Believe it or not, you can have a lot of things happening in your body without you even realizing it. Spinal Stenosis is one of those things. By the time you feel it, something may have to be done to slow down or reverse the symptoms that have finally decided to show themselves.
In spinal stenosis, the space for the nerves or the spinal cord is narrowed, potentially causing irritation of the nerve elements. It is an ongoing disease, we all have some degree of stenosis, but it has progressed in some patients by the time they feel the average symptoms of exertion fatigue, intolerance to walking any distance, leg pain (usually described as aching) and numbness and weakness.
In terms of anatomic, or diagnostic evaluations, MRI’s or CT scans can measure the diameters of the canal spaces. A space less than 10 mm in diameter, or 100 mm sq in area is considered to be a spinal stenosis. While the anatomic definition has been standardized, many people may have spinal stenosis without any complaints related to the diagnosis.
Spinal stenosis can happen at any level of the spine. At the cervical and thoracic level it is especially worrisome as the openings for the nerves (foramina) and the spinal column are already narrow so any further bone buildup can cause compression on the nerves or the spinal cord. Initial symptoms can be numbness, tingling and weakness in the upper extremities. As compression on the cord increases, it could cause the same symptoms in the lower extremities. The most severe symptoms (and a good reason to go to the ER) would be paralysis, or loss of function in the bowel and bladder.
More common is lumbar spinal stenosis. This is also due to a build up of bone around the lumbar foramina and patients generally present with low back pain and severe leg pain, numbness and tingling. The biggest clue that it is stenosis, is that the patient feels better when they lean forward, as in pushing a shopping cart. Poor circulation and neuropathy are often confused with spinal stenosis.
Because spinal stenosis complaints are usually associated with activities, many times standard physical examinations by your general physician will not identify any specific nerve irritation findings.
Spinal stenosis is better defined by a clinical history, rather than specific physical examination findings. It takes a certain level of clinical suspicion to order diagnostic tests that will identify the anatomic findings discussed above. If there are concerns for spinal stenosis, an evaluation by a spine specialist such as a Neurologist, Physical Medicine and Rehabilitation Physician, or Spine Surgeon can help differentiate the potential causes for the symptoms.
Treatment of spinal stenosis can include: prevention (exercise and weight training to prevent osteoporosis), Epidural Steroid Injections (to calm down temporarily inflamed nerves) and decompressive surgeries (such as laminectomies or foraminotomies). The goal is to safely remove anything pressing on the nerves or spinal cord.
So if grocery shopping is the most comfortable thing you do all week, you may want to consider talking to your physician about this.
- Yen D, Albargi A. Results and limitations of outpatient and overnight stay laminectomies for lumbar spinal stenosis. Can J Surg. 2017 Aug 1;60(5):2017. PubMed PMID: 28742014
- Ka Man Ng K, Pui Yin Cheung J. Is minimally invasive surgery superior to open surgery for treatment of lumbar spinal stenosis? A systematic review. J Orthop Surg (Hong Kong). 2017 May-Aug;25(2):2309499017716254. PubMed PMID: 28656871