Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Spinal stenosis occurs most often in the lower back and the neck. Some people with spinal stenosis may not have symptoms. Others may experience pain, tingling, numbness and muscle weakness. Symptoms can worsen over time.

Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves.

Types of spinal stenosis
The types of spinal stenosis are classified according to where on the spine the condition occurs.

It’s possible to have more than one type. The two main types of spinal stenosis are:

  • Cervical stenosis. In this condition, the narrowing occurs in the part of the spine in your neck.
  • Lumbar stenosis. In this condition, the narrowing occurs in the part of the spine in your lower back. It’s the most common form of spinal stenosis.
  • Symptoms

    Many people have evidence of spinal stenosis on an MRI or CT scan but may not have symptoms. When they do occur, they often start gradually and worsen over time. Symptoms vary depending on the location of the stenosis and which nerves are affected.

    In the neck (cervical spine)

    • Numbness or tingling in a hand, arm, foot or leg
    • Weakness in a hand, arm, foot or leg
    • Problems with walking and balance
    • Neck pain
    • In severe cases, bowel or bladder dysfunction (urinary urgency and incontinence)

    In the lower back (lumbar spine)

    • Numbness or tingling in a foot or leg
    • Weakness in a foot or leg
    • Pain or cramping in one or both legs when you stand for long periods of time or when you walk, which usually eases when you bend forward or sit
    • Back pain
  • Treatment

    Treatment for spinal stenosis depends on the location of the stenosis and the severity of your signs and symptoms.

    Medications
    Your doctor may prescribe:

    • Pain relievers. Pain medications such as ibuprofen (Advil, Motrin IB, others), naproxen (Aleve, others) and acetaminophen (Tylenol, others) may be used temporarily to ease the discomfort of spinal stenosis. They are typically recommended for a short time only, as there’s little evidence of benefit from long-term use.
    • Antidepressants. Nightly doses of tricyclic antidepressants, such as amitriptyline, can help ease chronic pain.
    • Opioids. Drugs that contain codeine-related drugs such as oxycodone (Oxycontin, Roxicodone) and hydrocodone (Norco, Vicodin) may be useful for short-term pain relief. Opioids may also be considered cautiously for long-term treatment. But they carry the risk of serious side effects, including becoming habit forming.

    Physical therapy
    It’s common for people who have spinal stenosis to become less active, in an effort to reduce pain. But that can lead to muscle weakness, which can result in more pain. A physical therapist can teach you exercises that may help:

    • Build up your strength and endurance
    • Maintain the flexibility and stability of your spine
    • Improve your balance

    Steroid Injections
    Your nerve roots may become irritated and swollen at the spots where they are being pinched. While injecting a steroid medication (corticosteroid) into the space around impingement won’t fix the stenosis, it can help reduce the inflammation and relieve some of the pain.

    Steroid injections don’t work for everyone. And repeated steroid injections can weaken nearby bones and connective tissue, so you can only get these injections a few times a year.

    Decompression procedure
    With this procedure, needle-like instruments are used to remove a portion of a thickened ligaments in the back of the spinal column to increase spinal canal space and remove nerve root impingement. Only patients with lumbar spinal stenosis and a thickened ligament are eligible for this type of decompression.

    The procedure is called percutaneous image-guided lumbar decompression (PILD). It has also been called minimally invasive lumbar decompression (MILD), but to avoid confusion with minimally invasive surgical procedures, doctors have adopted the term PILD.

    Because PILD is performed without general anesthesia, it may be an option for some people with high surgical risks from other medical problems.

  • Surgery

    Laminectomy – This procedure removes the back part (lamina) of the affected vertebra. A laminectomy is sometimes called decompression surgery because it eases the pressure on the nerves by creating more space around them. In some cases, that vertebra may need to be linked to adjoining vertebrae with metal hardware and a bone graft (spinal fusion) to maintain the spine’s strength.

    Laminotomy – This procedure removes only a portion of the lamina, typically carving a hole just big enough to relieve the pressure in a particular spot.

    Minimally invasive surgery- This approach to surgery removes bone or lamina in a way that reduces the damage to nearby healthy tissue. This results in less need to do fusions. While fusions are a useful way to stabilize the spine and reduce pain, by avoiding them you can reduce potential risks, such as post-surgical pain and inflammation and disease in nearby sections of the spine. In addition to reducing the need for spinal fusion, a minimally invasive approach to surgery has been shown to result in shorter recovery time.

    Sources: National Institute of Arthritis and Musculoskeletal and Skin Diseases, Mayo Clinic, The National Center for Biotechnology Information, Spine-Health.com