Understanding Spinal Stenosis

The spine protects the spinal cord and nerve roots, which carry signals between the brain and the rest of the body. These nerves travel through spaces in the spine called the spinal canal and foramina.

Spinal stenosis occurs when these spaces become narrowed, reducing the room available for nerves and potentially causing nerve compression and related symptoms.

Two main types of narrowing may occur:

Central Spinal Stenosis

Narrowing of the main spinal canal that houses the spinal cord.

Foraminal Stenosis

Narrowing of the openings where spinal nerves exit the spine.

When these spaces narrow, the nerves may become compressed, leading to pain, tingling or weakness.

What Causes Spinal Stenosis?

Spinal stenosis is most commonly caused by age-related changes in the spine. Over time, natural wear and tear can affect the discs, joints and ligaments that support the spine.

Common causes include:

• Degenerative disc disease: As spinal discs lose hydration and height, the space between vertebrae decreases, contributing to narrowing.
• Arthritis of the spine (spondylosis): Degeneration of spinal joints may lead to inflammation and the formation of bone spurs.
• Bone spurs: Extra bone growth can narrow the spinal canal and place pressure on nerves.
• Thickened ligaments: Ligaments that stabilize the spine may stiffen and thicken with age, reducing available space for nerves.
• Herniated discs: Bulging or ruptured discs may extend into the spinal canal and compress nerves.
• Spondylolisthesis: When one vertebra slips forward over another, the spinal canal may narrow.
• Congenital spinal stenosis: Some individuals are born with a naturally narrow spinal canal.
• Traumatic injury: Accidents or trauma may damage spinal structures and contribute to narrowing.
• Inflammatory or metabolic conditions: Conditions such as rheumatoid arthritis or Paget’s disease can affect bone and joint structure.

Types of Spinal Stenosis

Spinal stenosis is categorized based on the location of the narrowing in the spine. It most commonly affects the cervical or lumbar spine, while thoracic stenosis is relatively rare.

Lumbar Spinal Stenosis

Lumbar spinal stenosis affects the lower back, which supports much of the body’s weight. It is the most common form of spinal stenosis, especially in adults over age 50.

Symptoms may include:

• Lower back pain
• Pain radiating into the buttocks or legs
• Burning pain in the lower back or legs
• Numbness or tingling in the legs or feet
• Weakness or cramping in the leg muscles
• Difficulty standing or walking for long periods

Pain may radiate along the sciatic nerve, causing discomfort that travels down the leg.

Many patients with lumbar spinal stenosis experience neurogenic claudication, where leg pain worsens with walking and improves when sitting or leaning forward.

Cervical Spinal Stenosis

Cervical spinal stenosis occurs in the neck region of the spine.

When narrowing compresses nerves or the spinal cord, symptoms may affect the upper body.

Common symptoms include:

• Neck pain and stiffness
• Pain that radiates into the shoulders or arms
• Numbness or tingling in the hands or fingers
• Weakness in the arms or hands
• Difficulty with balance or coordination

Severe cervical stenosis can lead to cervical myelopathy, a condition involving spinal cord compression that affects movement and coordination.

Symptoms of Spinal Stenosis

Symptoms vary depending on the location and severity of nerve compression.

Common symptoms include:

• Chronic back or neck pain
• Numbness or tingling in the arms or legs
• Muscle weakness
• Pain that worsens with standing or walking
• Difficulty maintaining balance
• Reduced mobility or endurance

In rare cases, severe nerve compression may cause:

• Loss of bladder or bowel control
• Severe weakness in the legs
• Difficulty walking
• Foot drop (difficulty lifting the front of the foot)

These symptoms require immediate medical evaluation, as they may indicate serious nerve compression such as cauda equina syndrome.

Diagnosing Spinal Stenosis

A spine specialist will begin with a comprehensive review of your medical history and symptoms, followed by a physical examination.

During the exam, the physician may evaluate:

• Range of motion
• Muscle strength
• Reflexes
• Balance and walking ability
• Areas of nerve irritation

Imaging tests help confirm the diagnosis and determine the severity of stenosis.

Common diagnostic tools include:

X-rays

Used to evaluate spinal alignment and signs of arthritis.

MRI (Magnetic Resonance Imaging)

Provides detailed images of discs, nerves and soft tissues.

CT Scans

Offer detailed images of the spine’s bony structures.

In some cases, electrodiagnostic testing (EMG/NCS) may be used to evaluate nerve function.

Non-Surgical Treatment for Spinal Stenosis

Many patients find relief from spinal stenosis symptoms with conservative, non-surgical treatments.

Common treatment options include:

Physical Therapy

Targeted physical therapy exercises help strengthen the muscles supporting the spine, improve posture and reduce pressure on nerves.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce inflammation and relieve pain.

Activity Modification

Adjusting certain activities may reduce strain on the spine.

Spinal Injections

Epidural steroid injections or nerve blocks may help decrease inflammation and relieve nerve pain.

Many patients experience improvement within several weeks to months of conservative treatment.

Surgical Treatment for Spinal Stenosis

Surgery may be recommended when:

• Non-surgical treatments fail to relieve symptoms
• Nerve compression causes significant weakness or mobility problems
• Spinal cord compression threatens nerve function
• Spinal instability is present

Common surgical procedures include:

Laminectomy (Spinal Decompression Surgery)

Removes part of the vertebral bone to create more space for nerves.

Foraminotomy

Enlarges the openings where spinal nerves exit the spine.

Spinal Fusion

Stabilizes the spine by joining two or more vertebrae together.

Many procedures can be performed using minimally invasive spine surgery techniques, which may result in smaller incisions and faster recovery.

When to See a Spine Specialist

You should consider seeing a spine specialist if you experience:

• Persistent back or neck pain
• Pain that radiates into the arms or legs
• Numbness or tingling that does not improve
• Weakness affecting walking or grip strength
• Pain that interferes with daily activities

Early evaluation may help prevent symptoms from worsening and allow for more treatment options.

Spinal Stenosis Treatment at OrthoTexas

The spine specialists at OrthoTexas provide comprehensive care for spinal stenosis and other spine conditions affecting the neck and back.

Our team offers:

• Advanced diagnostic imaging
• Non-surgical spine treatments
• Interventional pain management
• Physical medicine and rehabilitation
• Minimally invasive spine surgery when needed