Spinal stenosis is a condition of the spine that occurs when the bones of the spinal column narrow, compressing the nerves that run up the spinal canal. This condition may exist in the body without any symptoms for a period of time, only to suddenly flare up into radiating leg pain or pain in other areas of the body. This pain can be debilitating and chronic. There are treatment options, including new research into a procedure that may instantly relieve years of leg pain.
Although this condition can be present in people with scoliosis at any age, spinal stenosis most often affects those over the age of 50. Besides age, other risk factors for spinal stenosis include genetics, pre-existing degenerative disease (e.g., degenerative arthritis, the most common cause of spinal stenosis), and hypertension. In rare cases, spinal stenosis is present at birth. There are multiple potential causes of this condition, many of which are present at the same time.
Extra weight puts more pressure on the spine. Over time, the spinal column may narrow under the force of gravity.
The U.S. is a forward-bending culture. Whether it’s hunched over a phone, lounging on the couch, or putting in long hours in front of a computer, our shoulders round forward and we collapse in our lower back. This misalignment can cause long-term issues like spinal stenosis.
Injury or previous back pain
Injury to the spine or pre-existing back pain seem to be two good predictors of a person’s risk for developing spinal stenosis. The reasons for this are unclear but may be due to the fact that previous trauma or pain make the structures of the spine more vulnerable.
Symptoms of spinal stenosis include neck and back pain, numbness in the extremities, weakness, limited range of motion and general mobility, and cramping. One of the most common symptoms is severe leg pain, including pain that radiates down the legs. This pain may be caused by the narrowing spinal column pressing on the sciatic nerve that begins deep within the muscles of the buttocks and runs down the back of the legs. Compression at the top of the spine puts increasing pressure all the way down to this nerve, resulting in debilitating pain.
Diagnosis of spinal stenosis involves multiple steps. The first step is a thorough physical examination that includes a medical history of not only the patient but also the patient’s family. The doctor will then test range of motion and mobility in the affected limbs and ask the patient to describe the location, duration, and intensity of pain. Supportive diagnostic imaging, such as magnetic resonance imaging (MRI), X-rays, computerized axial tomography (CAT), myelogram, ultrasounds, or bone scans may be ordered to confirm a diagnosis.
Treating spinal stenosis pain
Treatment for leg pain due to spinal stenosis is usually designed based on the degree of the narrowing and the progression of the condition. Over-the-counter non-steroidal anti-inflammatories may be effective for leg pain that is not severe. In some cases, short term opioids may be prescribed, but, as with all chronic pain conditions, long-term opioid use generally causes more harm than good. Other traditional treatments include epidural injections and spinal cord stimulation.
Sometimes minimally-invasive treatments relieve just enough pain for the patient to be able to participate in complementary approaches to pain management. Spinal stenosis compresses the spine, so it stands to reason that exercises designed to bring space between the vertebrae and length to the spine would be helpful. Yoga and Pilates may help with this, with an added benefit of core strengthening to help better support the spine.
Acupuncture is another complementary therapy that some research indicates is more effective for pain relief than surgery. Many patients use acupuncture as a treatment of last resort when other studies suggest that those utilizing acupuncture as a first-line treatment option have less pain, a lower chance of surgery, and much lower medical bills due to their pain.
For the most resistant cases of leg pain due to spinal stenosis, surgery may be the only option. Doctors at Loyola University Health System have pioneered a two-part surgery that offers patients with spinal stenosis a new option for their refractory chronic leg pain.
The first part of the surgery consists of decompression. In many cases, this may mean removing bony spurs that can form as spinal stenosis progresses. After the spurs are removed, sections of the spine are then fused together in a second surgery using rods and screws. This offers more stability to the patient’s spine, a plus if the spinal stenosis is caused by a degenerative condition.
Dr. Bartosz Wojewnik, assistant professor in the department of orthopedic surgery and rehabilitation of Loyola University Chicago Stritch School of Medicine, stresses that a two-part surgery is not a first-line defense for leg pain caused by spinal stenosis. This treatment is for those patients who have found no relief with less invasive procedures. He notes that:
“If, after trying everything else, you do the right procedure on the right patient at the right time, you can provide great results and make patients very happy.”
Not sure is the leg pain you are experiencing is due to spinal stenosis? Find out when to visit your doctor for pain here and get the answers you need!