Spinal Stenosis

What is spinal stenosis?

Spinal stenosis is a condition characterized by the narrowing of the spinal canal, which houses the spinal cord and nerve roots. This narrowing can put pressure on the spinal cord or nerve roots, leading to symptoms such as pain, numbness, tingling and weakness in the affected areas.

Spinal stenosis can occur in different regions of the spine, which are the cervical (neck), thoracic (mid-back) and lumbar (lower back). In the cervical spine, spinal stenosis can cause symptoms such as neck pain, arm pain, weakness and numbness or tingling in the arms and hands. In severe cases, it can lead to difficulty walking, balance problems and even bowel or bladder dysfunction.

What types of spinal stenosis are there?

• Cervical spinal stenosis: Narrowing of the spinal canal in the neck region.
• Thoracic spinal stenosis: Narrowing of the spinal canal in the mid-back region.
• Lumbar spinal stenosis: Narrowing of the spinal canal in the lower back region.

Lumbar spinal stenosis is the most common type and typically leads to symptoms such as lower back pain. You may also experience pain in the buttocks, leg pain (sciatica) and difficulty walking or standing for extended periods.

What causes spinal stenosis?

Spinal stenosis can be the result of a variety of causes, such as:

• Degenerative changes: Wear and tear on the spine, such as osteoarthritis or degenerative disc disease, can lead to the development of bone spurs and thickened ligaments, narrowing the spinal canal.
• Herniated discs: Discs between vertebrae may bulge or herniate, protruding into the spinal canal and causing compression on the spinal cord or nerve roots.
• Congenital conditions: Some individuals may be born with a narrower spinal canal, increasing the risk of spinal stenosis. Other inherited conditions can include scoliosis or achondroplasia.
• Trauma or injury: Accidents or injuries to the spine can result in fractures or dislocations, which may compress the spinal cord or nerve roots.
• Tumors: In rare cases, abnormal growths within the spinal canal, whether benign or malignant, can cause compression on the spinal cord or nerve roots.

What are the symptoms of spinal stenosis?

The most common symptoms of spinal stenosis are:

• Pain or discomfort in the affected area of the spine (neck, mid-back or lower back)
• Numbness or tingling sensation in the arms, hands, legs or feet
• Weakness in the muscles of the arms or legs
• Difficulty walking or maintaining balance
• Radiating pain or discomfort along the nerves affected by the stenosis (arm in the cervical spine or legs in the lumbar spine)
• Bowel or bladder dysfunction

How is spinal stenosis diagnosed?

Spinal stenosis is typically diagnosed through a combination of medical history, physical examination and imaging tests. At Ohio State, you can expect our team to do:

• Medical history: Your doctor will discuss your medical history as well as assess the severity of your symptoms.
• Physical exam: Your doctor will conduct a physical exam to evaluate your spine's range of motion, your muscle strength, reflexes and sensation.
• Imaging tests: Our team will then order medical imaging tests to help see the full picture.
  • X-rays: These can reveal changes in the bones and alignment of the spine, such as bone spurs or narrowing of the spinal canal.
  • MRI (magnetic resonance imaging): This provides detailed images of the spine, including soft tissues like discs, ligaments and nerves, allowing the doctor to visualize any compression or narrowing of the spinal canal.
  • CT scan (computed tomography): Sometimes used to provide additional detail, especially if MRI is not feasible or inconclusive.
  • Myelogram: In some cases, a contrast dye is injected into the spinal canal before imaging to highlight any abnormalities more clearly.
• Electrodiagnostic tests: In some cases, nerve conduction studies and electromyography (EMG) may be performed to assess nerve function and identify any nerve damage.

By combining the information from these tests, our team can accurately diagnose spinal stenosis and develop an appropriate treatment plan.

How is spinal stenosis treated?

At the Ohio State Wexner Medical Center, we provide guidance and support to help patients like you make lifestyle changes that promote spine health and overall well-being. We’re dedicated to finding the right nonsurgical or, if need be, surgical option that’s right for you.

Nonsurgical treatments for spinal stenosis focus on relieving symptoms, improving function and enhancing your quality of life. In fact, most cases of spinal stenosis can be effectively managed without surgery.

Some conservative (nonsurgical) approaches can include:

• Medications: Over-the-counter medications like acetaminophen (Tylenol®) and ibuprofen (Advil® or Motrin®) can help. In some cases, we may prescribe medications such as muscle relaxants or nerve pain medications.
• Physical therapy: Targeted exercises and stretches can help strengthen muscles, improve flexibility and reduce pressure on the spine. Our physical therapists can design personalized exercise programs to address your individual needs.
• Steroid injections: Corticosteroid injections into the affected area of the spine can help reduce inflammation and provide temporary pain relief.
• Lifestyle changes: Maintaining a healthy weight, practicing good posture and avoiding activities that exacerbate symptoms can help manage spinal stenosis.

What surgical options are there for spinal stenosis?

Surgical treatment options for spinal stenosis aim to relieve pressure on the spinal cord or nerves and alleviate your symptoms. The specific surgery depends on factors such as the location and severity of the stenosis, if you have other spinal conditions and your overall health.

Common spinal stenosis surgical procedures include:

• Minimally invasive lumbar decompression (MILD): If you’re spinal stenosis is specifically due to thickened ligaments, you may consider this minimally invasive procedure. MILD is similar to an epidural steroid injection, but your doctor resects small amounts of the thickened ligament to see if this can be enough to improve your symptoms.
• Interspinous spacers: A minimally invasive procedure for those with a moderate degree of spinal stenosis. Your doctor implants a small metallic spacer between the bones of the spine (vertebrae) to prevent compression of the spinal canal. If you have osteoporosis or severe spinal stenosis, you won’t be a candidate for this procedure.
• Laminectomy: This procedure involves removing a portion of the lamina (the bony arch of the vertebra) to widen the spinal canal and create more space for the spinal cord or nerves.
• Laminotomy: Similar to a laminectomy but involves removing only a portion of the lamina, typically to decompress a specific nerve root.
• Spinal fusion: In cases where there is instability of the spine or significant degeneration, spinal fusion may be performed to stabilize the spine by fusing two or more vertebrae together using bone grafts and hardware.
• Foraminotomy: This procedure involves widening the neural foramen, the openings through which nerve roots exit the spinal canal, to relieve pressure on compressed nerves.
• Discectomy: In cases where a herniated disc is causing spinal stenosis by compressing nerves, a discectomy may be performed to remove the portion of the disc that is pressing on the nerves.

What is the recovery time for spinal stenosis surgery?

The recovery process after spinal stenosis surgery varies depending on the type of procedure performed, as well as your overall health. Generally, patients can expect to stay in the hospital for a few days after surgery for monitoring and pain management.

Physical therapy may be started shortly after surgery to help regain strength, flexibility and mobility, with full recovery typically taking several weeks to months. If you have surgery, be sure to follow your surgeon’s postoperative instructions carefully, including restrictions on activities and proper wound care, to achieve the best possible outcome.