The pain of spinal stenosis

By Louis Neipris, M.D., Staff Writer, myOptumHealth

There's very little wiggle room for the spinal cord and its nerve branches. The spinal cord relays nerve signals to and from the brain. It passes through the spinal canal, a narrow tunnel encased by 24 back bones. From the spinal cord, nerve roots extend, threading through tight holes in each back bone. It doesn't take much to crowd the cord or its nerve roots. The bony spurs or growths of arthritis, a slipped disc or an injury can narrow the canal and pinch the nerves. This causes a painful condition called spinal stenosis.

What is spinal stenosis?

Spinal stenosis is a narrowing of areas where the spinal cord and nerve roots pass through. In narrowed places, bone pushes, presses or pinches against the spinal cord or on the nerves that branch out from the spinal cord. The narrowing is usually in either the upper or lower back.

Spinal stenosis affects men and women over 50, especially those with arthritis or herniated discs. You can also be born with the condition or develop it after an injury.

What causes spinal stenosis?

For most people, spinal stenosis develops due to other back problems that often come with aging. These age-related changes put pressure on the spinal cord or nerve roots and include:

Osteoarthritis. Cartilage between vertebrae wears away. Bone forms in place of cartilage and rubs up against nerve roots.
Herniated disc. The discs between vertebrae are like shock absorbers that cushion movement of the spine. Protrusion of a disc can narrow the spinal canal.
Spondylolisthesis. This is a shifting of one vertebra forward in relation to the vertebrae on either side of it.

Sometimes ligaments that run up and down the spine can become scarred, inflamed and tighten. Or, a tumor in the spine can grow and compress the spinal cord or nerve roots. Some people are born with spinal stenosis. This can occur in dwarfism or scoliosis (congenital curvature of the spine).

What are the symptoms?

Symptoms usually start out mild and gradually get worse. They may include any of the following:

Pain or cramping when you stand for a long period or when you walk, especially downhill. Pain goes away when you sit down or lean forward and pressure on the spinal cord is relieved.
Low back pain that may radiate down the leg (sciatica).
Pain in shoulders and arms.

Seek medical attention right away for:

Loss of bladder or bowel function
Severe pain

Call 9-1-1 if you have any of the following:

Severe pain with a tearing sensation
Sudden weakness or numbness in the arms or legs
Symptoms that start or worsen after a fall or trauma
Inability to walk

How is it treated?

Medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may help relieve pain and inflammation. Talk to your doctor before you take any of these, especially if you have medical problems, allergies or take other medications.
Physical therapy. This therapy can help teach you flexing exercises (for the lower back), along with stretching and strengthening exercises.
Spinal injections. Medications such as corticosteroid or anesthetic can be injected into the spinal cord for relief.
- Epidural steroid injection with a corticosteroid injected into the spinal fluid, around the spinal cord or nerve roots. This helps with pain that radiates to the leg. One injection may be all you need. Up to three in one year may be given.
- Nerve block near the involved nerve temporarily relieves symptoms.
Surgery. This may be an option if symptoms persist or get worse despite other treatments. Surgical procedures aim to release pressure off of the spinal cord and its nerve roots.
- Decompressive laminectomy. In this surgery, a portion of vertebra, the lamina (roof), and surrounding tissue is removed. This makes more room for the nerve.
- Fusion. This joins together the affected area of the spine using synthetic material or bone graft to give support for the spine. Restricting motion between vertebrae can make more room for the spinal cord.

How can I live with spinal stenosis?

If you have spinal stenosis, there are simple steps to help manage your symptoms.

Exercise regularly with your doctor's OK. In addition to exercises that target your lower back (forward bending), walk, jog or swim a few times a week.
Reach and maintain a healthy weight to prevent extra pounds from putting pressure on your lower back.
Use good body mechanics when:
- Standing. Take pressure off your lower back when you stand for long periods and place one foot on a foot stool. When shopping, lean forward on the shopping cart.
- Sitting. Sit in a comfortable chair with good back support.
- Lifting. Pushing an object is better than lifting. When you have to lift something, plan out how you're going to move the object and bend at the knees, not your back, as you lift.

View the original The pain of spinal stenosis article on myOptumHealth.com

SOURCES:

American College of Rheumatology. Patient education. Spinal stenosis.

Zeller JL, Lynm C, Glass RM. Spinal stenosis. Journal of the American Medical Association. 2008;299(8):980.

Curlee PM. Other disorders of the spine: Spinal stenosis. In: Canale ST, Beaty JH, eds. Canale & Beaty: Campbell's Operative Orthopaedics, 11th ed. Philadelphia, PA: Mosby Elsevier; 2007.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Questions and answers about spinal stenosis.

Markman JD, Gaud KG. Lumbar spinal stenosis in older adults: current understanding and future directions. Clinics in Geriatric Medicine. 2008;24(2):369-388.