Spinal Stenosis

Lumbar spinal stenosis

The most common symptom of lumbar spinal stenosis is leg pain that happens when you walk or stand and feels better when you sit. Other symptoms may include numbness, weakness and cramping in the back, legs, feet or buttocks. 

Cervical spinal stenosis

When the narrowing happens in your neck, it’s called cervical spinal stenosis. This condition typically causes stiffness, pain, numbness and weakness in the neck, shoulders, arms, hands or legs. Cervical spinal stenosis can even cause problems with your balance, coordination and bowel or bladder control. On the other hand, some people have no symptoms.

The most common cause of all types of spinal stenosis is changes in the spine that can happen as you get older. These changes include thickening of soft tissues, development of bony spurs and the slow breakdown of spinal discs and joints over time. Any of these conditions can narrow the spinal canal.

The doctor can diagnose spinal stenosis by asking about the history of your symptoms, doing a physical exam and using imaging tests. Your results of an MRI, CT scan and X-rays can help your doctor rule out other problems and confirm if you have stenosis.

Your care team will help identify the most effective treatment for you. The physicians and other providers at Parkview Neurosciences are committed to a comprehensive approach to treatment. This means that the care team will always offer non-surgical treatment first for spinal stenosis. Depending on how serious your symptoms, you may get effective relief from the following treatment therapies.

Medications

You might find that over-the-counter medications effectively manage symptoms. NSAIDS such as Ibuprofen or Naproxen (Tylenol) can be helpful for short term relief, particularly if your symptoms are mild. If NSAIDS are not effective, then stronger pain medications, a muscle relaxer or an anti-depressant may be prescribed. For some patients, corticosteroid injections in the affected area provide relief.

Physical therapy

The purpose of physical therapy is to decrease pain and allow you to gradually return to your normal activities. Physical therapy techniques may include:

• Stretching to reduce stress on joints
• Education to help you improve and maintain your posture
• Exercise to strengthen muscles
• Manual therapy, including massage, to improve or keep range of motion
• Heat therapy to improve blood circulation to the muscles and other soft tissues
• Ice therapy to help relieve pain
• Cycling and limited walking to promote good physical conditioning
• Aquatic exercises to allow your body to exercise without pressure on the spine

Your doctor or a physical therapist will design a program specific to your normal level of activity, physical fitness and severity of pain.

Surgical treatment

Lumbar Laminectomy

Decompressive laminectomy is the most common type of surgery done to treat lumbar (low back) spinal stenosis. This surgery is done to relieve pressure on the spinal nerve roots caused by age-related changes in the spine. It also is done to treat other conditions, such as injuries to the spine, herniated discs or tumors. In many cases, reducing pressure on the nerve roots can relieve pain and allow you to resume normal daily activities.

Laminectomy removes bone (parts of the vertebrae) and/or thickened tissue that is narrowing the spinal canal and squeezing the spinal nerve roots.
 

Anterior Cervical Discectomy and Posterior Cervical Laminectomy

Surgery for cervical stenosis removes any tissues that are pressing on the spinal cord. Tissues can include bone, ruptured discs and ligaments.

The surgery can be done from the back or the front of the neck. If surgery is done from the front, small pieces of bone or small plates and screws will be used to hold the spine in place after the tissue is removed. This process is called fusion. If surgery is done from the back, a fusion may or may not be done at the same time.

Your doctor will make an incision in the skin over the spine where the pressure on the spinal cord is focused. Your doctor will then remove any tissues that are putting pressure on the spinal cord through the incision.

Surgery is done to stop the pressure on the spinal cord. This may help with pain and numbness and may improve movement. It will also help prevent more damage. Some people notice that their symptoms improve very soon after surgery. But your neck and upper back may feel stiff and sore for several weeks after your surgery.
 

Lumbar Spinal Fusion

In some cases, a procedure called spinal fusion may be done along with a laminectomy to help stabilize sections of the spine. Spinal fusion is major surgery, usually lasting several hours. There are different methods of spinal fusion:

In the most common method, bone is taken from elsewhere in your body or obtained from a bone bank. This bone is used to make a "bridge" between adjacent spinal bones that form the vertebrae. This living bone graft stimulates the growth of new bone.

In some cases, an additional fusion method (called instrumented fusion) is done in which metal implants such as rods, plates or screws are secured to the vertebrae to hold them together until new bone grows between them.

There are a variety of specialized techniques that can be used in spinal fusion, although the basic procedure is the same. Techniques vary from what type of bone or metal implants are used to whether the surgery is done from the front (anterior) or back (posterior) of the body. The method chosen depends on several things, including your age and health condition, how many vertebrae are involved, the severity of nerve root pressure and associated symptoms. Spinal fusion may increase your recovery time after surgery.
 

Cervical Spinal Fusion

Spinal fusion may also be performed to treat cervical spinal stenosis. When done on the cervical area of the spine, spinal fusion joins together selected bones in the neck. The procedure may be performed with a few different approaches, just as it can for lumbar spinal fusion.
 

Life after spinal stenosis surgery

Following surgery for spinal stenosis, most people stay overnight in the hospital. You will probably be able to return to work or your normal routine in 4 to 6 weeks. In some cases, the doctor may recommend a rehabilitation program after surgery that incudes physical therapy and home exercises.

Call your physician about your spinal stenosis symptoms if:

• You have pain severe enough to restrict your daily activities or movement
• You have fallen, especially following surgery
• You have a fever