Spinal Stenosis

What is Spinal Stenosis?

Spinal stenosis is a narrowing of the spinal canal – the space within the vertebrae for the nerves. Lumbar Spinal stenosis can be found in the last 5 bones of the lower back, most often at the bottom of the back.

Causes of Lumbar Spinal Stenosis

Some patients are born with a narrowed spinal canal, but most often spinal stenosis is seen in patients over the age of 50. This is because the “wear and tear” process causes crowding of the spinal canal with overgrowth of the nearby bones (osteophytes), the ligaments thicken, a cyst may occur because of the joint inflammation and a disc may slip (herniate) into this space also. If there is a dynamic component to the narrowing, this is called Spondylolisthesis.

When these conditions occur in the spinal area, they can cause the spinal canal to narrow, creating pressure on the spinal nerve.

Narrowing of the Spinal Canal and its Effects

The narrowing of the spinal canal does not usually cause spinal stenosis symptoms. It is when inflammation of the nerves occurs at the level of increased pressure that patients begin to experience problems.

Common Symptoms

Patients with lumbar spinal stenosis may feel pain, weakness, or numbness in the legs, calves or buttocks. In the lumbar spine, symptoms often increase when walking short distances and decrease when the patient sits, bends forward or lies down. This is the reason why patients with spinal stenosis also feel relief when they lean over a shopping trolley, bicycle or walking frame.

In some patients, the pain starts in the legs and moves upward to the buttocks; in other patients, the pain begins higher in the body and moves downward. The pain may radiate like sciatica or may be a cramping pain. In severe cases, the pain can be constant.

Most doctors use a combination of tools, including:

History Taking

The doctor will begin by asking the patient to describe any symptoms he or she is having and how the symptoms have changed over time. These symptoms include:

Physical Examination

The doctor will then examine the patient by checking for any limitations of movement in the spine, problems with balance and signs of pain. The doctor will also look for any loss of arm or leg reflexes, muscle weakness, loss of touch, or abnormal reflexes which may suggest spinal cord involvement.

Tests for Spinal Stenosis

After examining the patient, the doctor can use a variety of tests to look at the inside of the body. Examples of these tests include:

Non Surgical Treatment

Medications

The three main groups that are helpful for pain, either alone or in combination are
•    Non-Steroidal Anti-Inflammatory Drugs (N.S.A.I.D)
•    Neuropathic pain medications
•    Simple analgesics

Some medications have a high risk of harm and are not recommended, these would include strong opiate painkillers and diazepam type medications.

Exercise Treatment

There are no specific exercise treatments for spinal stenosis. However, it is important to keep yourself fit and to keep as active as possible. Whatever exercise you enjoy and doesn’t cause too much discomfort is good for you. Cycling (e.g. on an exercise bike) can be very useful because the flexed position on the bike can give some relief of leg symptoms and is often an exercise tolerated well in spinal stenosis.

Injections

These can be helpful for pain that is going down the leg. They do not seem to be helpful for back pain.

Read more about non-surgical management in our article with insights from a recent webinar.

Surgical Treatment

Surgical treatment should be discussed as part of shared decision making with your Doctor. It is usually a ‘quality of life’ decision and would only rarely need emergency treatment.

The most common operation is a simple decompression. This surgery will involve removing some bone to widen the spinal canal to relieve the pressure on the spinal cord or nerves. If required, a fusion may be done as part of the operation to decompress the nerves. This may involve a bone graft and metal screws and rods to stabilise the spine. Large studies on the outcomes of surgery for spinal stenosis have shown that early results such as quality of life, satisfaction with symptoms and self-rated progress were improvements that lasted over a long time after surgery.

The results of surgery are good with many patients experiencing useful improvements in walking distance and leg pain. There are some risks with spinal surgery. Patients are advised to discuss all treatment options with their Doctor.