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Spinal Stenosis: Cervical, Lumbar and Lumbosacral

The are many causes of back and neck pain, ranging from nerve damage to wearing the wrong pair of shoes. But sometimes this pain can indicate an underlying disorder called spinal stenosis, a condition that can develop when the spinal canal narrows and painfully compresses the spinal nerves.

“Most people don’t know they have spinal stenosis until they develop symptoms,” says Andrew J. Schoenfeld, MD, an orthopaedic surgeon within the Department of Orthopaedic Surgery at Brigham and Women’s Hospital (BWH). “It usually starts with back pain, but it can progress to difficulty walking, loss of fine motor control and decreased bladder or bowel function.”

What Causes Spinal Stenosis?

There are many causes of spinal stenosis, but the most common is degeneration and bulging (herniation) of the intervertebral discs. These shock-absorbing discs are made of cartilage and pad the joints of the spine for comfortable motion.

The degeneration that can develop into spinal stenosis is similar to arthritis. It typically occurs in the mobile parts of the spine that experience the most wear and tear, such as the neck (cervical stenosis) and the lower back (lumbar or lumbosacral stenosis). Since the lower back carries more weight, lumbar stenosis is more common.

The elderly are especially at risk for spinal stenosis. Those who suffer trauma to the backbone may also develop spinal stenosis.

“Stenosis can develop for many reasons,” says Yi Lu, MD, PhD, spine surgeon and Director of Neurosurgical Trauma at BWH. “In elderly patients it’s usually wear and tear, but scoliosis, instability and injury can also lead to spinal stenosis.”

Other causes of spinal stenosis may include:

  • Bone spurs (bone overgrowths)
  • Thickened ligaments (the fibrous tissues that run through the spine)
  • Tumors and malformations

What are the Symptoms?

Symptoms of cervical stenosis may include neck pain, limb weakness, arm pain and numbness, loss of balance and loss of dexterity. The main symptoms of lumbar and lumbosacral stenosis are leg pain or numbness and lower back pain. The pain is typically due to inflammation or increased pressure on the lower spinal nerves, such as the sciatic nerve. This lower back pain may lead to a habit of stooping forward to find relief.

“The process of degeneration is usually gradual and subtle,” says Dr. Schoenfeld. “Rapid deterioration and sudden onset of severe symptoms are less common.”

Other symptoms of spinal stenosis include:

  • Cramps in the legs (lumbar and lumbosacral stenosis)
  • Loss of bladder or bowel control (cervical stenosis)
  • Numbness or tingling in the hands, arms, feet or legs (only feet and legs with lumbar and lumbosacral stenosis)

Prevention, Management and Treatment of Spinal Stenosis

Doctors are still investigating the most effective ways to prevent or delay spinal stenosis. Some suggest that exercise may lower your chances of developing the condition. Core-strengthening exercises, such as planks and crunches, can take pressure off the spine by strengthening the muscles that support your back.

“Exercises the strengthen the core slow down the wear and tear process,” says Dr. Lu. “People who exercise a lot may have fewer symptoms.”

Other behaviors such as smoking, and conditions like obesity and diabetes, may accelerate the onset of stenosis and worsen symptoms. Smoking can prevent normal blood flow to the spinal nerves, making pain worse.

“Blood carries oxygen and nutrients to the spinal cord, nerve roots and spinal joints,” says Dr. Lu. “Depriving the nerves of this oxygen supply can make them more sensitive to pain. Long-term smoking changes the pain receptors.”

The pain caused by spinal stenosis can often be relieved by physical therapy, low-impact exercise and over-the-counter painkillers. Individuals with severe spinal stenosis may require steroid injections to numb the pain or surgery to relieve pressure in the spinal canal.

Stenosis Treatment at BWH

Brigham and Women’s Hospital offers physical therapy, spinal injections and surgery for spinal stenosis through the Comprehensive Spine Center. There, a spine specialist will typically order an MRI, CT scan or X-ray to determine where your spinal canal has narrowed. Then they will assess those images and your medical history to recommend a personalized treatment plan.

“Many of the surgical options we offer are minimally invasive,” says Dr. Schoenfeld. “That means a quicker recovery, less pain and a shorter hospital stay.”

- Erin K.