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 characteristics can increase your chances of suffering from it. The National Institute of Arthritis and Musculoskeletal and Skin Diseases explains that inherited conditions that can increase your risk include:
- A naturally narrow spinal canal
- A curvature of the spine, called scoliosis, that puts additional pressure on tissues and ligaments of the spine
- Achondroplasia, a defective bone formation that leads to dwarfism
In rare instances, spinal stenosis may be present at birth (although it will usually not be immediately apparent).
What are common spinal stenosis risk factors?
Age is the most common risk factor for spinal stenosis. The majority of those with spinal stenosis are over the age of 50. Younger people who develop this condition generally have a genetic disease or other disorder that contributes to the narrowed spinal column.
A history of injury to the back can also increase the chances of developing spinal stenosis. In some cases, family history of genetically-linked back conditions is a risk factor for spinal stenosis. Women have a higher prevalence of spinal stenosis than men, as a major risk factor – osteoarthritis – is more predominant in women.
Other factors in the development of spinal stenosis include:
- Poor posture
- Injury to the lower back
- Being underweight or overweight
- Improper alignment in the body
- Tumors growing in the intervertebral space
Is spinal stenosis reversible?
There is no cure for spinal stenosis. Leading medical professionals recommend regular, low-impact exercise to greatly help reduce your pain. Other interventional options like injections, medication, or in severe cases, surgery, can also help you find relief from this condition.
How to treat spinal stenosis?
Treatments for spinal stenosis are often varied and range from minimally-invasive treatments for pain to surgery. Spinal stenosis treatments include:
- Low-impact exercises
- Activity modifications
- Physical therapy
- Chiropractic care
- Nerve blocks
- Epidural steroid injections
What are some home remedies for spinal stenosis pain?
Alternative therapies like acupuncture, yoga, massage, or dietary changes can and should be used in conjunction with other treatments to provide additional pain relief.
Spine-Health.com also notes practical and easy activity modifications you can do to reduce your pain. These include:
- Walking while bent over and leaning on a walker or shopping cart instead of walking upright
- Stationary biking (leaning forward on the handlebars) instead of walking for exercise
- Sitting in a recliner instead of on a straight-back chair.
What are the best exercises for spinal stenosis?
The American College of Rheumatology notes that “Exercise is very important in the treatment of this disease. Exercising regularly to keep muscles strong and improve flexibility boosts strength, reduces pain and improves general well-being.”
We’ve included our 15 favorite spinal stenosis exercises in this post. These exercises focus on low-impact exercises, along with core-strengthening routines to reduce your pain.
Is walking good for spinal stenosis?
Walking may be a decent option for spinal stenosis, with some modifications. Because walking puts more pressure on the spinal canal from remaining upright, longer walks can cause even more pain. That said, taking shorter and frequent walks can be a good option.
Other lower-impact workouts to try include:
- Slow-moving tai chi
When spinal stenosis is diagnosed, doctors may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to help relieve pain and inflammation. Taking NSAIDs for an extended period of time may result in serious side effects and is not recommended in large doses for long-term relief.
Will physical therapy help with my pain?
Physical therapy to build strength in the abdomen and back is offered in conjunction with other therapies such as those above or chiropractic care. A 2015 study found that physical therapy can be highly effective at treating spinal stenosis pain. In this study, one group of patients underwent surgery, while the other group underwent physical therapy (two sessions per week for six weeks). The study author noted:
“After both groups were re-examined at intervals of six months, one year and two years, the patient outcomes appeared to be equal. There were no detectable differences between the groups in how their pain abated and the degree to which function was restored in their backs, buttocks and legs.”
Therefore, it’s worth it to explore and exhaust all options, including physical therapy, before resorting to surgical treatment for spinal stenosis. In fact, one study found that long-term results of spinal stenosis treatment are comparable whether or not the patient underwent surgery.
What are interventional pain management options?
Interventional options can provide a fantastic opportunity to reduce more severe cases of pain, while avoiding surgery. These options are typically minimally-invasive and safe. Interventional options to treat spinal stenosis pain include:
- Epidural steroid injections that deliver pain medication and anti-inflammatory drugs directly to the affected nerves
- Spinal cord stimulation that interrupts pain signals with a mild electrical charge
- Adhesiolysis, which is the removal of potentially-painful scar tissue along the spine
You can learn more about epidural steroid injections in the video below.
“Chiropractic manipulation is generally safe and can help with some of the pain from lumbar stenosis. Care should be taken if a patient has osteoporosis or disk herniation. Manipulation of the spine in these cases can worsen symptoms or cause other injuries.”
Should I get surgery for spinal stenosis?
For some patients, pain relief interventions and exercise is enough to correct spinal stenosis. Others may find that surgery to correct the underlying condition is necessary. Some surgical options include:
- Laminectomy: Removes lamina of the vertebrae. May also include adding pins to strengthen the spine.
- Laminotomy: Removes less lamina than a laminectomy, just enough to relieve pressure.
- Laminoplasty: Addresses cervical spinal stenosis in the neck, creating a hinge on the lamina to open up space in the vertebrae and relieve pressure. A pin may be placed to stabilize the spine.
Surgical outcomes vary widely, due in part to variations in patient age, causes of spinal stenosis, and other health conditions. For many patients, surgery can help to address the cause of the pain and may result in less pain and greater mobility.
If there is extensive nerve damage due to advanced stages of spinal stenosis, it is possible that pain will persist and mobility and weakness will still be limited. Additionally, degeneration as a result of osteoarthritis will continue even if the initial degeneration is addressed.
A study conducted by the National Institute of Arthritis and Musculoskeletal and Skin Diseases – Spine Patient Outcomes Research Trial (SPORT) – found that patients utilizing surgical treatments had better outcomes in the long-term. Those patients who chose non-surgical interventions still experienced improved functionality and mobility over the course of the study.
Will surgery work for me?
Risk factors for negative spinal stenosis outcomes, including post-surgical complications or death, have been identified. Surgery may not be a good option for you if you have a history of:
- Sepsis or spinal wound infections
- Congestive heart failure or heart attacks
- The use of corticosteroids
- Preoperative neurological problems
These risks don’t necessarily mean that you can’t undergo surgery. However, it is extremely important to discuss any and all risk factors with your doctor so you can receive proper treatment. It may also be beneficial to quit smoking, undergo physical therapy or do regular exercise, or lose some weight before surgery, to make sure that you’re as healthy as possible. In addition, even mild symptoms of depression can negatively impact the outcome of spinal stenosis surgery, so it’s a good idea to speak to a physician about treating any possible depressive symptoms prior to surgery.
Despite the risks, and even if surgery is the last option, it can have very positive results for some people.
What can I do about my spinal stenosis?
For both long- and short-term treatments, the best approach is a holistic one that treats the acute stage of pain and then addresses the underlying issue. A pain management specialist will work directly with you to determine the best course of action and treatment. Find a pain doctor in your area to accurately diagnose the causes of your back pain, as well as treatment options that could work for you.