Lower back pain is one of the most common causes of doctor visits in the U.S. with an estimated 80 to 90% of adults in the U.S experiencing some form of it in their lifetime. While some back pain is resolved with proper rest and exercise, other causes may be more complicated and require a more comprehensive treatment plan. Spinal stenosis is one such type of back pain. If you’re suffering from lower back pain that you also feel in your arms and legs, and that gets worse when standing, you may be suffering from spinal stenosis.
What is spinal stenosis?
Spinal stenosis is compression of the spinal cord caused by a narrowing of the spinal column. This causes spinal stenosis, as shown in the diagram below. This can result in extraordinary, debilitating pain that is unrelieved for any long period of time. This condition is characterized by pain that gets worse after long periods of standing or walking, but feels better after sitting. It can also result in weakness, pain, tingling, or numbness in the hands or legs.
What is spinal stenosis anatomy?
The spine is a complex structure of bone, muscle, ligaments, tendons, and nerves. The bones of the spine, called vertebrae, provide the scaffolding for the rest of the spinal structures. Everything else is attached to or protected by the vertebrae.
Each vertebrae has three parts. A round, drum-shaped part provides most of the stability. Facing outward from the back are the protruding parts that help hold muscles; these are the little bumps visible on some people’s backs. In the center of the vertebrae is an arch-shaped bone. The vertebrae are stacked on top of each other, so these arch-shaped areas form a canal that protects the spine’s nerves. This bundle of nerves, called the spinal cord, is responsible for carrying information from the rest of the body to the brain and vice versa.
The 33 vertebrae in the spine are stacked in such a way to protect and enclose the delicate, sensitive spinal cord. When injury or age afflicts the lumbar area of the spine in the lower back, the vertebrae may weaken, collapse, or otherwise compress the spinal cord, as well as the peripheral nerves that branch off of the spinal cord.
How is spinal stenosis diagnosed?
Spinal stenosis can be difficult to diagnose, and as such, it can be difficult to treat correctly without an appropriate diagnosis. After a medical history and physical examination are done, Mayo Clinic notes that imaging tests can be used to help pinpoint and diagnose the true cause of your symptoms. These tests include:
- MRIs, the imaging test of choice
- CT myelogram, another option if you can’t have an MRI
What is cervical spinal stenosis?
Spinal stenosis can also be present in the cervical spine. This is the upper portion of your spine that supports your neck and head. Cervical spinal stenosis refers only to the location of your stenosis. The diagram below shows the different portions of the spine.
What is lumbar spinal stenosis?
Likewise, lumbar spinal stenosis refers to a narrowing of the spinal canal in the lower portion, or lumbar, spine. If you think you suffer from lumbar spinal stenosis, it’s even more important to get a good diagnosis to ensure it’s not a more serious condition. As Spine-Health.com explains:
“Lumbar spinal stenosis often mimics symptoms of vascular insufficiency. Both conditions can cause claudication, which means leg pain with walking. If vascular studies identify normal blood flow, and there is confirmation of spinal stenosis on diagnostic testing, the symptoms are then called neurogenic claudication.”
What are the symptoms of spinal stenosis?
The predominant symptom of spinal stenosis is extreme pain that is unrelieved for any long period of time. Symptoms may vary depending on the location of the stenosis. Symptoms can also range from mild to debilitatingly severe. Spinal stenosis symptoms typically emerge slowly and become progressively worse over time. Pain is a common symptom of spinal stenosis, often manifesting in the back, neck, or limbs. Pain might also radiate down the leg. Additional potential symptoms of spinal stenosis include muscle weakness or cramps or sensations of numbness.
The most common spinal stenosis symptoms include:
- Neck pain
- Less dexterity in hands
- Loss of motor control in hands (i.e. when buttoning a shirt or writing)
- Difficulty with balance
- Pain in other areas of the back
- Radiating leg pain (often termed sciatica, which is a collection of symptoms rather than a condition)
- Muscle weakness
- Numbness in legs and feet
- Limited mobility
- Muscle cramps and weakness
In very rare cases, trouble with bowel and bladder control develops. This situation, called cauda equine syndrome, is considered an emergency and requires immediate medical attention.
Spinal stenosis can make simple, everyday tasks impossible and can be a debilitating condition. If left untreated, symptoms will worsen. Patients may have trouble standing or sitting for extended periods of time. These symptoms can often lead to limited mobility, even becoming debilitating in some cases.
What causes spinal stenosis?
Spinal stenosis is most often caused by degenerative wear and tear of the vertebrae. This process can be accelerated by the presence of osteoarthritis in the lumbar spine. Osteoarthritis is characterized by the damage of cartilage around and in joints. The cartilage is a flexible material that protects joints from damage, wear, and shock. However, as the cartilage becomes damaged and wears away, painful inflammation can occur.
Over time, the daily stress that we place on our lower backs can cause connective tissues in the spine to break down. If the cartilage degeneration is severe enough, the bones of the joints may even come into contact with each other; bone-on-bone contact can be very painful. This can then lead to problems with the intervertebral discs, including herniated or bulging discs, bone spurs, and thickening tissue in between each vertebrae. Any of these conditions can lead to a narrowing of the spinal column and compression of the spinal cord.
Finally, as Healthline reports, Paget’s disease is a rare disease that can cause “abnormal bone destruction and regrowth” that can lead to spinal stenosis.
Is spinal stenosis hereditary?
The majority of spinal stenosis cases are caused by degenerative conditions associated with aging. Spinal stenosis is not an inherited condition, but certain inherited