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canstockphoto44625701Spinal stenosis occurs most often in the lower back and the neck. It is a narrowing of the open spaces within your spine, which can put pressure on your spinal cord and the nerves that travel through the spine to your arms and legs. Some people may experience pain, tingling, numbness, muscle weakness, while spinal stenosis may cause no signs or symptoms in some people. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves. Spinal stenosis is most commonly caused by wear and tear changes in the spine, known as osteoarthritis.

Incidence/Prevalence

According to statistics, around 325,000 U.S. residents have spinal stenosis symptoms. This is approximately 1 per 1,000 persons older than 65 years of age. In addition, 70 million Americans are older than age 50, and the incidence of spinal stenosis increases with age. Around 35% of those with the condition are asymptomatic.

Causes

Some people are born with a small spinal canal. Spinal stenosis occurs when disorders occur and reduce the amount of space available in the spine. A few causes of spinal stenosis5spinal stenosis:

  • Thickened ligaments. The cause of soft tissue overgrowth relates to degenerative changes in the spine occurring and the soft tissues enlarging to help stabilize the spine.
  • Overgrowth of bone. Osteoarthritis can cause wear and tear on your spinal bones, and this can cause the formation of bone spurs, which can grow into the spinal canal.
  • Degenerative spondylolisthesis. As arthritis occurs, one of the spinal levels may shift forward a bit on the level below it. This can pull on the spinal nerves a bit, and cause stenosis symptoms.
  • Tumors. Abnormal growths can form inside the spinal cord, within the membranes that cover the spinal cord or in the space between the spinal cord and vertebrae.

Symptoms

Many people may not have signs or symptoms of spinal stenosis, but evidence of the disease appears on X-rays and MRI scan. Once the symptoms begin, they usually come on gradually and worsen with time. Depending on the location of the stenosis, symptoms will vary:

  • Neck (cervical spine). Cervical stenosis can cause weakness, numbness, or tingling in a leg, foot, arm, or hand. People also report problems with walking and balance. Most often, the symptoms include pain and numbness.
  • Lower back (lumbar spine). Compression of the nerves in your lumbar spine can cause pain and cramping in the legs when standing for a long time or when you walk. The discomfort usually eases when you bend forward or sit down. The reason is this positioning increases the space available for the nerve roots.

Diagnosis

Spinal stenosis can be difficult to diagnose because its signs and symptoms resemble those of many age-related conditions. Imaging tests may be needed to help pinpoint the true cause of your signs and symptoms. These tests may include:

  • X-rays. Using a small exposure to radiation, X-rays can reveal bony changes.spinal stenosis2
  • Magnetic resonance imaging (MRI). MRI can show the specific spinal levels and where nerve compression is occurring.
  • CT myelogram. A CT myelogram, the CT scan is conducted after a contrast dye is injected. The dye outlines the spinal cord and nerves, and it can reveal herniated disks, bone spurs, and tumors. This technique is indicated when a person has a contraindication for an MRI or has had previous surgery where significant scar tissue exists.

Treatment

The severity of your signs and symptoms will help determine the type of treatment you receive for spinal stenosis. To control pain associated with spinal stenosis, your doctor may prescribe:

  • Muscle relaxants. They can calm the muscle spasms that occasionally occur with spinal stenosis.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) help relieve pain and reduce inflammation common to osteoarthritis.
  • Short term narcotics for periods of exacerbation.
  • Tricyclic antidepressants, such as amitriptyline, can help ease chronic pain.
  • Neurogenic drugs. This may include Lyrica or Neurontin which can ease nerve related pain well.
  • A physical therapist can teach you to improve balance, maintain stability, and improve flexibility of the spine, as well as build endurance and strength.
  • Epidural Steroid injections. Injecting a corticosteroid into the space around the constriction can help reduce the inflammation and relieve some of the pressure
Lumbar Transforaminal Epidural

Lumbar Transforaminal Epidural Injection

 

Surgery for spinal stenosis is considered as a last resort, elective, quality of life procedure when conservative treatments have failed. Over 90% of patients are able to avoid surgery with the first rate nonoperative treatments at our Phoenix pain management clinic.

Dr. Ramin Abbasian is a Double Board Certified, Fellowship Trained pain expert at Pain and Spine Clinics in Phoenix AZ. Patients come from all over the Valley including Scottsdale, Glendale, Cave Creek, Carefree, Fountain Hills, Peoria and more. Most insurance is accepted, call us today for top relief with your back pain and spinal stenosis issues!

 

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