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What is Spinal Stenosis?
Spinal stenosis is a deterioration of vertebrae that causes narrowing of the openings of the spinal column. Over time, this puts pressure on the nerves inside the spinal column. In most cases, individuals develop spinal stenosis in either the neck (called cervical stenosis) or the lower back (called lumbar stenosis).
What Causes Spinal Stenosis?
The most common cause of spinal stenosis is osteoarthritis that causes bone spurs. These spurs can impinge on the spinal cord or pinch one or more nerves emanating from the spinal column. Other causes of spinal stenosis include pressure on the spinal cord or nerves from herniated discs, tumors, thickened or inflamed ligaments, or trauma that dislocates or breaks vertebrae.
Types of Spinal Stenosis & Their Symptoms
Some people develop mild cases of spinal stenosis without experiencing any symptoms. However, if the deterioration continues over time, a variety of symptoms can develop. Symptoms are most common in individuals over 60 years of age and tend to become more severe with age due to wear and tear on the spinal vertebrae. Symptoms typically vary based on the location of the stenosis in the spine.
Lumbar Spinal Stenosis
Spinal stenosis is more common in the lower back than in the neck. This type of spinal stenosis is called lumbar stenosis. The most common symptom of lumbar stenosis is neurogenic claudication, which is leg pain that comes and goes due to pinched nerves in the spinal cord. It can cause weakness or cramps in the legs that can be severe. It is more troublesome when standing or walking for long periods, and it may become less severe or go away when you sit or bend forward.
Numbness or a pins-and-needles sensation in one or both legs is another symptom. The sensation is similar to when your foot falls asleep, but is more frequent or may last longer. Weakness in the feet or legs can also indicate lumbar stenosis. Gait issues such as foot drop may arise from weakness in the calves or quadriceps. Foot drop is the inability to raise the front of the foot properly due to weakness. Instead, the foot drops forward, often dragging on the ground or causing the person to trip.
When the pain is in one leg and accompanied by weakness, it may be referred to as sciatica, depending on which nerve is compressed. Some individuals may feel pain in the buttocks and lower back as well.
Cervical Spinal Stenosis
The narrowing of the spinal column that causes pressure on the spinal cord in the neck is called cervical stenosis. People with cervical stenosis can develop problems with their gait and keeping their balance, which affects their mobility. The gait problems arise from the compression of the spinal cord rather than a pinched nerve. This condition progresses over time, with the individual falling more frequently as the compression worsens.
Pain in the shoulder, arm, or neck may also be a sign of cervical stenosis, particularly if the pain is shock-like or is accompanied by a burning sensation. Some people experience numbness or a pins-and-needles tingling sensation in one or both hands. This is sometimes accompanied by weakness and loss of fine motor skills. Over time, it becomes increasingly harder to fasten buttons, use a pen, or perform simple tasks that require small movements.
In exceedingly rare cases, individuals with severe spinal stenosis may experience incontinence, severe weakness in the legs, or loss of feeling in the genitals and inner thighs. If this happens, contact emergency medical help immediately. For most people, spinal stenosis is diagnosed and treated before it progresses to this point.
Diagnosing Spinal Stenosis
Your doctor will initially diagnose cervical or lumbar stenosis based on your symptoms, medical history, risk factors (such as age and injury), and a complete physical exam. To confirm the diagnosis, they will use imaging procedures to determine the cause of your symptoms. These may include x-rays of the spinal column, MRIs, and CT scans. These techniques can reveal bone spurs, herniated discs, tumors, and areas where there is pressure on the spinal cord or nerves.
Conservative Treatments for Spinal Stenosis
There are several treatment options for mild to moderate spinal stenosis. Your doctor can help determine the best treatment (or combination of treatments) for you based on the severity of your condition and your pain level.
Conservative treatments for mild to moderate spinal stenosis may include:
- Pain relievers such as naproxen, ibuprofen, or acetaminophen for short-term relief
- Antidepressants to minimize chronic pain and any resulting minor depression
- Prescription opioids such as hydrocodone (used sparingly for short periods of time)
- Physical therapy to improve muscle tone and strength, maintain spinal stability, and improve balance
- Steroid injections to reduce the inflammation of irritated nerves
While these methods don’t correct spinal stenosis and may not work for everyone, they are typically done to reduce swelling, pain, and other symptoms. Surgery is the last resort after other options for alleviating the symptoms of spinal stenosis have proven ineffective.
Surgical Solutions for Spinal Stenosis
When the symptoms of spinal stenosis become moderate or severe, surgery may be the only option. This is particularly important when neurological issues, pain, or mobility problems have developed. The goal of spinal stenosis surgery is to relieve pressure on the nerves or spinal cord so they can heal and return to proper functioning.
The most common surgical treatment for either cervical or lumbar stenosis is a laminectomy. During this procedure, two vertebral laminae—which form the “roof” of the spinal canal—and the bony area connecting them are removed, relieving pressure on the spinal cord. Bone grafts or instrumentation are added to stabilize the site and protect the spinal cord. Depending on the severity of the stenosis, fusion of the surrounding vertebrae may be performed for added stability.
Transforaminotomy is generally for less severe cases of lumbar stenosis. This option is not as involved as a laminectomy and is reserved for situations when the stenosis is restricted to a small area of the lumbar spine. Transforaminotomy involves the widening of the bony openings between affected vertebrae, including the removal of any bone spurs that have developed. Your surgeon may also remove damaged soft tissue or herniated discs.
If spinal stenosis is caused by a degenerated or herniated disc pressing on a nerve or the spinal cord, discectomy surgery may be done to remove all or part of the affected disc. Partial discectomies are typically performed for lumbar stenosis, while complete discectomies are more common for cervical stenosis. Your surgeon may fuse the surrounding vertebrae if needed.
Any of these surgical procedures may include minimally invasive options, depending on the severity of the spinal stenosis. After surgery, appropriate care must be taken to allow the area to heal. In some cases, patients will need physical therapy to ensure proper mobility following surgery.
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