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

Spinal stenosis refers to a condition typically found only in adults over the age of 50 in which the spinal canal begins to narrow, reducing the cushion between the vertebrae, causing pain and an abundance of other potentially serious problems.

As we previously mentioned, the spine consists of connected vertebrae with soft discs in between. Aside from providing stable structure and supporting the upper body, the purpose of the spine is the protect the spinal cord, an essential part of the nervous system, responsible for connecting the brain’s signals to the rest of the body. Inside the spine, the cord rests in the canal protected by the vertebrae.

In most cases, stenosis occurs due to the changes caused by arthritis. This disease can cause the spinal canal to narrow, causing the available space around the spinal cord to get smaller and smaller. This can result in a spinal cord pinch, resulting in pain or numbness in the arms, legs, and torso.

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More About Spinal Stenosis

back pain

There are two types of stenosis, differentiated by which part of the spine is affected by the condition. The two are not mutually exclusive; it is possible to have more than one kind of stenosis. The two primary types are:

  • Cervical stenosis: When narrowing occurs in the neck, this is referred to as cervical stenosis.
  • Lumbar stenosis: When narrowing occurs in the lower back, this is referred to as lumbar stenosis.

Arthritis is often to blame for stenosis since the condition causes changes to the spine as cartilage breaks down and bone tissue grows. Osteoarthritis creates a thickening of the spine ligaments, and creates bone spurs that applies pressure to the spinal nerves and the cord.

Spinal Stenosis DiagnosisNot everyone affected by stenosis experience symptoms, but those who do usually experience them in the lower back or neck. Some specific symptoms include:

  • Foot drop: You may suddenly slam your foot down due to weakness
  • Sciatica: Shooting pains in the buttocks or legs
  • Difficulty standing or walking
  • Loss of bladder control: This occurs in extreme cases

What Are The Symptoms?

Symptoms may not occur in those who have developed spinal stenosis but may be able to see evidence thereof on a CT scan or MRI. When symptoms do appear, they begin mild and gradually get worse as time goes on. Specifics vary depending on the individual and location of the stenosis, as well as which nerves may be pressured.

Cervical stenosis symptoms:

  • Difficulty walking and maintaining balance
  • Weakness in one hand, foot, leg, or arm
  • Tingling or numbness in one hand, foot, leg, or arm
  • Pain in the neck
  • Bladder or bowel dysfunction

Lumbar stenosis symptoms:

  • Weakness, tingling, or numbness in a leg or a foot
  • Back pain
  • Cramping or pain in at least one leg after standing for a long time
  • Cramping or pain in at least one leg after walking
  • Relief when sitting or bending forward

How is a Spinal Stenosis Diagnosed?

Several conditions may be the culprit for stenosis, but they all boil down to the loss of space available for nerves in the spine to breathe. Because of this, when the doctor is making the diagnosis for stenosis, he or she will need to look for any symptoms of compression around the spinal canal. To do this, you will likely need to undergo a number of tests.

Medical History
The first and most important tool to make a diagnosis, the medical history gives your doctor an indication of what your current symptoms are and what the cause for your back pain could be.

X-Ray
A simple and easy-to-perform procedure, the x-ray offers little-to-no side effects and gives your doctor an idea of what your vertebrae are doing.

MRI Test
This is perhaps the most common imaging tool currently used to diagnose stenosis, relaying on magnetic signals to create images of the spine and the surrounding area.

CT Scan
Like an x-ray, the CT scan produces an image of the spine, but it is easier to see the tissues around the spine instead of just the vertebrae themselves.

Myelogram
This is another form of x-ray, but relies on an injected dye to produce the image.

Bone Scan
Though not specifically meant to detect stenosis, a bone scan can help rule out other possible conditions that mimic the symptoms of stenosis.

What Are the Causes of Spinal Stenosis?

low back pain

The entire length of the spine runs from the base of the neck all the way down to the end of the lower back. The vertebrae are shaped like a canal, serving as a home for the spinal cord and lots of fundamental nerves. Some are born with a naturally small canal, but stenosis occurs when something else narrows the space that would otherwise be there. Some of the most common causes of stenosis are:

  • Bone overgrowth: Bone spurs can grow as a result of osteoarthritis wear and tear, and they’ll grow right into the canal.
  • Herniated disks: The shock absorbers between the vertebrae will naturally dry out over the years, making cracks more likely.
  • Thickened ligaments: When the cords holding the spine together start to thicken, they can protrude into the canal.
  • Spinal injuries: As one might expect, trauma to the spine can result in stenosis and other changes that lead into stenosis. This is especially true if you broke or fractured your back during the injury.
  • Tumor: An abnormal growth within the spinal cord’s membranes can also place pressure that results in stenosis. A tumor can be detected with an imaging scan, but they are uncommon to develop.

How Is Spinal Stenosis Treated?

Treatment and procedure options for Spinal Stenosis range from conservative options like injections to more intensive procedures like spinal fusions.

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 Spinal Stenosis 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.

 

Equipment Used in Diagnosis and Treatment of Spinal Stenosis

To diagnose and treat stenosis, your doctor will interview you about your medical history, signs, and symptoms before conducting a physical exam. To help pinpoint his or her diagnosis, he or she may have you take imaging tests, such as:

  • X-Ray: The doctor will be able to check for bony changes, such as the growth of bone spurs, that could cause stenosis.
  • MRI: This test will check for damage to the ligaments or the disks between the vertebrae, as well as check for the existence of any tumors in the area. Most importantly, however, it will also be able to pinpoint pinched nerves.
  • CT or CT Myelogram: If you are not able to undergo an MRI for some reason, then you may have a CT exam instead. This combines X-ray technology to produce a cross-sectional image of the body, which can help reveal problem areas and herniated disks.

How Spinal Stenosis Compares to Similar Conditions

As common as it may be, stenosis goes mis- and un-diagnosed pretty commonly, as many patients tend to assume the pains are merely part of the aging process. Although this is technically true, the symptoms should not be ignored as there are still several avenues of intervention to take, and chronic pain is truly debilitating. Not only that, but, depending on the cause, the stenosis could be getting much worse.

As previously stated, there are many causes of stenosis, which means ruling out other conditions so that you can treat the correct one. For example, one common culprit for stenosis is spondylitis, otherwise known as inflammation of the vertebral tissues. In the elderly, the shock absorbers between the bones can also degrade naturally, resulting in a condition called degenerative disk disease. The disks may even slip out of place, which requires its own intervention.

Bone spurs are also a potential culprit, which add a new layer of cause-and-effect to trace. In the elderly, rheumatoid arthritis and osteoarthritis can mimic or cause the symptoms of stenosis, and so too can spinal tumors in rare cases. In patients of all ages, spinal injury can lead to stenosis.

When traditional, conservative treatments fail to work, the most common treatment for all of these conditions is surgery. There have not been systematic studies on the success rates of each technique, which makes it difficult to fairly compare the results to one another. Regardless, if you suddenly experience weakness in the legs or lose all feeling in your groin or legs, surgery should absolutely be considered.

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 stenosis 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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