Beejal Y. Amin MD

Spinal Stenosis

What is spinal stenosis?

Spinal stenosis is the narrowing of the space for the spinal cord or nerve roots. More specifically, as the spine degenerates over time, it can lead to the formation of bone spurs. As the bone spurs form, the size of the spinal canal (boney tunnel transmitting to the spinal nerves) becomes smaller. The bone spurs press on the spinal cord or the nerve roots, often causing pain. This degenerative condition commonly involves the lower spine (lumbar) region. It is also associated with spondylolisthesis (vertebra that slips forward and is not in line with the other bones) and scoliosis (abnormally curved spine). Many people suffer back and leg pain due to spinal stenosis, with men and women being affected equally. Women, however, are more likely to have symptoms that require treatment. Arthritis is the most common cause of spinal stenosis. While spinal stenosis can affect younger patients, it is most common in those 60 and older.

What are the symptoms of spinal stenosis?

Symptoms of spinal stenosis can come and go. Inflamed nerves lead to pain. Other symptoms include:

  • Legs, back or buttocks that are sore, numb, tingling or weak
  • Pain that decreases when sitting or bending forward (creating room in the spinal canal)
  • Pain that worsens with prolonged walking or standing
  • Cramping in legs
  • Pain that radiates into one or both legs, similar to sciatica
  • Loss of control of arms and legs (called spasticity) that can lead to trouble walking
  • Loss of use of legs and difficulty walking up stairs
  • Loss of bowel or bladder control

What causes spinal stenosis?

Spinal stenosis occurs as a result of arthritis and is part of the normal aging process. The gelatinous discs that cushion the vertebrae in the spine begin to dry out as we age, resulting in shortened disc height. This puts pressure on the facet joints. As they feel more pressure, they begin to degenerate. The arthritis can cause the ligaments around the joints to thicken and enlarge, decreasing space in the spinal canal for nerves to pass through. The cartilage that protects joints wears away as well. Too much wear leads to bone-on-bone rubbing. To compensate for the missing cartilage, the body may grow bone in the facet joints. This bone overgrowth is called spurs, and their formation further contributes to the narrowing of space in the spinal canal for nerves to pass through. Once the space within the spinal canal becomes too cramped, pain can ensue due to compression of nerve roots.

What is the treatment for spinal stenosis?

Dr. Amin begins with conservative, nonsurgical treatment for spinal stenosis.

Non-surgical Treatment

Non-surgical treatments do not correct spinal canal narrowing. Instead, the treatment options for spinal stenosis are aimed at controlling pain and improving quality of life for patients. These non-surgical treatment options include:

  • Nonsteroidal anti-inflammatory drugs to reduce swelling
  • Physical therapy to increase flexibility
  • Spinal epidural injections or “blocks”

Surgery to Treat Spinal Stenosis

Recent studies by the National Institute of Health show that surgical intervention leads to improved clinical outcomes when compared to non-surgical treatments for lumbar spinal stenosis.

Dr. Amin may recommend surgery if conservative treatment fails. The goal of surgery is to open up the spinal canal to provide nerves adequate space. While surgery to open the spinal canal relieves leg pain, it is less reliable in alleviating back pain. Based on the patient’s imaging, Dr. Amin may recommend one of these surgeries for spinal stenosis:

1.) Lumbar laminectomy

2.) Lumbar laminectomy and fusion