Stenosis means narrowing. When spinal tunnel is narrowed, the condition is called spinal stenosis. This can happen in the cervical spine, thoracic spine or lumbar spine. The reason behind spinal stenosis can be a herniated disc, degenerated facet joints, short pedicle, spinal ligament thickening, misaligned vertebrae (spondylolisthesis), synovial cyst and/or bone spurring. Spinal stenosis often is an aging disease and can present in an acute or chronic format.
Cervical spinal stenosis can cause neck pain, shoulder blade pain, arm pain, hand pain, numbness, tingling, and dexterity or balance issues. Symptoms can be in one or both arms. Symptoms can range from mild to severe. Lumbar spinal stenosis often limits one’s ability to walk. Patients with lumbar spinal stenosis complain of leg pain or heaviness with walking, and feel less pain when they sit or lean on a shopping cart. This condition is often associated with numbness, tingling, balance issues, and possibly weakness. Presentation of symptoms could be acute or chronic and could involve one or both legs. In rare cases, genital numbness, incontinence of urine or stool may develop and should alarm patient to be evaluated urgently.
If the first episode is acute and severe, patients often go to the emergency room. A clinical diagnosis is made based on imaging and physical examination. If there is no progressive neurological loss, further care is often deferred to a primary care physician and/or specialist in an outpatient setting. A spine specialist will examine the patient and determine proper workup. A thorough physical examination is performed by the spine specialist, which includes range of motion examination, sensory testing, strength testing and evaluation of reflexes. If there are alarming signs of spinal cord compression, recommendation for a further workup is made. The first diagnostic test is often an x-ray. The most accurate clinical test to identify spinal stenosis is an MRI. Some patients are unable to have an MRI, in which case a CT scan will help make a diagnosis.
If there are no alarming neurological deficits, simple x-rays, 6 weeks of physical therapy, short course of prednisone taper, soft tissue treatments along with use of nonsteroidal anti-inflammatory and muscle relaxants are recommended. In most cases, this conservative treatment results in improvement in symptoms. After physical therapy treatment, the patient is re-examined to evaluate for any residual deficits. If the pain subsides and function fully recovers, patient is discharged with a recommendation to continue a home exercise program and observe correct ergonomics. In some patients, the pain and dysfunction are not managed with oral medications or does not improve with physical therapy. In these cases, an x-ray guided epidural steroid injection can help reduce pain, improve function, and help with the recovery. The effect of an epidural injection may last several weeks to several months. If the symptoms return, such treatment could be repeated.
Persistent pain, bowel and bladder dysfunction, progressive weakness, myelopathy (cord compression) and frequent falls are among the indications of surgical solution for spinal stenosis. Careful risk assessment should be done by the primary care physician, spine surgeon and the patient before considering surgery. In most cases, the patient would benefit from Laminectomy surgery to relieve the pressure off the nerves and spinal cord. Surgery takes a few hours to complete, with a short course of inpatient hospitalization and a few weeks of outpatient rehabilitation after discharge from the hospital.