Spinal Stenosis: Diagnosis, Treatment, and Prevention
Spinal stenosis is a common cause of lower back pain, but the condition can also occur in the neck area, causing neck and upper back pain.
Spinal stenosis develops when the space around the spinal cord narrows, putting pressure on the spinal cord. If conservative approaches don’t relieve spinal stenosis symptoms, many sufferers undergo surgery to relieve the condition.
What Causes Spinal Stenosis?
The most common cause for spinal stenosis is osteoarthritis, a condition in which the cartilage that covers and protects the ends of bones in your joints wears away. If this process takes place in the spine, the body may respond by forming new bone in an attempt to support the vertebrae. Called bone spurs, this new bone growth can narrow the space the spinal nerves pass through, eventually pinching the nerves that travel down to the legs.
Some people with spinal stenosis don’t have any symptoms. But some people experience pain, numbness and/or weakness in the legs, groin, hips, buttocks, and lower back. Spinal stenosis symptoms are usually worse when you’re walking or standing, and they tend to decrease when you’re lying down or sitting, particularly if you lean forward, since this increases the space available for the nerves.
Diagnosing Spinal Stenosis
It can be difficult to diagnose spinal stenosis because symptoms are similar to those that accompany other lower back pain and upper back pain conditions. You will probably need to have imaging tests to be certain. These include:
- Computed tomography (CT scan), which uses multiple X-rays to produce cross-sectional pictures that show your spine in more detail than a standard X-ray
- Magnetic resonance imaging (MRI), which uses magnetic fields and radio waves to capture even more detailed images of your bones, soft tissue, and organs.
Treating and Preventing Spinal Stenosis
There is no cure for spinal stenosis, but there are strategies you can use to manage symptoms. If your condition is mild, staying as active as possible may help prevent spinal stenosis from progressing to severe. Physical therapy incorporating stretching exercises, and exercises that strengthen the muscles of the lower back and abdominal area, can help you maintain your flexibility.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn) can help ease pain from spinal stenosis, as well as alleviate the pinched nerve aspect of the condition, since these drugs reduce inflammation. Take the precaution of discussing NSAID use with your doctor, as these drugs have been associated with side effects such as bleeding, especially in older adults. Stronger pain medications include opioids like oxycodone (Percocet), but these must be used very carefully, since they are addictive.
Some anti-seizure drugs, such as gabapentin (Neurontin), and pregabalin (Lyrica), can be taken to reduce pain caused by damaged nerves, and corticosteroid injections into the space around the nerves also can help relieve pressure on the nerves by reducing inflammation. However, the latter can only be given a few times a year, since repeated steroid injections can weaken nearby bones and connective tissue. Some people with spinal stenosis report that acupuncture can be helpful in easing less severe spinal stenosis symptoms.
Spinal Stenosis Surgery
Surgery can be a successful strategy to restore mobility in people with progressive, severe spinal stenosis that is not eased by conservative therapies. A surgical procedure called a laminectomy has about an 80 percent success rate at improving your walking abilities if they are being seriously impeded by spinal stenosis.
Laminectomy enlarges the spinal canal by removing bone spurs, bone, and ligaments that may be pressing on the spinal nerves. Laminotomy is a less extensive version of laminectomy that removes less bone. Spinal fusion—which permanently joins two or more of the vertebrae to restrict movement in painful areas—also may be performed to provide stability to the spine.
If you have severe spinal stenosis symptoms in your neck, a procedure called cervical laminoplasty may relieve them. Laminoplasty reshapes and repositions the one or more of the cervical vertebrae to provide the spinal cord with more space.
Don’t let age put you off surgery to treat your symptoms. As long as you are otherwise healthy, spinal stenosis surgery can benefit even the oldest old. In a recent study that followed older adults for four years, patients who had a laminectomy and/or spinal fusion demonstrated greater improvement than older adults who didn’t have surgery when it came to pain and function.
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Originally published May 2016 and updated.
Spinal stenosis can also occur in the cervical spine. It's characterized by bone spurs that impinge on nerves emanating from the spinal chord and passing through the vertebrae.