Patient education: Spinal stenosis (The Basics)

What is spinal stenosis? — Spinal stenosis is a back condition that can cause pain, numbness, or tingling in the back or down the legs.

To understand more about spinal stenosis and how it causes symptoms, it's helpful to first know a little about the back and spine.

The back is made up of (figure 1):

●Vertebrae – A stack of bones that sit on top of one another like a stack of coins. Each of these bones has a hole in the center. When stacked, the bones form a hollow tube (called the spinal canal) that protects the spinal cord.

●Spinal cord and nerves – The spinal cord is the highway of nerves that connects the brain to the rest of the body. It runs through the vertebrae. Nerves branch from the spinal cord and pass in between the vertebrae. From there they connect to the arms, the legs, and the organs. (This is why problems in the back can cause leg pain or bladder problems.)

●Discs – Rubbery discs sit in between each of the vertebrae to add cushion and allow movement.

●Muscles, tendons, and ligaments – Together the muscles, tendons, and ligaments are called the "soft tissues" of the back. These soft tissues support the back and help hold the different parts together.

Spinal stenosis is a narrowing of the spinal canal or of the spaces between the vertebrae where spinal nerves pass through. This narrowing is usually caused by arthritis or injury, and can cause symptoms for different reasons.

●The vertebrae can form "bone spurs." These are bony growths that pinch the spinal cord or the nerves branching from the spinal cord.

●The discs can shrink and make the space between the vertebrae smaller. This can cause the vertebrae to pinch the nerves that pass through them.

This article will only discuss spinal stenosis in the lower back. This is called "lumbar spinal stenosis." Other parts of the back can have spinal stenosis, too.

What are the symptoms of a spinal stenosis in the lower back? — Spinal stenosis does not always cause symptoms. When it does, the most common symptoms are back pain and tingling or numbness that spreads down the legs. These symptoms usually affect both legs, but the symptoms can be worse in 1 leg than the other. Severe spinal stenosis can cause leg weakness or trouble controlling your bowels or bladder.

Symptoms of spinal stenosis are usually worse when the person is walking or standing upright. Usually, the symptoms get better if the person sits down or bends forward at the waist, for example, while leaning over a shopping cart.

Is there a test for spinal stenosis? — Yes. Imaging tests, such as an X-ray, MRI, or CT scan, can show what's going on inside the back. These tests can show if a person has bone spurs or other changes that happen with spinal stenosis.

In some cases, doctors also order tests called "electromyography" or "nerve conduction studies." These tests measure how well electrical signals travel across the nerves that start in the spine. They can also show how well electrical signals travel from the spine to muscles.

Should I see a doctor or nurse? — See your doctor or nurse right away if you have:

●Back or leg pain that is so severe that you cannot find a comfortable position

●Back or leg pain, plus a new problem controlling your bowels or bladder

●Back or leg pain, plus new numbness or weakness in the legs

●A problem called "foot drop," which is when you have trouble holding your foot up, for example, while walking

●Back or leg pain along with a fever or other symptoms that worry you

How is spinal stenosis treated? — A small number of people end up needing surgery to treat a spinal stenosis. But most people do well with simpler treatments, such as:

●Pain medicines that you can get without a prescription – If these do not work, doctors and nurses can prescribe stronger pain medicines.

●Medicines to relax the muscles (called muscle relaxants)

●Injections of medicines that numb the back or reduce inflammation

●Physical therapy to teach you special exercises and stretches to improve your strength and flexibility

●Spinal manipulation, which is when someone like a physical therapist or a chiropractor moves or "adjusts" the joints of your back

●Acupuncture, which is when someone who knows traditional Chinese medicine inserts tiny needles into your body to block pain signals

●Massage

How do I know if surgery is right for me? — Your doctor will tell you if surgery is likely to help you. The 2 of you can decide together if surgery is right for you. The surgery can help with symptoms, but it is not usually necessary. People can often find ways to cope with their symptoms that do not involve surgery.

Surgery to treat a spinal stenosis involves exposing the spine and cutting away pieces of bone that are pinching the spinal cord or other nerves. In some cases, surgeons treating people with spinal stenosis will also decide to join together 2 vertebrae. This is called spinal fusion. Fusion is usually appropriate only for people who have spinal stenosis plus another condition called "spondylolisthesis," which is when 2 vertebrae no longer line up with each other. Spinal fusion can involve more risk and a longer recovery time than regular surgery.

If your doctor suggests surgery to treat a spinal stenosis, ask:

●How likely is that surgery will help my symptoms?

●How quickly will I recover from surgery?

●What are the risks of surgery?

●What happens I do not have surgery?

Is there anything I can do on my own to feel better? — Yes. One of the most important things you can do to feel better is to stay as active as possible. Even if you have some pain or discomfort, you should not stay in bed or rest too long.

People used to think that bedrest was the best treatment for a bad back. The truth is, bedrest can actually make back problems worse. That's because the back can get weak and stiff with too much rest.

Find physical activities you like to do. If you have not been active for a while, start by doing just a few minutes of activity a few times a week. Then slowly do more. Also, ask your doctor if there are any activities, such as bending or lifting, that you shouldn't do.

More on this topic

Patient education: Low back pain in adults (The Basics)
Patient education: Cauda equina syndrome (The Basics)
Patient education: Do I need an X-ray (or other test) for low back pain? (The Basics)

Patient education: Low back pain in adults (Beyond the Basics)