Spinal Stenosis

In this post I will be talking about a pain disorder called spinal stenosis.  This can occur either in the neck, known as cervical spinal stenosis, or in the low back, known as lumbar spinal stenosis.  I will be mainly focusing on lumbar spinal stenosis.

Spinal stenosis is a generic term that is used to describe a narrowing in the spinal canal.  Stenosis can occur either in the foramina, which are the holes that the spinal nerves come out of, or centrally, in the area where the spinal cord and fluid lies.  I am not going to focus on foraminal stenosis in this blog post because it was already covered in my post on radiculopathy.

In the lumbar region, central spinal stenosis most often arises as a result of degenerative changes in the spine, which cause thickening in the joints and the soft tissues that then reduce the amount of space in the spinal canal.  Some people are more predisposed to this than others because they are born with slightly smaller canals at baseline. In the neck, these same changes can cause spinal stenosis, but sometimes a disc herniation is enough to cause central spinal stenosis because there is so much less room in this area.

Patients with lumbar spinal stenosis most often feel leg pain or “heaviness”, particularly when they walk. The pain tends to get better after a short period of rest, and then it starts up again with movement. Patients can report a “shopping cart sign”, which is when they feel better bending over something while walking (like a shopping cart!).  This motion opens up the space in the spine, so it isn’t surprising that it helps. The pain can be associated with numbness and tingling in the legs. Cervical spinal stenosis can present less specifically, but usually involves symptoms in the arms such as numbness, tingling and pain.

To make the diagnosis, after a good interview and examination, the pain doctor will normally order an MRI of the spine. Treatment options include pain medications, mainly ones that work on nerve pain, physical therapy to strengthen the back/condition the patient, and epidural steroid injections to reduce any inflammation from the compression.  If the stenosis is very severe, I will refer patients to a spine surgeon to see if they are a candidate for surgery to relieve the compression.

I hope that helps to explain spinal stenosis! Remember, the best way to be evaluated for this condition is to see a pain management doctor in person. And don’t forget to subscribe to my blog here so you never miss a new post.