Understanding Spinal Stenosis

Article written by Chris Sliva, MD

Spinal stenosis occurs when the available space for nerves is decreased and in the lower back when nerves traveling through the lumbar spine, en route to the legs, become compressed. It is usually a degenerative condition usually seen as part of the normal aging process that develops in patients 60 years and older. The condition, while rare, can occur in younger patients who have a congenitally narrow spinal canal.

Common symptoms of spinal stenosis include a deep aching pain or cramping sensation in the lower back or buttocks. Frequently, these symptoms radiate into one or both thighs and legs and this develops with walking or other activity. Symptoms are generally relieved through sitting, lying down or by bending at the waist. In rare cases, patients can lose motor function and sensation in the legs.

It is not uncommon for patients to have an x-ray as part of their initial diagnostic testing. X-rays can diagnose other common conditions associated with spinal stenosis such as arthritis (spondylosis) or spinal instability (spondylolisthesis) and help rule out other problems such as a fracture or a tumor in the vertebrae. Unfortunately, x-rays cannot visualize spinal nerves; therefore, a magnetic resonance imaging (MRI) study is utilized to detect spinal stenosis. For patients unable to undergo an MRI due to implanted devices such as pacemakers or a CT (computerized tomography), a myelogram may be used.

Usually, initial treatments are non-surgical. These include nonsteroidal anti-inflammatory medication, physical therapy and occasionally, epidural steroid injections. This approach may provide permanent or temporary relief. When symptoms are severe and progressive, surgery is indicated and it is usually recommended when back and leg pain limits normal activity and impairs quality of life.

There are several different surgical procedures and the choice of which is influenced by the severity and type of disease. The mainstay of treatment for spinal stenosis is a decompressive lumbar laminectomy to remove bone and soft tissue that is pressing on the nerves. In some patients, spinal instability make may it necessary for a fusion to be performed.

Following the surgical procedure, most patients notice relief of their leg discomfort and are able to walk longer distances. Physical therapy may be necessary for six to eight weeks after surgery for strengthening and conditioning.

It is most important to make an informed decision about your treatment. The potential benefits of surgery must be balanced with the risks for each individual patient in conjunction with any available treatment alternatives. Your spine surgeon will help you to determine whether or not you are a good candidate for surgery.