Spinal Stenosis

Spinal stenosis is a disorder in which the spinal canal narrows, leading to back pain and leg pain that comes and goes with activities such as walking. Although stenosis can occur in all areas of the spine, it most commonly affects the lumbar (lower) spine. However when spinal stenosis occurs in the back, it produces pressure on the spinal cord and may affect gait, bowel and bladder function. Thus spinal stenosis almost always requires spinal treatment. Since it most commonly results from a combination of aging and degeneration of the spine, stenosis usually affects people over 60 years of age. However, the disorder also occurs in younger people who have abnormally small spinal canals from birth.

Since spinal stenosis gives the spinal cord and nerves less room to move, they can become irritated and inflamed. Stenosis in the lower back can cause pain in both the back and legs, with the pain becoming worse when walking or standing for a prolonged period of time. Rest, which takes pressure off the nerve roots, may ease or even eliminate these symptoms.

Conservative Treatment
Spinal stenosis is a slowly progressive back problem that in its early stages may respond to conservative care, such as pain medications and rest. Your doctor may also recommend physical therapy and/or an epidural steroid injection (ESI). In some cases, simply bending over can relieve the back and leg pain caused by spinal stenosis, because bending over enlarges the spinal canal so that the blood flow to the spinal nerves increases.

Surgical Treatment
Spinal stenosis may worsen over time, necessitating surgery. The main goal of any surgical procedure is to remove the pressure on the nerve roots in the lumbar spinal canal. The surgeon will therefore enlarge the tube of the spinal canal and remove any bone spurs that are pushing into the nerve roots. This procedure is called a decompression, or a decompressive laminectomy, of the lumbar spine.

The surgeon may also have to remove a portion of the facet joints. The lamina and facet joints normally provide stability in the spine. Removal of either or both can cause the spine to become loose and unstable. If this occurs, doctors will restabilize the spine by including spinal fusion as part of the procedure. In most cases, surgery to correct spinal stenosis is appropriate only when the patient regards the pain as unbearable.

In the cervical spine, stenosis may sometimes require decompression from the front, back or both front and back of the spine depending on the severity of the stenosis.