What is spinal stenosis?
- means tightening of the space in the spinal canal that houses the nerves. This results in painful pinching of the nerves.
What are the symptoms of spinal stenosis?
The main symptoms of spinal stenosis are:
- Arm or leg pain
- Weakness in the arms or legs
- Back pain that spreads to the legs
- Difficulty or clumsiness when walking
- Numbness and tingling in the arms or legs
- Pain or numbness in the buttocks, thighs or calves that gets worse when you walk, stand or exercise
Dr. Robert Berkowitz answers questions about spinal stenosis
Dr. Robert Berkowitz is a specialty-trained, board-certified orthopedic surgeon specializing in spine surgery, sports medicine and arthroscopic surgery. He has advanced training in neck and back surgery and is the only orthopedic spine surgeon in Lorain County, Ohio.
What causes spinal stenosis?
Spinal stenosis is typically the result of arthritis in the back and neck, resulting in a variety of factors:
- The intervertebral discs can bulge or herniate
- The joints in the spine can develop bone spurs and hypertrophy, or get bigger.
- The ligaments in the back can thicken.
“All of these factors combine to crowd the nerves that run through the spinal canal, and this is what causes spinal stenosis. The nerves have a limited space that they live in, and when then get compressed, or stenosed, the result is spinal stenosis.”
Can spinal stenosis affect just the lower back?
“Stenosis often implies a tightening of the space surrounding the dural sac—the membranous sac that encases the nerves in the lower back. But you can also have stenosis of a single nerve, the upper back or cervical spine, or the mid-back or thoracic spine. Stenosis is simply a tightening of the space where the nerves live.”
What effect does aging have on spinal stenosis?
“Aging is the effect, because the bulging discs, the thickening of the ligaments, the bone spurs and the joint hypertrophy are due to the aging process.”
At what age do people typically develop spinal stenosis?
“The spine starts to age at about age 30. But the age when the effects of spinal stenosis are significant enough to actually cause symptoms varies from person to person. Spinal stenosis typically appears in people in their 50s to their 70s. The average person diagnosed with spinal stenosis is in his or her 60s.”
Is spinal stenosis related to osteoporosis?
“In most cases, no. Osteoporosis is the weakening or thinning of bone density and normally has no relation to spinal stenosis. However, in rare instances, a compression fracture resulting from osteoporosis can cause stenosis of the spine.”
What else can cause spinal stenosis?
“In addition to degeneration of the spine, anything that crowds the space where the nerves in your back live can cause stenosis:
- A tumor growing in your spine—whether cancerous or non-cancerous—can give you stenosis if it is pushing on your nerves.
- Trauma or fractures in your spine can cause spinal stenosis if the bones in your neck or back squash into the spinal cord and nerves.
- Bleeding—whether spontaneous or after surgery—can create spinal stenosis if the blood going into your spinal cord pushes on the nerves and squashes them.
- Infection can cause spinal stenosis. An abscess, for example, can decrease the amount of space for the nerves in the spinal column.”
How do you diagnose spinal stenosis?
“Like anything else in medicine, spinal stenosis is diagnosed by taking a careful medical history, a thorough physical exam and imaging studies such as X-rays and MRIs.
- In lumbar spinal stenosis, it’s common to have a relatively normal physical exam, but the patient has a history that is consistent with stenosis and the MRI will show it as well.
- Cervical stenosis, if it’s severe enough, will show up on a physical exam as well as in the history and the MRI.
How do you treat spinal stenosis?
“I’m very conservative in treating spinal stenosis. For the most part—except in certain situations in the cervical spine—spinal stenosis is a ‘safe problem.’ That means it’s not life-threatening and almost always will not lead to paralysis, or bladder or urinary problems.
“I give my spinal stenosis patients three treatment choices:
- Do nothing. If your spinal stenosis is tolerable, you can just live with it. Over-the-counter pain relievers such as NSAIDs can help make you more comfortable.
- Physical therapy and/or chiropractic care. Some patients also choose epidural steroid injections to reduce pain and inflammation.
- Surgery. For stenosis in the lumbar spine, surgery typically involves a laminectomy, a procedure that removes the thickened ligaments and bone spurs in the lower back to make more room for the nerves. A laminectomy is sometimes performed in combination with a spinal fusion. In my practice, it’s more common to do a laminectomy without a spinal fusion.”
- For stenosis in the cervical spine, surgery usually involves a laminectomy or an anterior cervical discectomy and fusion.”