Spinal stenosis is a narrowing in the spinal canal where the spinal cord and nerves of the spine travel and exit the bony spine structure.  It most commonly occurs in the neck and low back regions.  It can be caused by normal changes relating to aging, such as:

• Bony overgrowth
• Trauma
• Congenital changes

The body is highly adaptive, and if changes that lead to stenosis are slow, often no symptoms are present until the body can no longer compensate.

Causes & Symptoms

The symptoms of stenosis are signs of nerve damage at the spinal level that include:

• Pain
• Numbness
• Muscle weakness
• Bowel or bladder problems

Symptoms are dependent on the cause and location of the spinal narrowing.  Trauma, like car accidents, can cause sudden fracture of the spinal vertebrae. The bone pieces can damage the spinal cord causing immediate paralysis.  Congenital abnormalities may cause curvatures of the spine (scoliosis) and pinching of the nerves as they exit the spine.

Stenosis most commonly develops as one ages. The bone can become overgrown where the vertebral discs and joints are causing central and lateral spine narrowing.  In the neck, symptoms of pain, numbness, and weakness occur in the arms and head, but can also occur in the legs.  Low back stenosis causes symptoms in the low back and legs, and sometimes bowel and bladder control.  Symptoms in the low back may be very positional. Bending forward and sitting may significantly relieve the pain.  The most common symptoms that send a person to a doctor are pain or muscle weakness.

Diagnosis

Diagnosis of spinal stenosis is made based on symptoms, history, and physical examination.  Pain is often in the distribution of a particular spinal nerve level and muscle weakness corresponds to that level.  An exam shows sensation changes, weakness of muscles, and reflex changes.  If stenosis is suspected, CT or MRI scans of the spinal region can confirm the diagnosis.  Electrodiagnostic studies may also be useful to determine the extent of nerve damage, and are performed by Physical Medicine doctors or Neurologists.

Pain Management Options

Treatment for spinal stenosis needs to be individualized for every patient. Conservative care centers on physical therapy to strengthen spinal muscles and maintain proper posture, to medications for pain and spinal injections.  Many people can control symptoms for years with a variety of conservative care techniques.  If the conservative path is not controlling symptoms, then surgical care may be necessary to relieve spinal narrowing.

Spinal stenosis is a complex condition.  A good Physical Medicine pain specialist can lead one through the maze of diagnosis and treatment.  Most people do respond to conservative care.  Narrowing of the spine does occur in many people and often can be treated with PT, medications and other types of care.  Find a physician who can lead you through conservative care before you consider surgery.