The signs are hard to ignore: back pain, numbness or tingling in the arms or legs, muscle weakness, or even problems with bladder or bowel function. But what could cause such alarming symptoms? It might be spinal stenosis, a condition most common in adults over 50, according to Praveen Kadimcherla, MD, an orthopedic spine surgeon at Atlantic Spine Center.
A narrowing of the open spaces within the spine, spinal stenosis can put pressure on the spinal cord and nerves traveling through the spine to the arms and legs. Some who are affected experience no symptoms at all, while others can’t walk, sit, or do other activities for very long without feeling the effects, say Dr. Kadimcherla.
“Before they’re properly diagnosed, patients with spinal stenosis may not understand why just being in certain positions or doing everyday things is causing so much pain or discomfort,” he says. “They usually don’t pinpoint what’s wrong until they visit a spine specialist.”
Tips on Understanding the Causes of Spinal Stenosis
Those who develop spinal stenosis haven’t done anything wrong, and the condition is seldom preventable, Dr. Kadimcherla says. But educating patients on the causes of spinal stenosis is part of his job. These causes include:
Aging: Simply getting older is probably the biggest risk factor for developing spinal stenosis. That’s because aging can cause the bands of tissue supporting the spine to get thick and hard or cause bones and joints to get bigger. “The surfaces of bones may also bulge out, which is known as bone spurs,” Dr. Kadimcherla adds.
Arthritis: In some cases, arthritis – which wears away cartilage between joints – can trigger spinal stenosis because it reduces the spaces between spinal joints where nerves come through.
Herniated discs: When spongy spinal discs protrude from the spinal column, they can pinch nerve roots in its openings.
Thickened ligaments: Ligaments are the tough cords that help hold the bones of the spine together. When they stiffen or thicken over time, they can push into the spinal canal and press on nerves.
Heredity: Some people inherit a predisposition to spinal stenosis.
Injuries: Car accidents or other trauma can dislocate or fracture spinal vertebrae, and displaced bone may damage the spinal canal.
“Less-common reasons for spinal stenosis include tumors of the spine, calcium deposits on ligaments, and other rarer occurrences,” Dr. Kadimcherla says. “This is precisely why it’s important to be properly diagnosed, so the problem can be addressed.”
Tips on Diagnosing and Treating Spinal Stenosis
Getting an accurate diagnosis of spinal stenosis usually involves imaging tests such as X-rays, MRI scans, or CT scans, all of which provide a different look at hard and soft tissues in the back. Sometimes doctors will also use a myelogram, a test in which liquid dye is injected into the spinal column, or a bone scan that shows where bone is breaking down or forming.
Once doctors know the root cause, spinal stenosis can often be treated with conservative, non-surgical measures, many of which can be done at home. These include taking prescribed medications to relieve pain or swelling; limiting activity temporarily; in-office epidural cortisone injections; and physical therapy and prescribed exercises.
Sometimes, however, these conservative approaches don’t work. If you’re becoming disabled by your symptoms or spinal stenosis becomes severe, surgery becomes an option. Rarely, spinal stenosis requires emergency surgery if it triggers a complication known as cauda equina syndrome, which causes loss of control of the bowel or bladder, problems having sex, or loss of feeling in one or both legs.
But surgery for spinal stenosis is typically done in a minimally invasive procedure using only small incisions. The same-day surgery offers less pain and blood loss than traditional “open” surgery and a quicker recovery.
“Most of the time, surgery to improve spinal stenosis is a choice that a patient and doctor make together,” Dr. Kadimcherla says. “If a patient is coping with severe limitations – such as the inability to walk for significant periods without sitting to relieve pain – they’re probably at a point where surgery is a reasonable option.”
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