries
- Spinal tumors
- Paget’s Disease
Back pain. People with spinal stenosis may or may not have back pain, depending on the degree of arthritis that has developed.
Burning pain in buttocks or legs (sciatica). Pressure on spinal nerves can result in pain in the areas that the nerves supply. The pain may be described as an ache or a burning feeling. It typically starts in the area of the buttocks and radiates down the leg. As it progresses, it can result in pain in the foot.
Numbness or tingling in buttocks or legs. As pressure on the nerve increases, numbness and tingling often accompany the burning pain. Although not all patients will have both burning pain and numbness and tingling.
Weakness in the legs or “foot drop.” Once the pressure reaches a critical level, weakness can occur in one or both legs. Some patients will have a foot-drop, or the feeling that their foot slaps on the ground while walking.
Less pain with leaning forward or sitting. Studies of the lumbar spine show that leaning forward can actually increase the space available for the nerves. Many patients may note relief when leaning forward and especially with sitting. Pain is usually made worse by standing up straight and walking. Some patients note that they can ride a stationary bike or walk leaning on a shopping cart. Walking more than 1 or 2 blocks, however, may bring on severe sciatica or weakness.
Medical History and Physical Examination
After discussing your symptoms and medical history, your doctor at Westminster Ortho Med Clinic, DHCC, Dubai will examine your back. This will include looking at your back and pushing on different areas to see if it hurts. Your doctor may have you bend forward, backward, and side-to-side to look for limitations or pain.
X-rays. Although they only visualize bones, X-rays can help determine if you have spinal stenosis. X-rays will show aging changes, like loss of disk height or bone spurs.
X-rays taken while you lean forward and backward can show “instability” in your joints. X-rays can also show too much mobility. This is called spondylolisthesis.
Magnetic resonance imaging (MRI). This study can create better images of soft tissues, such as muscles, disks, nerves, and the spinal cord.
Additional tests. Computed tomography (CT) scans can create cross-section images of your spine. Your doctor may also order a myelogram. In this procedure, dye is injected into the spine to make the nerves show up more clearly. It can help your doctor determine whether the nerves are being compressed.
Nonsurgical treatment options focus on restoring function and relieving pain. Although nonsurgical methods do not improve the narrowing of the spinal canal, many people report that these treatments do help relieve symptoms.
Regular exercise can help you build and maintain strength in the muscles of your arms and upper legs (the hip adductors and abductors, quadriceps and hamstrings). This will improve your balance, ability to walk, bend and move about, as well as control pain. A physical therapist can show you which exercises are right for you.
Physical therapy. Stretching exercises, massage, and lumbar and abdominal strengthening often help manage symptoms.
A physical therapist, Ms. Hadel Radwan can teach you exercises that may help:
- Build up your strength and endurance
- Maintain the flexibility and stability of your spine
- Improve your balance
Lumbar traction. Although it may be helpful in some patients, traction has very limited results. There is no scientific evidence of its effectiveness.
Anti-inflammatory medications. Because stenosis pain is caused by pressure on a spinal nerve, reducing inflammation (swelling) around the nerve may relieve pain. Non-steroidal anti-inflammatory drugs (NSAIDs) initially provide pain relief. When used over the course of 5-10 days, they can also have an anti-inflammatory effect.
Steroid injections. Steroid injections around the nerves or in the “epidural space” can decrease swelling, as well as pain. They also reduce numbness, but not weakness, in the legs. Patients should receive no more than three injections a year.
Acupuncture. Acupuncture can be helpful in treating some of the pain for less severe cases of lumbar stenosis. Although it can be very safe, long-term success with this treatment has not been proven scientifically.
Surgery for lumbar spinal stenosis is generally reserved for patients who have poor quality of life due to pain and weakness. Patients may complain of difficulty walking for extended periods of time. This is often the reason that patients consider surgery.
There are two main surgical options to treat lumbar spinal stenosis: laminectomy and spinal fusion. Both options can result in excellent pain relief. Be sure to discuss the advantages and disadvantages of both with your doctor.
Laminectomy. This procedure involves removing the bone, bone spurs, and ligaments that are compressing the nerves. This procedure may also be called a “decompression.” Laminectomy can be performed as open surgery, in which your doctor uses a single, larger incision to access your spine. The procedure can also be done using a minimally invasive method, where several smaller incisions are made. Your doctor will discuss the right option for you.
Spinal fusion. If arthritis has progressed to spinal instability, a combination of decompression and stabilization or spinal fusion may be recommended.
Rehabilitation. After surgery, you may stay in the hospital for a short time, depending on your health and the procedure performed. Healthy patients who undergo just decompression may go home the same or next day, and may return to normal activities after only a few weeks. Fusion generally adds 2 to 3 days to the hospital stay.
Your surgeon may give you a brace or corset to wear for comfort. He or she will likely encourage you to begin walking as soon as possible. Most patients only need physical therapy to strengthen their backs.
Your physical therapist may show you exercises to help you build and maintain strength, endurance, and flexibility for spinal stability. Some of these exercises will help strengthen your abdominal muscles, which help support your back. Your physical therapist will create an individualized program, taking into consideration your health and history.
Surgical risks. There are minor risks associated with every surgical procedure. These include bleeding, infection, blood clots, and reaction to anesthesia. These risks are usually very low.
Surgical outcomes. Overall, the results of laminectomy with or without spinal fusion for lumbar stenosis are good to excellent in the majority of patients. Patients tend to see more improvement of leg pain than back pain. Most patients are able to resume a normal lifestyle after a period of recovery from surgery.
Living with Spinal Stenosis:
Spinal stenosis can lead to the slow but steady loss of strength in the legs. The severe pain caused by this condition can be quite disabling, even if you have no muscle weakness, since it greatly affects your ability to work and enjoy life. The natural course of the disease is one of slow progression over time. There is no cure for this condition but there are steps you can take to feel better. For example:
- Get moving. Regular exercise is very important, so do it often – at least three times a week for about 30 minutes. Start slowly with flexion-based (forward-bending) exercises. As you begin to feel stronger, add walking or swimming to your plan.
- Modify your activity. Don’t do anything that can trigger or worsen pain and disability such as lifting heavy objects or walking long distances.
- Talk to your physician about pain medications, as well as alternative therapies such as acupuncture or massage that can ease pain.
- Explore non-surgical options first except in rare cases when pain, weakness and numbness comes on quickly.
Should you require additional information or would like to make an appointment with our Consultant Orthopedic Surgeon Dr. Ishrat Khan , Pain Consultant Dr. Tarek Sultan OR Physical Therapists, Anil Daniel, OR Hadel Radwan please call us or e-mail us at firstname.lastname@example.org
- Rhematology.org- American College of Rheumatology
- orthoinfo.aaos.org – American Academy of Orthopedic Surgeons
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