Spinal stenosis is one of the most common conditions that cause low back and/or neck pain in adults. Here, we provide the answers to 5 important questions about spinal stenosis.
#1. What is spinal stenosis?
Stenosis is a Greek word that means “narrowing.” Spinal stenosis develops when the spinal canal and/or neuroforamen become narrow and compress the spinal cord and/or nerve roots. Compression of the cord/nerves causes inflammation and pain.
- The spinal canal is a round vertical hole down the middle of the spinal column.
- Neuroforamen are nerve passageways created by the discs between the upper and lower vertebral bodies. Nerve roots exit the spinal canal through the neuroforamen.
#2. What’s causing my spinal stenosis?
Most often, spinal stenosis is the result of disease or injury to the spine.The most common cause of spinal stenosis is osteoarthritis (spondylosis); cartilage that cushions joints starts to degenerate. Some patients are genetically more prone to stenosis. They may have osteoarthritis in their family.
- Other causes of spinal stenosis are bulging discs, herniated discs, or injury to the spine.
- Some people are born with spinal stenosis (congenital spinal stenosis), but that is very uncommon.
#3. What are some non-surgical ways to treat spinal stenosis?
There are many non-surgical treatment options for spinal stenosis.
- Acupuncture and/or massage are alternative therapies that may help reduce pain and symptoms..
- Low impact exercise can help strengthen your core muscles important to supporting your spine resulting in less pain. Swimming is a good form of exercise for people with spinal stenosis.
- Over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs) may help reduce inflammation and pain.
- Your doctor may send you to physical therapy.
- If your spinal stenosis is severe, your doctor may recommend an epidural steroid injection. This type of injection places a powerful anti-inflammatory medication near the nerves affected by spinal stenosis to reduce pain.
#4. Will I need surgery to relieve my spinal stenosis?
Most patients with spinal stenosis respond well to non-surgical treatments, and do not require surgery. However, there are situations when you may want to go ahead with a surgical recommendation.
- Medication and/or a combination of non-surgical treatments have failed to reduce pain and symptoms.
- Pain is severe or progressively becoming worse
- Radiculopathy; pain, numbness, tingling in the arms or legs
- Partial or total loss of sensation in an extremity
- Reduced or loss of strength or function in your arms or legs
- Loss of bowel or bladder control
#5. What types of surgery are performed for spinal stenosis?
- Decompression: Removal of tissue pressing on a nerve structure. Common decompression procedures are: foraminotomy, laminectomy, and laminotomy.
- Stabilization: Certain types of devices are used to stop movement of two or more levels of the spine; these fixation devices (eg, plate, screws) stabilize the spine.
- Fusion: Bone graft is packed into and around the instrumentation. The bone graft stimulates new bone growth to heal the spine.
SpineUniverse News/Research Comment: Key Research on Epidural Steroid Injections for Spinal Stenosis
Epidural steroid injections are among the most commonly prescribed non-surgical treatments for spinal stenosis, and researchers are continuously learning more about their true effectiveness.
While numerous studies have helped the medical community understand these injections, we’d like to highlight 2 studies that readers with spinal stenosis should know about.
The first study, published in 2015, showed that people with lumbar spinal stenosis may not see a “meaningful benefit” from epidural injections that contain a corticosteroid plus lidocaine versus injections that only contain lidocaine.
“The Lumbar Epidural steroid injections for Spinal Stenosis (LESS) trial results suggested that there was little to no benefit 6 weeks later from adding corticosteroids to lidocaine in epidural injections for the treatment of lumbar spinal stenosis symptoms,” said Judith Turner, PhD, Professor of Psychiatry and Behavioral Sciences and Rehabilitation Medicine at the University of Washington, Seattle, WA.
The second study, published in 2014, questions one of the primary benefits of epidural spinal injections: it’s ability to delay spine surgery. The study found that epidural steroid injections reduced the need for surgery in some patients, but this was a short-term effect—lasting up to one year.
These studies shouldn’t detract you from receiving epidural steroid injections, as many studies have shown their effectiveness (particularly for patients who have experienced symptoms less than 3 months at the time of therapy). Instead, we hope these findings prompt additional discussion with your physician on the risks and benefits prior to starting treatment.