What is Spinal Narrowing?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

Spinal narrowing refers to a common condition that occurs in the spinal canal–the part of the back that contains the spinal cord and several sensitive nerve roots. When the canal becomes compressed, then this is known as narrowing or stenosis. When this occurs, the sensitive roots or the spinal cord can become pinched, leading to cramping, pain, numbness, or weakness. Depending on the exact area where the spinal narrowing occurs, you might feel the pain in the shoulder, neck, and arms, or in the lower back and legs.

In most cases, osteoarthritis causes this narrowing of the discs between the vertebrae and the spinal column; there’s a reason they call it the wear and tear arthritis, after all. On the other hand, the narrowing could be the result of bulging of a slipped disc, or a thickening of back ligaments. Typically, the symptoms begin gradually and slowly get worse over the years. By the time it is a serious problem, you may find walking short distances hurts too much. In fact, you may also have to learn forward on a walker just to relieve the pain and remain mobile.

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More About Spinal Narrowing

lumbar foraminotomySpinal narrowing can occur in one or multiple parts of the spine, which is most common in the neck and the lower back. Regardless of which part of the spine narrows, this can put pressure on the nerves branching out from the tight spaces. In most cases, an affected person will complain of pain in the lower back, calves, or legs when walking or standing. It can occur suddenly when walking on a hill or staircase, but leaning over or sitting will relieve it.

Of course, not all spinal narrowing patients have symptoms, and it’s not clear why. Because of this, terms like spinal stenosis aren’t quite interchangeable with spinal narrowing, as the former refers to the pain felt caused by the latter.

Stenosis can lead to a gradual but consistent loss of leg strength. The pain from the narrowing can actually disable even without muscle weakness, because it causes the person to lose quality of life and the ability to work. Although there is no cure, there are spinal narrowing treatment methods that you can do at home, such as:

  • Keep active: It is important to exercise, so do so at least 90 minutes a week, broken up over three days. Don’t try to do too much at once, either; start with some forward-bending exercises, and then add walking and swimming as you regain strength.
  • Change your activity: Avoid any movements that will worsen the pain, like lifting heavy weights, and stick to baby steps.
  • Get medications: Your doctor can talk to you about which medications you should try and how much.

What are the Symptoms?

As previously stated, you may not experience any symptoms at all from spinal narrowing. Whether or not you develop symptoms largely depends on whether or not the narrowing is applying pressure to the spinal cord or its nerve roots. If there are only nerve roots affected, then you will experience radiculopathy affecting the legs or arms. Other related conditions include:

Myelopathy:
This refers to neurologic symptoms experienced as a result of pressure on the spinal cord, and it is serious–it has the potential to cause permanent damage to the spinal cord. Myleopathy happens when spinal narrowing pinches the spinal cord, which can lead to serious nerve damage if left untreated, resulting in paralysis and even death. Less serious symptoms include a reduction in both gait and balance, as well as restriction to bladder function, grip strength, and fine motor skills.

Neurogenic Claudication:
This is a common symptom of lumbar spinal narrowing; the name literally means painful or cramping legs as a result of a nerve problem. Note that this is not the same as vascular claudication, which is a condition that causes cramping as a result of poor blood supply. In the case of the spine, it can lead to weakness, numbing, and pain in the legs and buttocks.

Cauda Equina Syndrome:
Another symptom of chronic spinal narrowing is cauda equina, which literally translates to “horse tail” as it affects the end of the spinal cord. Damage to this area can result in this syndrome, which causes a loss of lumbar nerve root functions. Some symptoms of the syndrome include a loss of sensation over the inner thighs, anus, genitals, and legs, and both incontinence and sexual dysfunction.

How is Spinal Narrowing Diagnosed?

