Spinal Stenosis Pain
Spinal stenosis is a health condition that has a high prevalence rate the world over.
In the United States, approximately 250,000–500,000 exhibit symptoms of spinal stenosis annually. It is estimated that this condition will increase by about 18 million in the next decade in the United States alone.1
Spinal stenosis is primarily age-related and is caused by the natural wear and tear of the body as well as conditions such as osteoarthritis. With the onset of spinal stenosis, a narrowing of the spaces in the spine is known to occur, which in turn increases the pressure on the nerves that pass through the spine. This condition, where the nerves get pinched and compressed, causes severe to excruciating pain in the lower back (lumbar) and neck (cervical) region.
Lumbar spinal stenosis can cause pseudoclaudication, or neurological claudication. Pseudoclaudication is pain and weakness in the lower extremities caused by pinched nerves.
What is spinal stenosis, and how does it cause pain?
The narrowing of the spaces in the spine puts extreme pressure not only on the spinal cord but also on the nerve roots that exit each point in the vertebrae. Spinal Stenosis pain often manifests as a feeling of numbness, weakness, a tingling sensation, or the loss of control over bladder/bowel functions. The pain experienced as a side effect of spinal stenosis can range from mild to excruciatingly severe. In some cases, it has also been reported that some people do not feel any pain at all, but only weakness.
Depending on where the pain of spinal stenosis is manifested, there are two main classifications of spinal stenosis. They are:
- Lumbar Canal Stenosis — The narrowing of the spinal column occurs in the lower back or lumbar region.
- Cervical Spinal Stenosis — The narrowing of the spinal column occurs in the spinal column in the neck or cervix.
What are the causes of spinal stenosis?
Let us first understand the structure of the spine.
The spine or the backbone of the body connects the basic framework of the body from the cervical or the neck to the lumbar or lower back region. The spine is comprised of bones that form a canal-like structure called the spinal canal, which protects the nerves or cords that run through the spinal canal.
In rare cases, people have been known to be born with a small spinal canal. This is known to be a congenital defect and termed congenital stenosis. This is an inherited condition and is known in medical terminology as short pedicle syndrome. In most cases, spinal stenosis is a condition that is a result of aging or injury.
Based on this, the causes of spinal stenosis and the associated pain can be classified as the following:
- Primary — Primary spinal stenosis is a congenital condition known as congenital stenosis or short pedicle syndrome.
- Acquired — Acquired spinal stenosis develops as a result of the natural process of wear and tear that can cause the onset of degenerative disc disease or osteoarthritis. It can also be caused by an injury or an accident. Its prevalence is higher among people above the age of 50; however, it can occur at any age depending on the underlying cause.
Following are some of the most common causes of spinal stenosis:
- Osteoarthritis or Degenerative Disc Disease — This condition causes wear and tear of the spinal structure along with depleting and drying out the supporting parts such as the cartilage. It can also aggravate and develop growths or bone spurs, which grow into the spinal column, compressing the nerves in the spine.
- Bone Diseases — One of the reasons for the overgrowing of the bone into the spinal column can also be Paget’s disease, a chronic autoimmune inflammatory condition that affects bone re-absorption. This causes the bones to become fragile and increases the chances of overgrowths.
- Injuries/Accidents — Any trauma that is caused to the spinal column can, in turn, manifest as bone dislocations or fractures, which may cause moderate to severe damage to the spinal column.
- Tumors — The growth of tumors inside the spinal structure can also compress the nerves in the region and result in spinal stenosis.
- Herniated Discs — The spinal disc may undergo some changes either as cracks in its exterior or with the flattening/drying of the cartilage that cushions the vertebrae. In both cases, the nerves can get compressed, causing pain.
- Bulging Ligaments — The bones of the spinal canal are held together by cords, which can thicken over time and bulge into the spinal canal.
- Post-Operative Side Effects — The inflammation that can occur post back surgeries can put pressure on the spinal cord or on the nerves.
What are the symptoms of spinal stenosis?
The characteristic narrowing of the spinal canal, which causes the condition known as spinal stenosis is a slowly progressing process. The symptoms of the condition may not manifest at the onset and even when they do, they may vary based on the individual and the region where spinal stenosis occurs.
The most common areas that spinal stenosis can occur are the lumbar and the cervical regions.
Spinal stenosis of the lumbar or the lower back region may manifest as any of the following symptoms:
- Dull, aching pain, or tenderness can be felt in the lower back (axial pain).
- Sensation of the pain can range from mild to moderate or even be experienced as a burning one.
- A painful sensation can begin in the buttocks and extend to the feet. This pain is also known as sciatica, or radicular pain.
