Spinal Stenosis

Symptoms:

  • Pain, cramping or numbness in the back, buttocks or legs aggravated by walking or standing.
  • Relief of leg symptoms by bending forward or sitting.
  • Numbness or tingling extending into the arms (for cervical stenosis) or into the legs (for lumbar stenosis).
  • Leg weakness resulting in poor balance or reduced walking distance.
  • In severe cases of cervical stenosis problems with hand dexterity and coordination.

Causes:

  • Ligament and bone spur growth due to aging, causing narrowing of the spinal canal.
  • Degenerative disc disease causing reduction in intervertebral disc height and thus spinal canal.
  • Herniated disc causing canal narrowing.
  • Spondylolisthesis causing the reduction of the nerve space.
  • Congenitally narrow spinal canal.

Risk factors:

  • Ageing, as spinal stenosis occurs mostly in people older than 50.
  • Spinal degenerative disorders such as arthritis.
  • Prior spinal injury or surgery.
  • Obesity, causing additional stress on the spine.

Ways to manage :

  • Physical therapy  including flexion and core strengthening exercises.
  • Anti-inflammatory medication.
  • Epidural steroid injections to decrease inflammation and ease pain in the legs.
  • Changing physical activities including the use of assistive devices and the practice of leaning forward while walking.
  • Diet modification to manage weight.
  • Individuals who have a small spinal canal.
  • Stationary cycling which is usually better tolerated than walking.
  • Core-strengthening to support the lower spine.
  • Pelvic tilts and knee to chest exercise.
  • Gentle walking with rest periods.

Surgical options:

Surgical treatment is required when the symptoms are interfering with everyday life or when there is progressive muscle weakness despite conservative management.

  • Laminectomy – removal of bone and ligaments to increase spinal canal space.
  • Laminotomy/Foraminotomy – more specific decompression.
  • Spinal fusion – when stenosis occurs with spinal instability.