Cervical Spinal Stenosis
What Is Spinal Stenosis?
Spinal stenosis is the narrowing of the space for the spinal cord or nerve branches. More specifically, as the spine degenerates over time, it can lead to the formation of bone spurs. As the bone spurs form, the size of the spinal canal (boney tunnel transmitting the spinal nerves) becomes smaller. The bone spurs press on the spinal cord or the nerve roots, often causing pain or weakness. This degenerative condition is most common in the upper spine (neck / cervical spinal stenosis) region or in the lower spine (lumbar) region. It is also associated with spondlylolisthesis (slipping forward of one vertebra relative to another) and scoliosis (crooked spine). More than 1.2 million Americans suffer back pain stemming from spinal stenosis, with men and women being affected equally. Women, however, are more likely to have symptoms that require treatment. And while spinal stenosis can affect younger patients, it is most common in those 60 and older. Arthritis is the most common cause of spinal stenosis.
What Are the Symptoms of Spinal Stenosis?
Patients with spinal stenosis may have the following symptoms:
- Tingling, pain or numbness that originates in the neck and extends down the arms
- Weakness in legs
- Loss of control over the arms or legs (called spasticity) that can lead to trouble walking or the inability to hold objects
- Numbness in arms or legs
- Loss of position sense, meaning the inability to know what position arms or legs are in if they are not visible.
- With major weakness or loss of bladder or bowel control, seek help immediately as this could signal a serious problem
What Are the Causes of Spinal Stenosis?
The natural aging process is far and away the main cause of spinal stenosis. Osteoarthritis is the most common cause of spinal stenosis. The gelatinous discs that cushion the vertebrae in the spine begin to dry out as we age, resulting in shortened disc height. This puts pressure on the facet joints. As they feel more pressure, they too deteriorate, leading to arthritis. The arthritis can cause the ligaments around the joints to thicken and enlarge, decreasing space in the spinal canal for nerves to pass through. The cartilage that protects joints wears away as well. Too much wear leads to bone-on-bone rubbing. To compensate for the missing cartilage, the body may grow bone in the facet joints. Bone overgrowth is called spurs, and their formation further contributes to the narrowing of space in the spinal canal for nerves to pass through. Once the space within the spinal canal becomes too cramped, pain can ensue.
Stenosis can also be caused by other conditions as well. Those include:
- Spondylosis or spondlylolisthesis (slipped disc)
- Injury or fracture
- Rheumatoid arthritis or ankylosing spondylitis
- Metabolic conditions such as Paget’s disease or fluorosis, an excessive level of fluoride in the body.
What Are the Treatments for Spinal Stenosis?
Physicians at Midwest Orthopaedics at Rush first use conservative, non-surgical treatments for spinal stenosis. Non-surgical treatments, however, do not correct spinal narrowing. Instead, the treatment options for spinal arthritis and spinal stenosis are aimed at controlling pain and improving quality of life for some patients. Some treatment options include:
- Nonsteroidal anti-inflammatory drugs to reduce swelling
- Physical therapy to increase flexibility
- Spinal steroidal injections or “blocks”
If a patient does not improve after non-surgical treatment, Dr. Singh may suggest surgery as a solution for spinal stenosis. The goal of the surgery is to open the spinal canal to give nerves adequate space. There are two primary kinds of surgery to treat spinal stenosis, depending on whether or not the patient has coexisting instability (abnormal movement) or deformity (abnormal alignment of the spine). Dr. Singh would only consider fusion surgery for indications that are supported by the spine literature:
- Lumbar laminectomy
- Lumbar fusion