By J. Michael Simpson, MD
Spinal stenosis is a general term used to describe a narrowing of the spinal canal. The spinal canal is best described as the passageway for our neurological structures, i.e., spinal cord and spinal nerves. Therefore, spinal stenosis can produce symptoms consistent with neurologic compression to include pain, numbness, tingling, weakness, and loss of balance.
Spinal stenosis can occur anywhere along the spinal axis, but most commonly affects lumbar (low back) and cervical (neck) regions. Stenosis of the thoracic spine is relatively rare. Spinal stenosis is generally a result of aging and degeneration and therefore most commonly presents in patients 60 years or older. Occasionally, younger patients may develop symptoms consistent with spinal stenosis. These patients commonly have a congenital based narrowing that predisposes them to symptoms at an earlier age.
Symptoms Associated with Spinal Stenosis
The symptoms of spinal stenosis depend on the anatomical region affected and the severity of neurological compression, and can vary widely from patient to patient.
Our neurological anatomy should be understood to account for the variety of symptoms produced by spinal stenosis. Our spinal cord is a solid structure approximately one centimeter (3/8”) in diameter. The spinal cord extends through the cervical and thoracic regions extending to the junction of the thoracic and lumbar spine. In the lumbar spine, the neurological structures are basically individual nerves travelling within the spinal canal and referred to as the cauda equina. Related to the fact that the spinal cord and spinal nerves are different anatomical structures, the symptoms of spinal cord compression and spinal nerve compression are different. Let’s review the symptoms of spinal stenosis for each region of the spine.
Symptoms and Treatment of Lumbar Stenosis
Lumbar spinal stenosis is the most common form of spinal stenosis. Patients generally find themselves comfortable when seated and usually also when lying down. Pain is exacerbated by standing and walking and will usually start in the low back or buttock region and then radiate to one or both lower extremities. The longer the patient stands or walks, the more intense the symptoms become. The patient may describe numbness or tingling and possibly a sense of weakness. Sometimes burning in the legs is described. The patient finds relief by sitting, bending forward, or sometimes squatting. If the neurologic compression involves a single nerve, the pain is well localized to one leg and referred to as “sciatica.” If the entire spinal canal is narrowed, typically both legs are symptomatic (neurogenic claudication). Many patients find some relief by leaning forward, something doctors refer to as the “grocery cart sign.”
Treatment for lumbar spinal stenosis depends on the extent of symptoms that the patient is experiencing. Patients with milder forms of stenosis are encouraged to engage in an exercise program, particularly one with a cardiovascular component. Aerobic activity seems to help patients deal with the symptoms from early spinal stenosis. Physical therapy modalities oftentimes can help individual patients jumpstart their exercise program.
Patients who fail physical therapy or may present with more significant symptomatology oftentimes can benefit from epidural steroid injections. Some patients will experience dramatic improvement for periods of time with these injections. Such injections could be administered approximately no more than three times in a given year.
If all such measures fail over a period of time and patients feel that they are severely functionally limited by their pain or have weakness in their lower extremities, they may require surgery. The surgical procedure to remove pressure from the neurological structures is called a laminectomy.
Age, condition of the patient, and activity levels are all taken into account before suggesting any sort of operative intervention for patients. Properly selected patients with significant degrees of spinal stenosis, however, can enjoy a very high success rate with this surgery. Success rates in the properly selected patient group approximates 90%.
Symptoms and Treatment of Cervical and Thoracic Stenosis
Related to the fact that the spinal cord travels through these different regions, one can understand how the symptoms can be different and potentially more harmful. Excessive pressure on the spinal cord can lead to permanent injury. Pressure on the individual nerves in the cervical and thoracic spine are less concerning but certainly can produce significant pain.
Compression of a nerve root in the cervical spine is usually painful to one side. Pain between the shoulder blade with radiation of pain, numbness, and tingling into the arm is classic. Patients may describe a sense of weakness. Compression of the spinal cord, however, does not always include pain. Patients may describe a loss of balance, many of them feeling like they’re walking like they’re drunk. Numbness and tingling to the hands and loss of dexterity are common. Many of these symptoms often are accepted by the elderly, attributing it simply to the aging process. Progressive symptoms, however, should be thoroughly evaluated.
Compression of an individual nerve root in the neck can be treated conservatively. Anti-inflammatory medication and physical therapy oftentimes bring success without the need for surgical intervention. However, patients with persistent pain and dysfunction unresponsive to those measures represent good surgical candidates.
Significant compression of the spinal cord, however, oftentimes requires surgical intervention to prevent permanent neurological injury.
If you’re concerned you might be suffering from spinal stenosis, schedule an appointment with us today to discuss treatment options with one of our spine doctors.