Spinal Stenosis Symptoms and Diagnosis
Generally speaking, the various types of spinal stenosis produce similar symptoms.
The most common symptoms of lumbar spinal stenosis include leg pain (sciatica) that may be accompanied by:
- Low back pain
- Leg numbness and tingling
- Limitations in walking.
Common Symptoms of Spinal Stenosis
Leg pain with walking (claudication) can be caused by either arterial circulatory insufficiency (vascular claudication) or from spinal stenosis (neurogenic or pseudo-claudication). Leg pain from either condition will go away with rest, but with spinal stenosis the patient usually has to sit down for a few minutes to ease the leg and often low back pain, whereas leg pain from vascular claudication will go away if the patient simply stops walking.
Although occasionally the leg pain and stenosis symptoms will come on acutely, they generally develop over the course of several years. The longer a patient with spinal stenosis stands or walks, the worse the leg pain will get.
Flexing forward or sitting will open up the spinal canal and relieve the leg pain and other symptoms, but they recur if the patient gets back into an upright posture. Numbness and tingling can accompany the pain, but true weakness is a rare symptom of spinal stenosis. An older person leaning over the handle of their shopping cart while making short stumbling steps often has spinal stenosis.
Overview of Lumbar Spinal Stenosis Symptoms
Overall, lumbar spinal stenosis symptoms are often characterized as:
- Developing slowly over time
- Coming and going, as opposed to continuous pain
- Occurring during certain activities (such as walking) and/or positions (such as standing upright)
- Being relieved by rest (sitting or lying down) and/or any flexed forward position.
Spinal Stenosis Diagnosis
Diagnostic imaging studies for patients with cervical stenosis or lumbar stenosis include either an MRI scan or a CT scan with myelogram (using an x-ray dye in the spinal sack fluid), and sometimes both. CT scans that are plain or not enhanced are of limited value unless made with very fine segmental scan slices.
It can be shown that each form of spinal stenosis has a dynamic (changing) effect on nerve compression, such as when bearing weight. Due to this changing compression, spinal stenosis symptoms vary from time to time and the physical examination generally will not show any neurological deficits or motor weakness. Some recent scanning methods allow the upright body position to study the effects of spinal loading.
Cervical foraminal stenosis can be pinpointed not only by the CT and MRI scans, but by injecting the suspicious nerve with a small volume of about 2 dozen drops of local anesthetic (selective nerve root block). After the injection a remission of the symptoms of cervical spinal stenosis when walking, along with true temporary weakness of the limb, is clinically diagnostic and helps the patient decide about stenosis surgery.
Since spinal stenosis at two or even three levels (sub-laminar, foraminal and far lateral) can affect a single emerging nerve, a combination of anatomical and clinical clarification is needed if spinal stenosis surgery is contemplated in order to make sure that one surgical procedure will address all contributing components of that particular case.
Depending on the severity of symptoms, spinal stenosis can often be managed through non-surgical treatments.
The three most common non-surgical spinal stenosis treatments include:
- Activity modification
- Epidural injections
Non-surgical Treatment for Spinal Stenosis
Non-surgical spinal stenosis treatment options for patients may include:
- Exercises. Although a suitable program ofspinal stenosis exercises may be helpful in the hands of a good physical therapist, it is not curative. Even though stenosis exercises are not a cure, however, it is very important for patients to remain active as tolerated and not additionally debilitated from inactivity; therefore, an appropriate spinal stenosis exercise program is a key part of any treatment program.
- Activity modification. With this treatment for stenosis, patients are usually counseled to avoid activities that cause adverse spinal stenosis symptoms. Patients are typically more comfortable while flexed forward. Examples of activity modification for treatment of spinal stenosis might include: walking while bent over and leaning on a walker or shopping cart instead of walking upright; stationary biking (leaning forward on the handlebars) instead of walking for exercise; sitting in a recliner instead of on a straight-back chair.
- Epidural injections. An injection of cortisone into the space outside the dura (the epidural space) can temporarily relieve symptoms of spinal stenosis. While injections can seldom be considered curative, these spinal stenosis treatments can alleviate the pain in about 50% of cases. Up to three injections over a course of several months can be tried. Although they are not considered diagnostic in and of themselves, generally, if the pain caused by spinal stenosis is relieved by an epidural steroid injection, then the patient can also be expected to have a good result if they later choose to have spinal stenosis surgery.
Additional Treatments for Spinal Stenosis
Anti-inflammatory medication (such as aspirin or ibuprofen) may be helpful in treating spinal stenosis. Some physicians recommend a multiple B-complex vitamin with 1200 mcg of folic acid daily, but this has not been substantiated in the medical literature as an effective treatment for stenosis.
Some people may successfully manage the symptoms of spinal stenosis with the non-surgical therapies either for a period of time or indefinitely. The key in choosing whether or not to have surgery is the degree of physical disability and disabling pain from lumbar spinal stenosis.
As a guideline, when the (usually elderly) patient can no longer walk sufficiently to care for himself or herself (such as to go shopping for essentials), then lumbar spinal stenosis surgery is usually recommended. Surgery for lumbar stenosis is mainly designed to increase a patient’s activity tolerance, so he or she can do more activity with less pain.