Join the discussion about health care issues in our nation and community on our blog, WakeMed Voices.

Related Links

Share/Save/Bookmark
Decrease (-) Restore Default Increase (+)

Related Links

Spinal stenosis

Definition

Spinal stenosis is narrowing of the spinal cord that causes pressure on the spinal cord, or narrowing of the openings (called neural foramina) where spinal nerves leave the spinal column.

Alternative Names

Pseudo-claudication; Central spinal stenosis; Foraminal spinal stenosis

Causes, incidence, and risk factors

Spinal stenosis typically develops as a person ages and the disks become drier and start to shrink. At the same time, the bones and ligaments of the spine swell or grow larger due to arthritis or chronic inflammation.

However, other problems, including infection and birth defects, can sometimes cause spinal stenosis.

Spinal stenosis may be caused by:

  • Arthritis involving the spine, usually in middle-aged or elderly people
  • Herniated or slipped disk, which often occurred in the past
  • Injury that causes pressure on the nerve roots or the spinal cord itself
  • Defect in the spine that was present from birth (congenital defect)
  • Tumors in the spine
  • Bone diseases, such as Paget's disease of bone and achondroplasia

Symptoms

Often, symptoms will be present and gradually worsen over time. Most often, symptoms will be on one side of the body or the other.

  • Numbness, cramping, or pain in the back, buttocks, thighs, or calves (or problems in the lower back), or in the neck, shoulders, or arms (or problems in the neck)
  • Weakness of a portion of a leg or arm

Symptoms are more likely to be present or get worse when you stand or walk upright. They will often lessen or disappear when you sit down or lean forward. Most people with spinal stenosis cannot walk for a long period of time.

Patients with spinal stenosis may be able to ride a bicycle with little pain.

More serious symptoms include:

  • Difficulty or imbalance when walking
  • Problems controlling urine or bowel movements
  • Problems urinating or having a bowel movement

Signs and tests

During the physical exam, your doctor will try to pinpoint the location of the pain and figure out how it affects your movement. You will be asked to:

  • Sit, stand, and walk. While you walk, your doctor may ask you to try walking on your toes and then your heels.
  • Bend forward, backward, and sideways.
  • Lift your legs straight up while lying down. If the pain is worse when you do this, you may have sciatica, especially if you also feel numbness or tingling in one of your legs.

Your doctor will also move your legs in different positions, including bending and straightening your knees. All the while, the doctor is assessing your strength, as well as your ability to move.

To test nerve function, the doctor will use a rubber hammer to check your reflexes. Touching your legs in many locations with a pin, cotton swab, or feather tests your sensory nervous system (how well you feel). Your doctor will instruct you to speak up if there are areas where the sensation from the pin, cotton, or feather is duller.

A brain/nervous system (neurological) examination can confirm leg weakness and decreased sensation in the legs. The following tests may be done:

Treatment

When your back pain does not go away completely, or it gets more painful at times, learning to take care of your back at home and prevent repeat episodes of your back pain can help you avoid surgery. Your doctor and other health professionals will help you manage your pain and keep you as active as possible.

Generally, conservative management is encouraged. This involves the use of medications, physical therapy, and lifestyle changes. Steroid injections may relieve pain for a period of time.

Various other medications may help with chronic pain, including phenytoin, carbamazepine, or tricyclic antidepressants such as amitriptyline.

For more information about treatment, see: Low back pain - chronic

If the pain is persistent and does not respond to these measures, surgery is considered to relieve the pressure on the nerves or spinal cord. Surgery is performed on the neck or lower back, depending on the site of the nerve compression.

See also:

Expectations (prognosis)

Many people with spinal stenosis are able to carry on active lifestyles for many years with the condition. Some change in activities or work may be needed.

Spine surgery will often provide full or partial relief of symptoms. However, future spine problems are still possible after spine surgery. The area of the spinal column above and below a spinal fusion are more likely to be stressed when the spine moves. Also, if you needed more than one kind of back surgery (such as laminectomy and spinal fusion), you may be more likely to have future problems.

Complications

Injury can occur to the legs or feet due to lack of sensation. Infections may get worse because you may not feel the pain related to them. Changes caused by nerve compression may be permanent, even if the pressure is relieved.

Calling your health care provider

Call your health care provider if you have symptoms of spinal stenosis.

More serious symptoms that require immediate attention include:

  • Difficulty or imbalance when walking
  • Problems controlling urine or bowel movements
  • Problems urinating or having a bowel movement

References

Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008;358:794-810.

Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med. 2008;358:818-825.

Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr., Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-491.

Chou R, Baisden J, Carragee Ej, Resnick DK, Shaffer WO, Loeser JD. Surgery for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34:1094-1109.

Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34:1078-1093.


Review Date: 5/25/2010
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery (7/10/2009).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com