Your physician will ask for your medical history and a description of your symptoms. If the specialist suspects you have spinal narrowing or stenosis, then you will need to undergo a physical exam. A few of the physical symptoms that the specialist will check for include:

  • Abnormal bladder or bowel function
  • Pain shooting down the leg
  • Weakness, numbness, pain, or cramping in the feet, thighs or legs that make walking challenging
  • Loss of sexual function
  • Complete leg paralysis, in severe cases — this is a medical emergency

Additionally, the specialist will want to rule out any other conditions that could manifest similar symptoms, such as a disorder of the nervous system, a disorder of the blood vessels and heart, or arthritis in the knees or hips. Therefore, the doctor may wish to order a number of additional tests to make an accurate diagnosis:

  • A spinal x-ray to rule out bone spurs and osteoarthritis
  • A CT scan for better images of the spinal canal
  • An MRI to check on the nerves and spinal cord
  • An EMG to test the nerves extending to the legs

What are the Causes of Spinal Narrowing?

low back pain

The full length of the spine runs from the neck all the way down to the lower back, forming a spinal canal that houses the spinal cord and several nerve roots. Some people simply have a small spinal canal, making narrowing that much more likely. However, stenosis occurs once something happens to cause the open space to narrow further. Some potential causes include:

  • Bone growth: Damage from osteoarthritis causes the vertebrae and discs to encourage the development of bone spurs, which may grow inside the spinal canal. Paget’s disease can also cause bone growth within the spine.
  • Thickened ligaments: The cords that are meant to hold the vertebrae together may become thicker over the years, which can cause a bulging into the spinal canal, narrowing the available space.
  • Herniated discs: The shock absorbers between the spinal bones naturally dry out over time. This can cause cracks, which can allow the inner gel to leak out, causing pressure on the nerves.
  • Spinal injury: Car accidents and similar trauma could dislocate at least one vertebrae. A displaced bone can cause damage to the spinal canal, which can cause swelling in the region as well as pressure on the spinal cord.
  • Tumors: Unusual growths can form inside the spinal cord’s membranes, but they can be detected with an MRI.

How is Spinal Narrowing Treated?

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

How Much Does Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. IN the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used to Diagnose and Treat Spinal Narrowing

In order to correctly diagnose spinal narrowing, your doctor will ask about your symptoms, review your medical history, and perform a physical examination to verify some signs. Some of the imaging tests that may be ordered to help make this diagnosis include:

  • X-rays: These tests can show bone spurs and similar abnormalities that are growing in the spinal canal, causing narrowing. Note this involves some exposure to radiation.
  • MRI: As the name suggests, a magnetic resonance imaging test relies on magnets as well as radio waves to produce powerful images of the spine and its nerve roots. With this test, you can see damage to the ligaments and discs.
  • CT or CT Myelogram: If you are not able to have an MRI, then you may undergo this test instead. A contrast dye is injected with a CT myelogram, which helps outline the nerves and spinal core, as well as tumors, bone spurs, and slipped discs.

How Does Spinal Narrowing Compare to Similar Conditions?

Symptoms of spinal narrowing may appear similar to other conditions due to their related symptoms.

Conditions that can appear to be cervical narrowing include:

  • Peripheral arterial disease: The arteries that supply the arms blood can harden which can cause a cramping pain that occurs when using the arms.
  • Slipped disc in the neck: When the cushion between the spinal bones becomes damaged from age, disease, or injury, then it can bulge or even rupture. In both cases, this is called a herniated disc.
  • Infection of the neck
  • Tumor of the neck
  • Changes to the nervous system: This includes folic acid deficiency and multiple sclerosis.

Conditions that can appear to be lumbar narrowing include the following:

  • Lower back pain
  • Peripheral arterial disease: Once again, this occurs when the arteries responsible for bringing blood to the rest of the body have hardened. In the case of mimicking lumbar narrowing, the mistaken pain in this case is cramping in the leg while exercising. You may also notice relief when you are resting.
  • Infection of the lower back area
  • Tumor of the lower back area
  • Changes to the nervous system: As with the conditions listed above, this can also be due to focal diabetic neuropathy, Guillain-Barré syndrome, or even changes to your vitamin B12 levels
  • Abdominal aortic aneurysm

Analogy: A Tunnel with a Train Track

The nerves of your spine travel like trains on a track. Along their journey, they duck through many enclosed spaces in the vertebrae, like foramen. In order for them to function properly, they must pass through these enclosed spaces cleanly. Spinal narrowing can collapse some of these spaces like a collapsed tunnel on a train track. If the train of your nerves can’t get through or are pinched by a space that has become too tight, you will feel pain.

Good Tunnel

Bad Tunnel

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