What is Spinal Stenosis?
Hitting a 50th birthday is a big milestone and certainly something to celebrate. With it, though, often comes new health conditions that can be a pain in the neck — literally. Spinal stenosis mostly affects people over the age of 50, causing almost no symptoms in some, to debilitating pain in others.
Spinal stenosis develops when pressure is placed on the nerves that run through the spinal column. General “wear and tear” of the back, accidents, arthritis, and genetics are examples of factors that can contribute to the narrowing of the space within the spinal column. Any part of the spine can be affected but spinal stenosis is generally divided into two groups – cervical (upper neck) and lumber (lower back) (x).
Diagnosis usually requires a medical exam and imaging tests like an MRI or X-ray. Identifying the presence of stenosis is relatively straight-forward compared to treatment options, however. Treatment depends on the underlying cause of the condition, the severity of the symptoms and the patient’s overall health. Sometimes an exercise program, rest, and over-the-counter pain killers can provide relief. For others, treatment might include surgery and mobility aids such as walkers or braces (x). Keeping the spine as strong and healthy as possible through movement, diet and supplements can also help (x).
Spinal Stenosis Symptoms
Symptoms of spinal stenosis vary depending on which area of the spine is affected. They may seem mild at first but can progress over time if not treated. Even with treatment, some effects may persist.
Some symptoms that can be associated with cervical stenosis include (x):
- Tingling sensation on the hand, foot, arm, or leg
- A weakness of the hand, foot, arm, or leg
- Neck pain
- Balance and walking issues
- In more severe cases, there might be a dysfunction in the bladder and bowel
Lumbar stenosis can bring about these symptoms (x):
- A weakness of the legs and arms
- Pain in the lower back
- Numbness of the buttocks and legs
- Tingling sensation in the feet and legs
- Pain in one or both legs when standing for a long time which maylessen when sitting or bending forward
- Balance issues
Because someone can have a narrowing in the spine but not experience any effects from it, spinal stenosis is only diagnosed when a person feels symptoms (x).
Spinal Stenosis Causes
To understand the possible causes of spinal stenosis, it may be helpful to better review the structure of the spine. Also known as the backbone, the spine is a series of bones called vertebrae that begin in the neck and continue all the way down to the tailbone. These bones encircle and protect the spinal canal which houses the important nerves inside (x).
Spinal stenosis is most commonly caused by osteoarthritis (x). With this degenerative joint disease, cartilage between bones wears down. In the case of spinal stenosis, the cartilage that cushions the vertebrae becomes thin, allowing the spine to move more easily. This in turn stimulates the growth of bone spurs on the vertebrae which can protrude into the spinal canal and disrupt the nerves (x).
Rheumatoid arthritis can also cause spinal stenosis, though less frequently (x).
Paget’s disease primarily affects older adults and can cause spinal stenosis. With this condition, new bone growth in certain areas of the body, including the spine, is delicate or misshapen. Like osteoarthritis, bone begins to encroach into the space meant for the nerves (x).
Congenital and Genetic Factors
Some people are simply born with spinal canals that are unusually narrow. (x) In addition, twin studies suggest possible genetic factors that may play a role in the development of spinal stenosis (x).
Thickening of the Ligaments
The strong cords that hold the bones in our spine are called ligaments. Over time, ligaments can become thick and hardened. When this happens, they can create a protrusion into the spinal canal (x).
Discs are the cushions that serve as the suspension system between a person’s vertebrae. With age, or due to an injury or obesity, discs can wear down and eventually rupture. This is called a “slipped disc” or “herniated disc”. The contents of the ruptured disc can move out of place and put pressure on the nerves in the spine (x).
While not a common cause of spinal stenosis, tumors that grow in or near the spine can aggravate the nerves within the spinal canal (x).
Accidents, sports injuries, or any type of trauma to the spine can lead to spinal stenosis. Dislocations and fractures can swelling, tissue damage, and herniated discs, for example. Injuries may also require surgery which puts someone at a greater risk of spinal stenosis in the future (x).
Additional Risk Factors
- Smoking cigarettes
- Having a sedentary lifestyle
- Being female
- 50 years or older
- Prior spinal surgery (x)
Spinal Stenosis Treatment
Treatment for spinal stenosis depends on many factors including the severity of the condition, where the symptoms are located, and age and general health the patient. Some trial and error is also used. For example, if exercise and physical therapy don’t provide improvement, surgery may be necessary. Luckily, treatments that don’t involve operations are usually enough to relieve symptoms (x). Here are some common approaches to stenosis management:
Many people with stenosis experience varying levels of pain. Over-the-counter pain medications and anti-inflammatories like ibuprofen, acetaminophen and naproxen may be recommended. If that doesn’t sufficiently control pain, various types of prescription medications could be used (x).
Physical therapy reduces pain, increases mobility, and prevents progression of spinal stenosis for many people. It can include exercise, stretching, heat and/or ice application, and manual therapy by a professional therapist (x).
Since factors like excess weight, smoking, and lack of exercise can exacerbate pain and symptoms of spinal stenosis, taking measures to minimize them is part of the overall plan to manage the condition. This may require a change in diet, controlling diabetes, quitting smoking, and following the exercise plan recommended by a doctor or physical therapist (x).
Injections of a pain reliever and a corticosteroid (a medication that reduces inflammation) into either the spaces between the vertebrae or into the facet joints can temporarily provide pain relief caused by spinal stenosis. Sometimes epidurals don’t provide the intended effect but if they do, their effects can last weeks to months (x). While getting an injection in the spine may seem invasive, epidurals are still considered a “conservative” treatment for stenosis (x).
For those who don’t find relief other ways, surgical measures may be necessary. One type of procedure, which varies in invasiveness, is called a “decompression” because it’s meant to decompress the pressure placed on the nerve roots. Surgeons do this by removing surrounding tissue such as all or part of thickened ligaments (x).
Decompression may be combined with a spinal fusion that attaches some vertebrae together to maintain the strength of the spine (x). Depending on the extent and location of decompression surgery, it may also be called a laminectomy, laminotomy, or laminoplasty.
Dietary supplements can help support the overall health of the spine by reducing the effects of osteoarthritis (one of the most common causes of spinal stenosis), helping to maintain a healthy weight, and keeping overall inflammation to a minimum. As always, if you have health problems, take medication, or are pregnant or nursing, speak to your doctor before starting any supplements.
Studies show that supplementing with MSM, a sulfur-containing compound that humans produce naturally, can improve pain and mobility associated with osteoarthritis (x). Take 1000 to 1300 mg four times per day, or as directed by a physician.
Glucosamine and Chondroitin
Glucosamine and chondroitin are probably two of the most recommended supplements for managing both osteoarthritis and rheumatoid arthritis. Studies suggest that they can be beneficial individually, however they may provide even greater benefit when taken in combination (x). These don’t work well for everyone but given their relative safety profile, especially compared with NSAID drugs, arthritis organizations don’t discount their usefulness (x). Take 1000 mg up to three times daily of glucosamine and 750 mg to 1500 mg daily or as recommended by your doctor.
Fish oil has several known benefits ranging from healthier skin to improved cardiovascular function. What is also does is reduce inflammation — even the kind that occurs with arthritis — and helps people maintain a healthy weight while increasing muscle mass (x). Suggested serving size for fish oil softgels is 2 capsules, which should be taken anywhere from two to three times per day or as directed by your doctor. Since fish oil can thin the blood, it shouldn’t be taken before undergoing surgery.