�Diseases, Conditions and Injuries

Spinal Stenosis

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Definition

Spinal stenosis is a narrowing of the space called the spinal canal, which is located within the backbone. The spinal canal is a small space that holds the nerve roots and spinal cord. If for any reason this space becomes smaller, it can squeeze the nerves and the spinal cord, causing pain and other symptoms. Stenosis can occur anywhere along the spinal cord but is more common in the lumbar region.

Spinal Stenosis

Causes

Some people are born with narrowed canals, but most often stenosis is a result of aging. Conditions that can cause spinal stenosis include:

Osteoarthritis and osteophytes (bony spurs) associated with aging
Rheumatoid arthritis
Spinal tumors
Trauma
Paget's disease of the bone
Previous surgery

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Being born with a narrow spinal canal
Age: 50 or older
Previous injury or surgery of the spine

Symptoms

Symptoms include:

Numbness, weakness, cramping, or pain in the legs and thighs
Radiating pain down the leg
Abnormal bowel and/or bladder function
Decreased sensation in the feet causing difficulty placing the feet when walking
Loss of sexual function
Partial or complete paralysis of legs

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

X-ray � to check for abnormalities in the bones of the back including osteoarthritis, bone spurs, and obvious narrowing of the spinal canal.

CT Scan � a type of x-ray that uses a computer to make pictures of the bony architecture of the back. This helps to evaluate the spinal canal.

MRI Scan � a test that uses magnetic waves to make pictures of soft tissues such as the spinal cord and the spinal nerves inside the back

Treatment

Treatments include:

Medication

Nonsteroidal anti-inflammatory drugs (NSAIDs) � to relieve pain and inflammation
Analgesics � to relieve pain
Corticosteroid injections � to reduce pain and inflammation (not often used)

Physical Therapy

Special exercises can help stabilize the spinal cord by increasing muscle endurance and mobility of the spine. Exercises are, however, often ineffective in spinal stenosis.

Support Devices

Wearing a corset or lumbar brace can help stabilize the spine and alleviate pain.

Surgery

Surgery is reserved for severe cases.

Decompression laminectomy � removal of a build-up of bony spurs or increased bone mass in the spinal canal. This can free up space for the nerves and the spinal cord.
Spinal fusion � fusing together two vertebrae to provide stronger support for the spine; this is almost always done after decompression laminectomy.

Prevention

There are no guidelines for preventing spinal stenosis.

RESOURCES:

American Academy of Orthopaedic Surgeons
http://www.aaos.org

Arthritis Foundation
http://www.arthritis.org

REFERENCES:

Arthritis Foundation

American Academy of Family Physicians

The Merck Manual of Medical Information, Home Edition. Merck Research Laboratories; 1999.

National Institute of Arthritis and Musculoskeletal and Skin Diseases

Last reviewed September 2005 by David Horn, MD, FACP

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