Spinal Stenosis

Stenosis, which means “narrowing” or “choking”, can occur anywhere along the spine. The two main types are cervical stenosis (stenosis in the neck region of the spine) and lumbar stenosis (stenosis in the lower back region of the spine).

Symptoms of cervical spinal stenosis can include:

• Pain, numbness, weakness, or tingling in the shoulders, arms, hands, fingers
• Problems with coordination, motor function, balance, reflexes, dexterity
• Pain may be dull or sharp
• Stiffness in the neck
• Headaches
• Often, minimal or no pain in the neck
• Incontinence
• Symptoms that go through cycles of remaining stable and flaring up
• Symptoms may worsen or alleviate during certain activities
• Cervical myelopathy (severe cases)

Symptoms of lumbar spinal stenosis can include:

• Pain (often severe) in the lower back, buttocks, and/or legs
• Tingling, weakness, numbness, or cramping in the legs
• Pain that inhibits daily activities
• Problems with balance and coordination
• Incontinence
• Symptoms that go through cycles of remaining stable and flaring up
• Symptoms may worsen or alleviate during certain activities or while sitting, lying down, and leaning forward
• “Shopping cart sign” (leaning over to alleviate intense pain)

Treatment for spinal stenosis begins with a detailed assessment of how far the condition has progressed and the severity of symptoms. For patients diagnosed with lumbar stenosis, conservative nonsurgical treatments will usually be recommended first. If conservative treatments are ineffective, symptoms are debilitating, and/or the degree of nerve compression is severe, surgery may be advised. For patients diagnosed with cervical stenosis, conservative treatments may provide some symptom relief, but surgery is often the only effective treatment to prevent permanent nerve damage.

• Physical Therapy (PT): PT is often recommended to improve mobility and alleviate symptoms of spinal stenosis.
• Anti-Inflammatory Medication: Non-steroidal anti-inflammatory medications can decrease inflammation and pain from lumbar stenosis and cervical stenosis. Patients undergoing physical therapy may benefit from taking anti-inflammatory medications (over-the-counter or prescription strength) to reduce pain while they work to improve mobility.
• Injections: Patients who need temporary pain relief or who cannot undergo surgery at this time may benefit from spinal injections to relieve their symptoms.
• Lifestyle Modifications: Weight management, posture management, and using an assistive device such as a walker or cane may help patients manage their symptoms and improve mobility.
• Stenosis Surgery (Spinal Decompression): Spinal decompression surgery can remove excess bone and arthritic debris as well as align and decompress the joints of the spine. This relieves pressure on the spinal cord, alleviating symptoms and preventing long-term damage.
• Disc Replacement Surgery: Where appropriate, disc replacement surgery can replace a degenerative disc with an artificial disc. This technique preserves full mobility of the spine and can alleviate symptoms.
• Minimally Invasive Spinal Fusion: Minimally invasive spinal fusion surgery can relieve compression in the spine by permanently fusing together two or more spinal vertebrae. This restricts some mobility of the spine but can alleviate symptoms.