- A feeling of weakness, heaviness, numbness, or tingling in the lower limbs can come and go (pseudoclaudication).
- Increase in pain while walking or standing for a longer duration.
- Decrease in pain while sitting or when in a slightly bent position.
Cervical spinal stenosis may manifest as any of the following symptoms:
What are the risk factors that increase the chances of spinal stenosis incidence?
Spinal stenosis affects those above the ages of 50 or those with a congenital predisposition to the disease. In some cases, trauma, injury or accidents can expedite the onset of the wear and tear and cause spinal stenosis. Apart from age and genetics, there are several lifestyle-related factors that can also expedite the condition. They include:
- Sedentary lifestyle with zero or low levels of activity
- Improper nutrition
- Poor posture
What are the complications that can arise due to spinal stenosis?
Spinal stenosis, in its more severe form, can show up as neurological deficits such as cauda equina syndrome (occurs in the case of lumbar spinal stenosis), radiculopathy or myelopathy. Chronic pain and motor weakness could develop when lumbar and cervical spinal stenosis are not treated at the onset. Dexterity, gait, balance, and grip strength may be initially affected and then lead on to other more severe symptoms.
When the nerves or the spinal cord are compressed for a long time and timely medical intervention is not sought, complications such as myelopathy and the loss of control over bladder/bowel function can lead to potentially dangerous consequences. Though rare, permanent numbness or paralysis and even death can occur if the severe symptoms are ignored and not treated.
When should I see a doctor?
If you are developing any of the following symptoms, then you will know that your condition of spinal stenosis has already progressed into a more severe category, requiring medical assistance:
- Problems with gait and balance
- Bladder or bowel dysfunction
- Numbness in the limbs
- Weakness in the limbs
- Need to relieve the pressure on the lower back
- Trouble walking or climbing
- Severe pain in limbs
In case there is the onset of the cauda equina syndrome, which occurs in the lumbar region, your condition could qualify as a medical or surgical emergency, requiring emergency surgery.
How is spinal stenosis diagnosed?
When you approach a spine specialist or pain management specialist at Advanced Pain Care, they will diagnose your condition after a 3-step evaluation process:
- Medical history including symptoms and genetic predispositions
- Physical examination to observe the range of motion of the spine and limbs, the path of the pain, reflexes, the different sensations of numbness and tingling, rotation of the neck, etc.
- Medical imaging such as X-rays, MRIs and CT Myelograms may be conducted. While X-rays are useful to detect bone spurs and overgrowths, MRIs are used to detect the exact location of nerve compression and the presence of tumors. CT Myelograms can detect bone spurs, tumors, and herniated discs.
How is spinal stenosis treated?
The treatment plan proposed by your physician or pain management specialist will depend on the location of the pain as well as the severity of the symptoms. The treatment plan could include the following:
As a first line of treatment, the main goal of your pain management specialist at Advanced Pain care will be to reduce the pain and give you a better quality of life.
This could be done by:
- Self-care remedies such as light exercises, application of cold packs and ice, and application of heat
- Over-the-counter pain relievers such as non-steroidal anti-inflammatory medications, muscle relaxants, and prescription medication for the pain and swelling
2. Physical Therapy
Or a physical therapy plan with a trained therapist which includes:
- Physical therapy to strengthen the core, spine, back and the related muscles to increase flexibility and stability
- Exercises to improve gait
3. Non-Surgical Intervention
Non-surgical intervention can be done in the form of:
- Corticosteroid injections in the region where the nerves are compressed to reduce the swelling and pain. This is called an epidural steroid injection or ESI.
4. Surgical Intervention
Surgical intervention could vary from simple outpatient procedures to more complex forms of spinal surgery.
The procedure of percutaneous image-guided lumbar decompression is performed as an outpatient one to remove a part of a thickened ligament and reduce the pressure on the nerves. As a procedure requiring no stitches, there is absolutely no disruption to the body structure, making recovery almost immediate. You can go home in a matter of hours and begin physical therapy as soon as your spine surgeon recommends it.
When is surgery required?
While the onset of the cauda equina syndrome qualifies as an immediate surgical emergency, if there is steady progression in your symptoms, your physician may recommend surgery.
The most effective way of treating spinal stenosis via surgery is to relieve the pressure on the nerves or the spinal cord. Some of the most effective surgical procedures include:
- Laminotomy — a portion of the vertebrae or lamina is removed to relieve the pressure.
- Laminectomy — a portion of the back part of the affected vertebrae or lamina is removed to relieve the pressure. Your surgeon may also need to perform spinal fusion to maintain the strength and stability of the spine.
