Spinal Stenosis

Spinal stenosis is the narrowing of the spaces in the spine, resulting in compression of the nerve roots or spinal cord by bony spurs or soft tissues, such as disks, in the spinal canal. This occurs most often in the lumbar spine (in the low back) but also occurs in the cervical spine (in the neck) and less often in the thoracic spine (in the upper back).

Spinal stenosis is most often caused by degeneration of the discs between the vertebrae due to osteoarthritis. Rheumatoid arthritis usually affects people at an earlier age than osteoarthritis does and is associated with inflammation and enlargement of the soft tissues of the joints. The portions of the vertebral column with the greatest mobility (for example, the neck area) are often the ones most affected in people with rheumatoid arthritis. Nonarthritic causes of spinal stenosis include tumors of the spine, trauma, Paget's disease of bone, and fluorosis.

Pressure on the lower part of the spinal cord or on nerve roots branching out from that area may give rise to pain or numbness in the legs. Pressure on the upper part of the spinal cord (that is, the neck area) may produce similar symptoms in the shoulders, or even the legs. The symptoms vary depending location on the nerve tissues being irritated and the degree of irritation. When the neck is affected, it can result in unusual sensations in the arms and/or poor leg function and incontinence. When the low back is affected, the classic symptom is pain radiating down both legs while walking that is relieved by resting (called pseudoclaudication).

Persistent mechanical irritation of the nerves to the leg can have longterm consequences. If symptoms are mild, conservative measures designed to relieve the nerve irritation are used, such as medications to relieve inflammation and/or mechanical supports and/or back exercises. Antiinflammation medications can be given to reduce the swelling of tissues (disk or other local soft tissues) that are pressing against the nerves. Examples include by mouth: ibuprofen/naproxen and others and cortisone related medication, such as prednisone; by injection: either throughout the body by injection into the muscle; or into the spinal canal (epidural injection).

When symptoms are severe, surgery is necessary. The operation involves surgical resection of the bone and soft tissues that are impinging on the nerves and/or spinal cord. Operation is generally considered only with persisting, intolerable symptoms