Spinal stenosis is a condition that occurs when the small spinal canal, which contains the nerve roots and spinal cord, becomes compressed (or narrowed). This narrowing occurs most often in the lower back or neck, and can put pressure on the spinal cord and nerves, causing a “pinching” of the spinal cord and/or nerve roots. The pinching can lead to a variety of symptoms, including pain, weakness and numbness. Symptoms often start slowly and get worse over time, and typically a person with this condition complains of severe pain in the legs, calves or lower back when standing or walking. Other symptoms include abnormal bowel/and or bladder function and loss of sexual function. Depending on where the narrowing takes place, you may feel these symptoms in the lower back and legs, neck, shoulder or arms. Usually, it is relieved by sitting down, leaning over or sitting forward.
In most cases, the narrowing is caused by osteoarthritis of the spinal column and discs between the vertebrae. It may also be caused by a thickening of the ligaments in the back, as well as by a bulging of the discs that separate the vertebrae. If you suffer from any or all of the above you should schedule an appointment with an orthopaedic spine specialist to determine if you have spinal stenosis.
How is Spinal Stenosis Treated?
The preferred treatment for cases of persistent back pain from spinal stenosis is a combination of physical therapy, prescribed exercise, and medications for chronic pain. Only if you have persistent pain, or if your pain does not respond to these efforts, will your physician consider surgery to relieve the pressure on the affected nerves or on your spinal cord. Here is what you can do:
- Exercise: Regular exercise can help you build and maintain strength in the muscles of your arms and upper legs. This will help to improve your balance, ability to walk, bend and move about, as well as control pain. A physical therapist will identify and show you what exercises are right for you.
- Medications: The most common treatment for chronic pain in spinal stenosis is non-steroidal anti-inflammatory drugs (NSAIDs). These include: ibuprofen (Advil, Motrin), acetaminophen (Tylenol) and Naproxen (Aleve). Your physician may also prescribe other medications to help with pain and/or muscle spasm.
- Cortisone injections: Injections directly into the area around the spinal cord (known as epidural injections) may provide a great deal of temporary, sometimes permanent, relief. These medications include: Cortisone (Celestone, Kenalog) and methylprednisolone acetate (Depo-Medrol, Medrol).
- Surgery: In some cases you may need surgery to relieve spinal stenosis, particularly if a disc fragment is lodged in your spinal canal and is pressing on a nerve, which can cause significant loss of function. Some patients with severe or worsening symptoms (but who are otherwise healthy) may be candidates for what is known as a decompression laminectomy. This surgery removes the bone spurs and buildup of bone in the spinal canal, freeing space for the nerves and the spinal cord. This may be done in conjunction with a spinal fusion to connect two or more vertebrae and better support for the spine. It should be noted that while surgery may bring some relief, it will not cure spinal stenosis and symptoms may recur.
Living With Spinal Stenosis:
Spinal stenosis can be a real challenge day to day, but certain steps can be taken to ease some of the symptoms. Some treatment options include:
- Get moving. If you’re capable, regular exercise is very important and you should do it often – at least three times a week for about 30 minutes. Start slowly and as you begin to feel stronger, add walking or swimming to your plan.
- Modify activity. Don’t do anything that can trigger or worsen pain and disability such as lifting heavy objects or walking long distances.
- Hot or cold packs. Some symptoms of cervical spinal stenosis may be relieved by applying heat or ice to your neck.
- Canes or walkers. In addition to providing stability, these assistive devices can help relieve pain by allowing you to bend forward while walking.
About Dheera Ananthakrishnan, MD
Dr. Ananthakrishnan trained with one of the pioneers of scoliosis surgery, Dr. David Bradford, at the University of California at San Francisco. After completion of her fellowship, she practiced orthopedic and spine surgery for over three years at the University of Washington in Seattle. In 2007, she left Seattle to work with Medecins Sans Frontieres/Doctors without Borders in Port Harcourt, Nigeria. She then worked as a volunteer consultant at the World Health Organization in Geneva, Switzerland, before starting her position at Emory University, where her focus is on adult and adolescent scoliosis.
In 2009, Dr. Ananthakrishnan co-founded Orthopaedic Link, a non-profit dedicated to improving orthopaedic care in the developing world by mobilization of unused implants from the United States. She is also a candidate member of the Scoliosis Research Society. Although Dr. Ananthakrishnan routinely performs complex spinal reconstruction surgery, an injury in 2012 caused her to reevaluate her own approach to musculoskeletal health. Her practice philosophy now focuses on strengthening, stretching and general conditioning as an adjunct to surgical care of her patients.