Spinal stenosis is the narrowing of the spinal canal (the bony tunnel carrying the spinal nerves) which results in pressure on the nerves causing pain and dysfunction. Lumbar spinal stenosis is a major cause of disability and the most common reason for back surgery in people over the age of 65.
The most common cause of lumbar spinal stenosis is the degeneration of the spine that occurs with aging and osteoarthritis, the gradual wear and tear of the spine over time. The degenerative process:
The space around the spinal cord and nerves is composed of bony vertebrae, discs, and ligaments that hold the surrounding structures in place. If any of these components takes up too much space, is damaged, or is shifted, it can narrow the space around nerves running through the spine, causing stenosis.
As the spinal cord runs along the spine, smaller nerves leave the spinal cord through exits in the vertebrae called the neuroforamen. Narrowing of the exit (neuroforamina), known as foraminal stenosis, can also cause symptoms by pressing on the nerves.
The jelly-like discs that cushion the vertebrae in the spine begin to dry out as we age, resulting in a loss of disc height. This disc height loss puts pressure on the surrounding joints, leading to arthritis. This height loss can also cause the ligaments around the joints to thicken and enlarge, decreasing space in the spinal canal for nerves to pass through causing compression.
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 in an attempt to stabilize and limit motion in the degenerated disc. The bone overgrowth is called spurs, and their formation further contributes to the narrowing of space in the spinal canal for nerves to pass through.
There may be no symptoms with spinal stenosis, or the symptoms can come and go. Symptoms can include:
Legs, back or buttocks that are sore, numb, tingling, or weak
Pain in the back and leg decreases when sitting or bending forward (creating room in the spinal canal)
Pain, numbness and/or tingling in the back and leg that worsens with prolonged walking or standing
Cramping in the legs
Pain that shoots into one or both legs
Severe spinal stenosis can result in changes in the bowel and bladder leading to difficulty with urinating and/or sexual dysfunction.
If you experience major weakness or can’t control your bladder or bowels, seek help from a board-certified spine physician immediately as these symptoms can signal a more serious problem.
Chicago spine surgeon Dr. Kern Singh will review your medical history, inquire about your symptoms and perform a thorough physical exam to assess your range of motion, muscle strength, reflexes and sensations, and evaluate your posture and gait. These findings can provide clues that point strongly towards a diagnosis of lumbar stenosis. The pattern of pain and worsening with certain positions, for example, can indicate lumbar stenosis.
Dr. Singh will order diagnostic testing to confirm his diagnosis and evaluate the extent of spinal stenosis. This workup will include X-rays of the spine to visualize the bones, view alignment of the bones and identify conditions like bone spurs, arthritis and instability. Misalignment of the bones can contribute to lumbar stenosis.
The best imaging study to evaluate the spinal cord and surrounding soft tissue structures is an MRI. MRI can identify areas of narrowing around the spinal cord or nerves, confirming a diagnosis of lumbar stenosis. If non-surgical management has not improved symptoms, or if red flag symptoms are present, getting an MRI immediately is warranted.
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If you or a loved has back and or leg pain, contact Chicago spine surgeon Dr. Kern Singh,MD who can assess your situation, provide an accurate diagnosis and guide you on the most suitable treatment options.
Dr. Kern Singh, MD is an internationally renowned spine surgeon specializing in outpatient minimally invasive and motion-preserving techniques and endoscopic spine surgery at Midwest Orthopedics at Rush and Professor in the Department of Orthopedic Surgery at Rush University Medical Center in Chicago, Illinois. Dr. Kern is one of the nation’s Top 100 spine surgeons and beloved by his patients for his compassionate care and excellent outcomes. He welcomes nationally and internationally-based patients.
