Stenosis is a general term that refers to a condition where there is narrowing in the spinal canal. This narrowing can either occur in the central spinal canal where the spinal cord resides (central stenosis) or in the holes on each side (foramen) of the spine at every level where the cervical nerves exit (foraminal stenosis).
A number of conditions can contribute to stenosis, including disc bulging, arthritis and overgrowth of the facet joints at each level, disc herniation, or through fracture of the vertebral bodies. Some patients may be born with a narrower spinal canal, predisposing them to earlier symptomatic spinal canal stenosis.
Patients with cervical spinal stenosis may describe neck pain, or neck and arm pain if there is nerve root compression within the foramen. Along with neck pain, patients may describe arm pain and associated symptoms such as numbness, tingling, or a sensation of weakness or clumsiness. Occasionally, there may be actual weakness of the arm.
With symptomatic thoracic spinal stenosis, patients suffer from mid-back pain that may travel around the chest or abdomen if there is also nerve root compression within the foramen. In addition to mid-back pain, patients may also have numbness, tingling, or a subjective sensation of weakness or clumsiness in the legs.
Patients with lumbar spinal stenosis may suffer from low-back pain that may travel down the buttocks, thighs, or legs if there is also nerve root compression within the opening known as the foramen. In addition to low-back pain, patients may also have numbness, tingling, or a subjective sensation of weakness or clumsiness in the legs. Occasionally there may be actual weakness of the legs.
It is important to note that not all stenosis visible on an imaging study is symptomatic.
Unless there is significant muscular weakness of the upper extremity or signs of myelopathy, surgery is not typically immediately warranted as a first-line treatment. Myelopathy is a term that describes damage to the spinal cord from stenosis. Symptoms include weakness in the limbs (both upper and lower extremities), tightness or spasticity of movement, altered sensation, and possible bowel or bladder incontinence. In these instances, early diagnosis and treatment is important in salvaging spinal cord function and avoidance of possible long-term consequences such as neurologic deficits.
Stenosis can occur from multiple causes. It may be the result of cumulative natural “wearing and tearing” of the spine. The intervertebral discs (the “cushions” of the spine) along with the pair of joints at every level known as facet joints will break down over time as a consequence of inevitable degeneration. As this degeneration occurs, the bulging of the discs, bone spurs, and overgrowth of the facet joints can cause narrowing of the spinal canal or the foramen. Other possible causes include a herniated disc, congenital narrowing, or fracture of the vertebral bones.
Your Center for Pain Management doctor will evaluate your specific case and work with you to develop an individualized treatment plan. Appropriate treatment is always based on an accurate diagnosis. Our initial evaluation will include a thorough review of your history, a detailed examination, and review or acquisition of appropriate imaging.
Possible treatments range from non-invasive therapy such as physical therapy, modification of activity and medication to minimally invasive options such as epidural steroid injections. These epidural steroid injections provide significant reduction in inflammation and pain. They also help localize and confirm the source of the pain, providing diagnostic information and allowing the creation of a more well-defined and accurate long-term plan of treatment. If a patient has failed conservative, non-surgical options, surgical intervention can be considered.