Narrowing of the spinal canal due to arthritis and thickening of spinal ligaments
By Don O Stovall, Jr., MD
WHAT IS IT?
Spinal stenosis is a narrowing of the spinal canal. It usually occurs in the lumbar spine (lower back).
There are several causes of spinal stenosis. It is usually a degenerative (arthritis) problem where a combination of bone spurs, calcification of ligaments and disc degeneration or bulging causes the narrowing.
The main symptoms of spinal stenosis are back and leg pain. Pain in the legs can occur with standing or walking. Usually, people will have progressive difficulty walking for any distance and feel weakness, numbness or heaviness in the hips and legs. They may feel better leaning forward (on a shopping cart or walker) or even riding a bicycle. The severity of the symptoms usually progresses slowly as the spinal canal becomes more narrow.
Determining if you have spinal stenosis may involve the following tests:
- History and physical exam
- X-ray: Shows bone spurs, calcifications
- MRI or CT scan: Shows the degree of narrowing in the spinal canal
- Vascular tests: Evaluate the blood flow to the legs
- Neurologic testing: EMG/nerve conduction testing
There are other diseases that cause similar symptoms, including PVD (peripheral vascular disease) and diabetic neuropathy. Other tests may be needed to determine if they are a factor in your symptoms.
Treatment depends on the severity of the symptoms. Options for spinal stenosis include:
- Medications: To reduce inflammation, either over the counter or prescription NSAIDs (non-steroidal anti-inflammatory drugs)
- Physical therapy: To strengthen the core muscles and back muscles to help stabilize the spine.
- Bracing: To help stabilize the spine in more severe cases
- Spinal injections: Corticosteroid (cortisone) injections reduce inflammation within the spinal canal and reduce irritation of the nerves. People with mild to moderate stenosis can have long term relief from these injections.
- Surgery: Surgery is always a last resort, but sometimes is needed if symptoms become severe enough or if there is damage. The surgery involves removing bone spurs, calcified ligaments and anything that is narrowing the spinal canal in order to relieve the pressure on the nerves.