Spinal stenosis is one of the more difficult conditions to diagnose because the symptoms may be an indication of any number of health conditions. That said, there are some key signs to watch for as well as testing and evaluation that can yield an accurate diagnosis. Here we will go over the signs and symptoms of spinal stenosis and what treatment options are available if you have this condition.
What is Spinal Stenosis?
Spinal stenosis is a narrowing of the spinal canal. The spine is comprised of many intricate parts, including vertebrae, discs, ligaments, facet joints, and the spinal cord itself, which is a bundle of nerves that are critical for many body functions. With spinal stenosis, this narrowing compresses the spinal cord and nerves. This can cause an array of symptoms throughout the body, including long-term (and sometimes permanent) nerve damage.
What Causes Spinal Stenosis?
Most often, spinal stenosis is the result of osteoarthritis or age-related wear and tear on the spine. It can also occur from bone spurs, inflammation, swollen ligaments, herniated discs, slipped discs, and (rarely) deformities or injuries to the spine. Most affected individuals are over age 50.
What Areas of the Spine Can be Affected by Stenosis?
Spinal stenosis can occur anywhere along your spine, but it is most common in the neck and lower back regions. Depending on where the spine is affected, it may be called cervical spinal stenosis (neck area) or lumbar spinal stenosis (lower back area). The area of compression affects different nerve groups, which can lead to different symptoms.
Signs and Symptoms of Cervical Spinal Stenosis (Neck)
The most common symptoms of spinal stenosis in the neck are pain, numbness, tingling, and/or weakness that radiates down your arms to your hands and fingers. These common symptoms are among the main reasons that cervical stenosis is often misdiagnosed as carpal tunnel syndrome, multiple sclerosis, vitamin deficiencies, or even written off as natural aging. Sometimes even if the pain is severe in the shoulders, arms, or hands, the neck itself may feel little or no pain. The associated pain may be dull or sharp and may be accompanied by stiffness and headaches.
Additional symptoms of cervical stenosis include:
- Problems with fine motor function and coordination
- Problems with balance, dexterity, and reflexes
- Difficulty walking
- Other bodily function issues, such as incontinence
- In severe cases, cervical myelopathy which can cause paralysis or severe loss of function
Just as important as the symptoms of cervical stenosis is the pattern in which you experience them. With cervical spinal stenosis, your symptoms may flare during certain activities or physical movements. Symptoms tend to worsen slowly but may go through cycles of remaining stable or rapidly worsening.
Signs and Symptoms of Lumbar Spinal Stenosis (Lower Back)
The most common symptom of spinal stenosis in the lower back is severe pain in the lower back, buttocks, and/or legs. This symptom often leads to a misdiagnosis of hip arthritis or other conditions. The pain associated with lumbar stenosis is often severe and may inhibit daily activities. A common sign is the “shopping cart sign”: lower back pain that is so intense that older patients must lean over a shopping cart or walker to experience relief.
Additional symptoms of lumbar stenosis include:
- Tingling, weakness, or numbness in the legs
- Cramping in the legs while walking
- Progression of symptoms may cause permanent numbness, weakness, incontinence, balance problems, or even paralysis
As with cervical stenosis, it is important to watch for how you experience the symptoms of lumbar stenosis. Symptoms may lessen when sitting down, flexing forward, or lying down, but they tend to worsen when walking or standing for longer than a few seconds. Symptoms usually fluctuate over time, with alternating periods of pain flareups and few or no symptoms. In most cases, symptoms develop slowly over time.
How is Spinal Stenosis Diagnosed?
Diagnosing spinal stenosis begins with a detailed medical history, physical examination, and evaluation of symptoms. Diagnostic testing with tools such as an MRI, CT scan, X-rays, reflex testing, electrical studies, and other evaluation methods will also be employed to achieve a proper diagnosis. Early diagnosis can lead to better treatment results because less damage has been done to the spinal cord.
What are my Treatment Options?
Spinal stenosis tends to be progressive, which means it is important to get treatment early.
Treatment for Cervical Stenosis
Cervical stenosis patients with mild symptoms and mild compression may experience relief with conservative treatments such as lifestyle modifications, physical therapy, medications, and steroid injections. However, even minor cases should be taken seriously because cervical stenosis has a higher risk of permanent nerve damage.
Surgery can prevent long-term damage and alleviate symptoms. Options for cervical stenosis surgery include laminectomy and decompression, cervical disc replacement, and spinal fusion. Your symptoms, pathology, and options will be unique, and Dr. Pehler will carefully consider your situation before recommending the best cervical stenosis surgery for you.
Treatment for Lumbar Stenosis
Nonsurgical treatments are usually preferred if quality of life is largely unaffected by lumbar stenosis. Conservative treatments for lumbar stenosis include anti-inflammatory medications, spinal injections, weight management, posture management, stretching, physical therapy, and lifestyle modifications (such as using a cane or walker).
Surgical treatment may be recommended if nonsurgical treatment options have been unsuccessful or if your lumbar stenosis has significantly affected your quality of life. The most common lumbar stenosis surgery is laminectomy and decompression; other surgery options include laminotomy, lumbar disc replacement, interspinous process spacer insertion, and spinal fusion. Your symptoms, pathology, and options will be unique, and Dr. Pehler will carefully consider your situation before recommending the best lumbar stenosis surgery for you.
Recognizing the symptoms of spinal stenosis is an important part of diagnosing this condition and getting you on the path to treatment. If you are experiencing signs and symptoms of spinal stenosis, schedule a consultation with an orthopedic spine surgeon to get properly evaluated and begin treatment toward better health and preserving your quality of life.
Dr. Pehler is a board-certified, fellowship-trained, Denver-based Orthopedic Spine surgeon with extensive experience helping patients get an accurate diagnosis and treatment for spinal stenosis. Call 303-695-6060 or complete our online contact form to schedule your consultation with Dr. Pehler today.