- Laminoplasty — This is done on the vertebrae in the cervix to create space in the spinal canal and relieve the pressure on the nerves.
- Interspinous Process Spacers — A minimally-invasive procedure, spacers are inserted between the bones in the vertebrae to create more space in the spinal canal. This procedure is performed under local anesthesia. This procedure is also called Vertiflex.
What happens after spinal surgery?
Before the surgery is scheduled, your spinal surgeon will ask you to begin preparing for it. This could include beginning a regular schedule of exercise and following a healthy diet to expedite post-operative recovery as well as stopping smoking and alcohol consumption.
Post-operative do’s and don’ts:
- If you have had a percutaneous image-guided lumbar decompression, you will be sent home in a few hours and will require regular follow-up visits as well as physical therapy.
- In case of a laminectomy, you will be discharged after a maximum of 48 hours; however, in case of a spinal fusion, the stay could extend to 5 days.
- Depending on your overall health condition as well as how well you have recovered, you may be asked to go into a rehabilitation facility to recuperate completely.
- You may be asked to wear a neck or a back brace and given medications for the pain and inflammation.
- You will be asked to start light exercises and self-care remedies.
- Regular follow-up visits along with evaluation tests will be scheduled.
Your recovery after surgery depends on the surgery you have had and how well you have progressed in your physical therapy. As a rule of thumb, complete recovery and return to normal activities could take a maximum of 3 months. In case a spinal fusion procedure has also been performed, your return to work could take a few weeks. For all other procedures, the time taken to recuperate at home is much less.
What are the risks of surgery?
As is the case with all surgeries, there are some risks associated with spinal procedures. They could include:
- Tear in the membranes near the spinal canal
- Persistent pain
- Nerve injury or deterioration
- Blood clots
- Problems with the implants
- Failure of the bone to heal
- Reaction to anesthesia
- No relief of the symptoms
Before you schedule the surgery, ask your surgeon the following questions to prevent any possible post-surgery risks:
- What are symptoms or the red flags that may indicate that something is wrong?
- Are there any potential risks or complications associated with my procedure?
What precautions can I take to avoid the severe onset of spinal stenosis?
The onset of spinal stenosis cannot be completely prevented especially if it is caused by the natural process of aging. Ensuring good spinal health can help reduce the symptoms and the progression of the condition. The following steps can help you to improve your spinal health:
Additionally, depending on whether you have lumbar or cervical spinal stenosis, wearing a brace and making simple changes in your posture while sitting, walking, and exercising can be helpful.
Q: Where is the pain with spinal stenosis?
A: The most common regions where pain is experienced with spinal stenosis is the spine and extremities.
Q: What is the best treatment for spinal stenosis?
A: There is no complete cure for spinal stenosis and once it begins, it cannot be reversed. Your physicians can help you manage the pain and other symptoms. They can also use surgical and non-surgical interventions to help in the more severe cases of spinal stenosis.
Q: Is spinal stenosis a permanent disability?
A: Though rare, permanent numbness or paralysis and even death can occur if the severe symptoms such as weakness, numbness, tingling, and the loss of control over bladder/bowel function are ignored and not treated.
Q: What happens if spinal stenosis is left untreated?
A: When the nerves or the spinal cord are compressed for a long time and timely medical intervention is not sought, complications such as nerve damage and the loss of control over bladder/bowel function can lead to potentially dangerous consequences.
Q: Can spinal stenosis be reversed or completely cured?
A: There is no complete cure for spinal stenosis, and once it begins, it cannot be reversed. Your physicians can help you manage the pain and other symptoms. They can also use surgical and non-surgical interventions to assist in the more severe cases of spinal stenosis. Following basic preventive measures can help slow down the progress. These include:
- Being moderately active and exercising regularly.
- Maintaining good posture.
- Avoiding all intoxicants, including smoking and alcohol.
- Taking a balanced diet.
Q: Can spinal stenosis heal on its own?
A: Spinal stenosis caused by genetic defects or age-related wear and tear cannot heal on its own. However, rest, self-care therapies, physical therapy, and basic medications can help reduce the pain and other symptoms.
Q: Can spinal stenosis occur in more than one area of the spine simultaneously?
A: Yes. At times, spinal stenosis may manifest itself in both the lumbar and cervical regions. This condition is known as tandem stenosis.
Q: What other medical problems are like spinal stenosis and often confused with each other?
A: There are some medical conditions such as neuropathy, ankylosing spondylitis and peripheral artery disease that can be mistaken for spinal stenosis.a