Age-related changes to your spine may lead to compression of the nerves in the back, a condition called spinal stenosis. It can cause numbness, tingling, or pain in your back, legs, or neck.
Spinal stenosis is diagnosed most frequently in people 60 and older. It is more likely to occur within the lower (lumbar) or upper (cervical) portions of the spine, although it can also occur within the central (thoracic) part of the spine.
Spinal stenosis is treated based on the symptoms it causes. A variety of non-surgical and surgical solutions can provide relief. Most people with mild or moderate spinal stenosis may find relief from their symptoms after doing a course of exercises and/or physical therapy.
What is spinal stenosis?
Spinal stenosis is a condition that arises when the spinal cord and/or nerves become compressed within the spinal canal. This may cause pain, numbness, or weakness in the extremities that are affected by the compressed nerves.
Each vertebra (the name for each bone that, stacked up, makes up the spine) contains a section that has what’s called a “canal.” When aligned, top to bottom, these canals form the spinal canal, the column that houses the spinal cord. The average person has enough room within their spinal canal to comfortably house the spinal cord/nerves. However, age often brings changes to the spine, resulting in encroachment upon the space designated for the spinal cord/nerves.
When changes in the spine put pressure on the spinal cord and/or nerves, a person may feel pain, numbness, muscle weakness, or other symptoms. In severe cases, they may have trouble maintaining their balance, difficulty with walking, and possibly even difficulty controlling their bladder or bowel function.
What causes spinal stenosis?
The most common cause of spinal stenosis is a buildup of the bones and ligaments of the spine. Age-related changes to the spine may happen gradually. These small changes may develop into a noticeable problem over time.
A number of age-related changes may affect the spine, including:
- Bone spurs
- Thickening of the ligament within the spinal canal
- Calcium deposits forming on the ligament within the spinal canal
- Thickening of the joints within the spinal column
- Herniated disks
- Spondylolisthesis (in which one of the vertebra slips forward)
Some people experience spinal stenosis because of a congenital (present at birth) condition, such as:
- A narrow, small spinal canal
- Achondroplasia dwarfism
What are the symptoms of spinal stenosis?
Typically, symptoms of spinal stenosis develop over time. Discomfort may be felt on one or both sides of the body.
When spinal stenosis affects the lower spine, symptoms may include:
- Lower back pain
- Pain that radiates from the buttocks down the legs
- Lower back or leg pain that worsens while standing and improves while leaning forward or sitting
- Tingling, numbness, weakness, or muscle cramps in the buttocks, legs, or feet
- Leg discomfort or numbness that worsens while walking or standing
- Poor balance while walking
- Bladder dysfunction
- Bowel dysfunction
- Sexual dysfunction
When spinal stenosis affects the upper spine within the neck, symptoms may include:
- Neck pain
- Neck spasms
- Pain that radiates from the upper arms down to the hands
- Tingling, numbness, weakness, or cramps in the arms or hands
- Issues doing fine motor skills or balance-related activities
What are the risk factors for spinal stenosis?
People who are more likely to develop spinal stenosis include those who:
- Are older, particularly aged 60 or older
- Are born with a narrower-than-average spinal canal
- Experience an injury to the spine
- Have osteoarthritis
- Have rheumatoid arthritis
- Experience swelling or inflammation of the spine
- Develop tumors on the spine
- Have Paget’s disease
- Previously had neck or back surgery
- Have a history of lower back pain
How is spinal stenosis diagnosed?
Your doctor can diagnose spinal stenosis by learning more about your medical history, performing a physical exam, and offering diagnostic tests.
During the medical history part of the visit, you should tell your doctor about any symptoms and the type of discomfort you have, how long symptoms have been present, what activities they impact, and what makes them better or worse. You should also discuss relevant health conditions, including herniated disks, arthritis, or previous injuries to your spine or back.
During a physical exam, you may be asked to move around so that your doctor can assess your range of motion. You may be asked to walk normally, then walk on your heels and toes. You may also be asked to bend forward from a standing position to see if that helps to alleviate any pain or other symptoms. Your doctor will also perform a neurological exam, checking your reflexes, sense of balance, muscle strength, nerve sensation, and more.
The following tests may be used to diagnose spinal stenosis:
- X-rays, which may identify the presence of bone spurs, calcifications, or slipped vertebrae, as well as scoliosis or other conditions
- MRI, which evaluates the space available for the spinal cord and/or nerves, and gives information about the soft tissues of the spine, including nerves, ligaments, and disks
- CT scan, which provides three-dimensional scans of the anatomy of the bones, spurs, and arthritis of the spine.
- Electromyography with a nerve conduction velocity test, which may identify whether there are abnormalities in the nerves or muscles of the legs or other affected body parts
- Blood tests, which may be used to rule out other conditions
How is spinal stenosis treated?
A variety of treatments are available to manage spinal stenosis. The type of treatment depends on the severity of your symptoms and how much of a negative impact the symptoms have on your life.
Treatments may include:
- Physical therapy helps to strengthen abdominal and back muscles to support the spine and can improve your range of motion
- Practicing exercises can strengthen core muscles and improve flexibility
- A back brace may provide extra support
- Anti-inflammatory medications, such as ibuprofen, reduce pain and swelling
- Hot or cold therapy, such as ice packs or heating pads, as well as massage, may provide temporary help for pain
- Muscle relaxants may help with muscle spasm
- Epidural spinal injections, during which medication (such as corticosteroids) is injected into the epidural space near the spinal cord, may be offered to limit inflammation
- Surgery can be considered to remove bone spurs or part of a herniated disk or to enlarge the spinal canal
- Spinal fusion surgery may be considered when a patient has a slipped vertebra; the procedure fuses the bones together.
What is the outlook for people with spinal stenosis?
Many people who have spinal stenosis find that their symptoms improve after treatment. However, some people may not experience complete relief. For example, those previously diagnosed with arthritis or chronic back problems are more likely to have lingering pain, weakness, numbness, or other symptoms after treatment.