Spinal stenosis (patient information)

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Overview
Spinal stenosis is narrowing of the spinal column that causes pressure on the spinal cord, or narrowing of the openings (called neural foramina) where spinal nerves leave the spinal column.

What are the symptoms of Spinal stenosis?
Often, symptoms will be present and gradually worsen over time. Most often, symptoms will be on one side of the body or the other.


 * Numbness, cramping, or pain in the back, buttocks, thighs, or calves (or problems in the lower back), or in the neck, shoulders, or arms (or problems in the neck)
 * Weakness of a portion of a leg or arm

Symptoms are more likely to be present or get worse when you stand or walk upright. They will often lessen or disappear when you sit down or lean forward. Most people with spinal stenosis cannot walk for a long period of time.

Patients with spinal stenosis may be able to ride a bicycle with little pain.

More serious symptoms include:


 * Difficulty or imbalance when walking
 * Problems controlling urine or bowel movements
 * Problems urinating or having a bowel movement

What causes Spinal stenosis?
Spinal stenosis typically develops as a person ages and the disks become drier and start to shrink. At the same time, the bones and ligaments of the spine swell or grow larger due to arthritis or chronic inflammation.

However, other problems, including infection and birth defects, can sometimes cause spinal stenosis.

Spinal stenosis may be caused by:


 * Arthritis involving the spine, usually in middle-aged or elderly people
 * Herniated or slipped disk, which often occurred in the past
 * Injury that causes pressure on the nerve roots or the spinal cord itself
 * Defect in the spine that was present from birth (congenital defect)
 * Tumors in the spine
 * Bone diseases, such as Paget's disease of bone and achondroplasia

Who is at highest risk?
Patients with pre-existing conditions, such as:


 * Arthritis involving the spine, usually in middle-aged or elderly people
 * Herniated or slipped disk, which often occurred in the past
 * Injury that causes pressure on the nerve roots or the spinal cord itself
 * Defect in the spine that was present from birth (congenital defect)
 * Tumors in the spine
 * Bone diseases, such as Paget's disease of bone and achondroplasia

Diagnosis
During the physical exam, your doctor will try to pinpoint the location of the pain and figure out how it affects your movement. You will be asked to:


 * Sit, stand, and walk. While you walk, your doctor may ask you to try walking on your toes and then your heels.
 * Bend forward, backward, and sideways.
 * Lift your legs straight up while lying down. If the pain is worse when you do this, you may have sciatica, especially if you also feel numbness or tingling in one of your legs.

Your doctor will also move your legs in different positions, including bending and straightening your knees. All the while, the doctor is assessing your strength, as well as your ability to move.

To test nerve function, the doctor will use a rubber hammer to check your reflexes. Touching your legs in many locations with a pin, cotton swab, or feather tests your sensory nervous system (how well you feel). Your doctor will instruct you to speak up if there are areas where the sensation from the pin, cotton, or feather is duller.

A brain/nervous system (neurological) examination can confirm leg weakness and decreased sensation in the legs. The following tests may be done:


 * EMG
 * Spinal MRI or spinal CT scan
 * X-ray of the spine

When to seek urgent medical care?
Call your health care provider if you have symptoms of spinal stenosis.

More serious symptoms that require immediate attention include:


 * Difficulty or imbalance when walking
 * Problems controlling urine or bowel movements
 * Problems urinating or having a bowel movement

Treatment options
When your back pain does not go away completely, or it gets more painful at times, learning to take care of your back at home and prevent repeat episodes of your back pain can help you avoid surgery. Your doctor and other health professionals will help you manage your pain and keep you as active as possible.

Generally, conservative management is encouraged. This involves the use of medications, physical therapy, and lifestyle changes. Steroid injections may relieve pain for a period of time.

Various other medications may help with chronic pain, including phenytoin, carbamazepine, or tricyclic antidepressants such as amitriptyline.

For more information about treatment, see: Low back pain - chronic

If the pain is persistent and does not respond to these measures, surgery is considered to relieve the pressure on the nerves or spinal cord. Surgery is performed on the neck or lower back, depending on the site of the nerve compression.

See also:


 * Foraminotomy
 * Laminectomy
 * Spinal fusion

Where to find medical care for Spinal stenosis?
Directions to Hospitals Treating Spinal stenosis

What to expect (Outlook/Prognosis)?
Many people with spinal stenosis are able to carry on active lifestyles for many years with the condition. Some change in activities or work may be needed.

Spine surgery will often provide full or partial relief of symptoms. However, future spine problems are still possible after spine surgery. The area of the spinal column above and below a spinal fusion are more likely to be stressed when the spine moves. Also, if you needed more than one kind of back surgery (such as laminectomy and spinal fusion), you may be more likely to have future problems.

Possible complications
Injury can occur to the legs or feet due to lack of sensation. Infections may get worse because you may not feel the pain related to them. Changes caused by nerve compression may be permanent, even if the pressure is relieved.