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Spinal Stenosis

Spinal stenosis is a narrowing of the spinal canal in the spine. This narrowing places pressure on the spinal cord and/or nerves. While some patients are born with this narrowing, most cases of stenosis occur in patients over the age of 50 and are the result of aging and "wear and tear" on the spine. Spinal stenosis can be "lumbar" (lower part of the spine), or "cervical" (related to the neck).

Many patients with stenosis remain symptom-free until other conditions further compress the spinal canal. Other conditions that can cause compression include:

  • Calcification (the ligaments of the spine thicken and harden)
  • The formation of osteophytes (bony growths on bones and joints)
  • Bulging or herniated discs
  • The slipping of one vertebra onto another (called spondylolisthesis)
  • Trauma (such as from an accident)

Symptoms
The symptoms of spinal stenosis can include:

  • Low back pain that eases when bending forward or sitting.
  • Pain, weakness, or numbness in some part of the body.
  • Burning sensations, tingling, and pins and needles in an extremity, such as a leg.
  • Bladder and bowel problems (in severe cases).
  • Although rare, very severe cases can also cause significant loss of function or even paraplegia.

Diagnosis
We will use a combination of techniques and sophisticated technology to help make an accurate evaluation of your condition:

  • Medical history. We will talk to you about your symptoms, how severe they are, and what treatments you have already tried.
  • Physical examination. You will be carefully examined by one of our spine specialists for limitations of movement, problems with balance, pain, loss of reflexes in the extremities, muscle weakness, loss of sensation, and other signs of spinal cord injury.
  • Diagnostic tests. Generally, we start with plain x-rays, which allow us to rule out other problems such as tumors and infections. CT scans and MRIs give us three-dimensional views of the spine and can help detect osteophytes and herniated discs. With some patients we may order a mylogram. This is a test that involves injecting a liquid dye into the spinal column to show where the pressure on the nerve is occurring.

Non-Operative Treatment
Most cases of lumbar stenosis are successfully treated with non-surgical techniques such as pain medications and anti-inflammatory medications. Severe pain may also be treated with corticosteroids that are injected into the lower back (i.e. epidural steroid injections). Depending on the extent of nerve involvement, some patients may need to temporarily restrict their activities. However, most patients only need to rest for a brief time. Physical therapy exercises will also be prescribed to help strengthen and stabilize the spine as well build endurance and increase flexibility.

If these non-surgical measures do not work, you may require surgery. There are a number of surgical techniques that can be used to treat this condition. The goal of each of these surgical treatments is to widen the spinal canal and relieve the pressure by removing the cause of compression.

Surgical Treatment

For those patients who need surgical repair on more than one level, or who have significant spinal instability, spinal fusion may be required in addition to the decompression surgery. This traditionally involves taking a small piece of bone and grafting it onto the spine. More recently, for some cases, bone substitutes such as bone morphogenetic proteins (BMPs) may be used to facilitate spine fusion. Spinal implants (called instrumentation) such as screws and rods are used to support the spine and provide additional stability while the fusion is healing. In most cases, we can determine ahead of time if fusion surgery is necessary.